Preoperative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case-control study.

BACKGROUND: The authors investigated the usefulness of preoperative treatment with the BIB intragastric balloon in super-obese patients before undergoing laparoscopic adjustable gastric banding (LAGB). METHODS: The case-control study involved 43 case patients treated with the intragastric balloon followed by LAGB ("Case" group) and 43 sex-, age- and BMI-matched historical controls treated with LAGB alone. RESULTS: Mean length of the intragastric balloon treatment was 164.4+/-39.7 days, with a fill volume of 609+/-95 ml. Total complication rate with balloon was 7.0% and percent excess weight loss (%EWL) was 26.1 +/- SD 9.3 %. At the time of gastric band placement, both operative time and hospital stay were shorter in patients treated previously with the balloon (Case group) than in the Control group patients. No Case patients required conversion to open surgery or had intraoperative complications. In the Control group, the rate of conversion was 16.3% (P<0.05) and the rate of intraoperative complications was 7.0%. Postoperative follow-up length was 1.1+/-1.0 years in Case patients and 4.4+/-1.8 years in Control patients (P<0.001). The %EWL produced by the intragastric balloon in the Case patients was identical to the %EWL observed in the first 6 months after LAGB in the Control group (26.1+/-9.3 vs 25.3+/-12.4%). %EWL 6 months after banding was higher in the Case patients than in Controls (33.6+/-12.5 vs 25.3+/-12.4%, P<0.01). However, no significant difference in %EWL between the two groups was observed at the subsequent postoperative evaluations. CONCLUSION: Preoperative treatment with the intragastric balloon reduced the risk of conversion to open surgery and the risk of intraoperative complications in super-obese patients treated with LAGB. Preoperative treatment with the intragastric balloon did not change the total weight loss after LAGB.

Helicobacter pylori infection diagnosis in hospitalised elderly patients: the stool antigen test (HpSA) in comparison with other methods.

BACKGROUND AND AIMS: Helicobacter pylori (Hp) infection prevalence increases with age. In elderly patients, who often do not collaborate and who are affected by multiple pathologies, worldwide-recognised invasive and non-invasive methods (histology and Urea Breath Test) are not easy to apply. A new test based on the detection of Hp antigens in the stool (HpSA test) is now available. The aim of our study was to evaluate the sensitivity and specificity of the HpSA test, and the interference of drugs (acid suppression, antibiotics) on test performance. METHODS: Hp infection was detected by UBT, HpSA and histology in 122 hospitalised elderly subjects, divided into two groups according to therapy in the last month. Subjects were classified as being Hp-positive if two test results (histology and UBT) were positive, and Hp-negative if the same two test results were negative. RESULTS: The sensitivity and specificity of the HpSA test compared with two tests (histology and UBT) were respectively 76 and 95%. In the group of patients who had not received drugs, the sensitivity and specificity of the HpSA test were respectively 76 and 96%. Instead, in the group of patients who had received pharmacological therapy, sensitivity and specificity values were respectively 67 and 100%. HpSA-positive patients had received acid suppression for 9.2 +/- 8.9 days, and false-negative patients for 27.2 +/- 9.9 days. CONCLUSIONS: The HpSA test is simple, inexpensive, and non-invasive for Hp detection, especially in elderly subjects with no compliance. It is influenced only after several days by therapy common in the elderly.