American Society for Gastrointestinal Endoscopy-European Society of Gastrointestinal Endoscopy guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity.

This joint ASGE-ESGE guideline provides an evidence-based summary and recommendations regarding the role of endoscopic bariatric and metabolic therapies (EBMTs) in the management of obesity. The document was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. It evaluates the efficacy and safety of EBMT devices and procedures that currently have CE mark or FDA-clearance/approval, or that had been approved within five years of document development. The guideline suggests the use of EBMTs plus lifestyle modification in patients with a BMI of ≥30 kg/m2, or with a BMI of 27.0-29.9 kg/m2 with at least 1 obesity-related comorbidity. Furthermore, it suggests the utilization of intragastric balloons and devices for endoscopic gastric remodeling (EGR) in conjunction with lifestyle modification for this patient population.

Spontaneous Intragastric Balloon Hyperinflation: Two Cases and Outcomes.

Endoscopic bariatric therapies can provide treatment options for obesity in non-surgical candidates, as a part of combination or serial treatment plans, and for the reduction of obesity-related comorbidities. Several complications of intragastric balloons have been documented, but spontaneous hyperinflation is a risk that has not been well reported previously. We describe two cases of spontaneous intragastric balloon hyperinflation and their outcomes.

Meta-analysis: Impact of intragastric balloon therapy on NAFLD-related parameters in patients with obesity.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease affecting approximately 25% of adults in the western world. Intragastric balloon (IGB) is an endoscopic bariatric therapy -a therapeutic endoscopic tool that has shown promise in inducing weight loss. Its role in the treatment of NAFLD is yet to be established. AIM: To evaluate the effect of IGB as a treatment option in NAFLD. METHODS: We searched MEDLINE (PubMed) and EMBASE from inception to September 2022. We included studies evaluating the impact of IGB on obesity with the assessment of one or more liver-related outcomes and studies primarily evaluating the impact of IGB on NAFLD. We included comparative and non-comparative studies; primary outcomes were liver-related NAFLD surrogates. RESULTS: We included 19 studies with 911 patients. IGB demonstrated an effect on NAFLD parameters including NAFLD activity score (NAS): mean difference (MD): -3.0 [95% CI: -2.41 to -3.59], ALT: MD: -10.40 U/L [95% CI: -7.31 to -13.49], liver volume: MD -397.9 [95% CI: -212.78 to 1008.58] and liver steatosis: MD: -37.76 dB/m [95% CI: -21.59 to -53.92]. There were significant reductions in non-liver-related outcomes of body weight, BMI, glycated haemoglobin and HOMA-IR. CONCLUSION: Intragastric balloons may play an important role in addressing the treatment gap in NAFLD management.

Torsade de pointes secondary to long QT syndrome after intragastric balloon placement. A rare but severe complication

The obesity pandemic is becoming one of the most prevalent diseases nowadays. There is a wide spectrum of treatment, ranging from hygienic-dietary measures to bariatric surgery. Endoscopic intragastric balloon placement is becoming increasingly more frequent, due to its technical simplicity, safety and short-term success(1). Although complications are rare some can be severe, so pre-endoscopic evaluation must be carried out carefully. A 43-year-old woman with a history of grade I obesity (BMI 32.7) had an Orbera® intragastric balloon implanted successfully. After the procedure she presented frequent nausea and vomiting, partially controlled with antiemetics. She attended the Emergency Department(ED) with a persistent emetic syndrome - oral intolerance and short-term loss of consciousness(syncope), for which she was admitted. Lab tests showed metabolic alkalosis with severe hypokalemia(K+ 1.8mmol/L), so fluid therapy was initiated for hydroelectrolytic replacement. During the patient’s stay in the ED, two episodes of polymorphic ventricular tachychardia “Torsades de Pointes” (PVT-TDP) occurred, leading to cardiac arrest and requiring electrical cardioversion to restore sinus rhythm, in addition to a temporary pacemaker placement. Telemetry showed a corrected QT interval of >500ms, compatible with Long QT Syndrome(LQTS). Once the patient was hemodynamically stabilized a gastroscopy was performed. The intragastric balloon located in the fundus was removed using an extraction kit, puncturing and aspirating 500ml of saline solution, and extracting the collapsed balloon without any complications. The patient achieved an adequate oral intake afterwards, and no recurrence of emetic episodes were noticed. Previous ECGs revealed a prolonged QT interval and a genetic study confirmed a congenital type 1 LQTS. Treatment was initiated with beta-blockers and a bicameral automatic defibrillator was implanted in order to prevent recurrences. ... (AU)

Intragastric balloons in high-risk obese patients in a Brazilian center: initial experience / Balões intragástricos em obesos de alto risco em um centro brasileiro: experiência inicial

ABSTRACT Objective: to assess the short-term efficacy, tolerance and complications in high-risk morbidly obese patients treated with an intragastric balloon as a bridge for surgery. Methods: we conducted a post-hoc analysis study in a Brazilian teaching hospital from 2010 to 2014, with 23 adult patients with a BMI of 48kg/m2, who received a single intragastric air or liquid balloon. We defined efficacy as 10% excess weight loss, and complications, as adverse events consequent to the intragastric balloon diagnosed after the initial accommodative period. We expressed the anthropometric results as means ± standard deviation, comparing the groups with paired T / Student's T tests, when appropriate, with p<0.05 considered statistically significant. Results: the balloons were effective in 91.3% of the patients, remained in situ for an average of 5.5 months and most of them (65.2%) were air-filled, with a mean excess weight loss of 23.7kg±9.7 (excess weight loss 21.7%±8.9) and mean BMI reduction of 8.3kg/m2±3.3. Complications (17.3%) included abdominal discomfort, balloon deflation and late intolerance, without severe cases. Most of the participants (82.7%) did not experience adverse effects. We removed the intragastric balloons in time, without intercurrences, and 52.2% of these patients underwent bariatric surgery within one month. Conclusion: in our center, intragastric balloons can be successfully used as an initial weight loss procedure, with good tolerance and acceptable complications rates.

RESUMO Objetivo: identificar a eficácia em curto prazo, a tolerância e as complicações em obesos mórbidos de alto risco, tratados com balão intragástrico como ponte para cirurgia. Métodos: estudo de análise post-hoc em um hospital acadêmico brasileiro durante o período de 2010 a 2014, de 23 pacientes adultos com IMC de 48kg/m2 que receberam um único balão intragástrico de ar ou líquido. Eficácia foi definida como perda de excesso de peso de 10%, e complicações como eventos adversos consequentes ao balão intragástrico diagnosticados após o período acomodativo inicial. Expressaram-se os resultados antropométricos com média ± desvio padrão, comparando os grupos com testes T Pareado / T de Student, quando apropriado, com p<0,05 considerado estatisticamente significante. Resultados: os balões foram efetivos em 91,3% dos pacientes, permaneceram in situ por em média 5,5 meses e a maioria deles (65,2%) era de ar, com perda média de excesso peso de 23,7kg±9,7 (perda de excesso de peso de 21,7%±8,9) e redução média de IMC de 8,3kg/m2±3,3. As complicações (17,3%) compreenderam desconforto abdominal, deflação do balão e intolerância tardia, sem casos graves. A maioria dos participantes (82,7%) não experimentou efeitos adversos, seus balões intragástricos foram extraídos em tempo, sem intercorrências e 52,2% desses pacientes submeteram-se à cirurgia bariátrica no intervalo de um mês. Conclusão: no nosso centro, balões intragástricos podem ser usados com sucesso como procedimento inicial de perda ponderal, com boa tolerância e taxas aceitáveis de complicações.

Perforación gástrica por balón intragástrico en paciente con funduplicatura de Nissen / Gastric perforation by intragastric balloon in patient with Nissen fundoplication

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Pancreatitis aguda asociada a balón intragástrico / Acute pancreatitis associated with the intragastric balloon

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Estallido gástrico secundario a oclusión producida por un balón intragástrico / Gastric burst due to occlusion caused by an intragastric balloon

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Balón intragástrico ingerible Elipse(R). Viabilidad, resultados y requerimientos endoscópicos. Experiencia inicial / Feasibility, results and endoscopic requirements of the Elipse(R) swallowable intragastric balloon: initial experience

Antecedentes: el balón intragástrico Elipse(R) consiste en una cápsula ingerible que se rellena bajo control radiológico. Pasadas 16 semanas, su válvula se degrada, el balón se vacía y se elimina por vía natural, sin endoscopia. El objetivo del estudio es valorar su viabilidad, eficacia, duración, seguridad y requerimientos endoscópicos. Métodos: estudio prospectivo y descriptivo, no aleatorizado, de los primeros pacientes remitidos para Elipse(R). Tras colocación, se realizaba sistemáticamente una radiografía para confirmar su correcto rellenado. Se determinaba la duración del balón en función de su visualización excretado o por radiografía/ecografía. Se recogieron datos de eficacia, tolerancia, efectos adversos y su resolución (requerimientos endoscópicos), así como el grado final de satisfacción a las 16 semanas. Resultados: participaron en el estudio 30 pacientes con peso e índice de masa corporal (IMC) medios basales de 83,3 +/- 10,7 kg y 30,6 +/- 2,7 kg/m². Todos pudieron ingerir la cápsula con correcto control radiológico. A los cuatro meses presentaban una pérdida media de 11,2 +/- 5,5 kg (12,1 +/- 5,8% de pérdida total de peso [PTP], 64,7 +/- 25% de pérdida del exceso de peso [PEP]), con pérdida de peso > 10% en el 80% de pacientes (p < 0,05). Obtuvimos una eliminación precoz del balón con duración insuficiente (< 12 semanas) en 2/24 pacientes (8,3%). La tolerancia fue aceptable en el 80%. Efectos adversos: un vómito del balón, una intolerancia (extracción por gastroscopia) y una oclusión ileal (extracción por ileoscopia). El grado final de satisfacción fue bueno en el 60%. Conclusiones: la implantación del balón Elipse(R) mediante radiología parece viable y segura. A pesar de que algunos balones presentan una duración inferior a la estimable (< 16 semanas en el 29%, incluyendo < 12 semanas en el 8,3%), se obtuvo una aceptable pérdida de peso a los cuatro meses. Existen efectos adversos que requieren endoscopia, por lo que aconsejamos que sea supervisado por un endoscopista bariátrico

Background: the Elipse(R) intragastric balloon (EIGB) is a swallowable capsule that is filled under x-ray control. After 16 weeks, its self-releasing valve is degraded and the balloon is deflated and excreted naturally, without endoscopy. The aim of this study was to assess the feasibility of EIGB and its efficacy, duration, safety and endoscopic requirements. Methods: this is a prospective, descriptive, non-randomized study of the first patients enrolled for EIGB. An x-ray was systematically performed after placement to ensure the correct filling of the balloon. The balloon duration was determined according to its excreted visualization or by x-ray/ultrasound. The efficacy, tolerance, adverse events and their resolution outcome (endoscopic requirements), as well as the final satisfaction degree at 16 weeks, were analyzed. Results: the study included 30 patients with a basal mean weight and body mass index (BMI) of 83.3 +/- 10.7 kg and 30.6 +/- 2.7 kg/m². All subjects swallowed the capsule with correct x-ray control. The mean weight loss was 11.2 +/- 5.5 kg (12.1 +/- 5.8% of total weight loss [TWL], 64.7 +/- 25% of excess weight loss [EWL]), with a weight loss > 10% in 80% of patients (p < 0.05) after four months. Early elimination of the balloon with an insufficient duration (< 12 weeks) was observed in 2/24 patients (8.3%). There was an acceptable tolerance in 80%. With regard to adverse effects, one balloon was vomited up, there was one intolerance and the balloon was removed by gastroscopy and one small bowel ileal obstruction, which was removed by ileoscopy. The final satisfaction degree was good in 60% of cases. Conclusions: EIGB placement by x-ray seems feasible and safe. Although some devices have a shorter duration than expected, such as < 16 weeks in 29% patients and < 12 weeks in 8.3% of patients, an acceptable weight loss at four months was obtained. There were some adverse effects that required endoscopy, thus we advise that the procedure be supervised by a bariatric endoscopist

Perforación gástrica por balón intragástrico en paciente con funduplicatura de Nissen. Respuesta del Grupo Español de Endoscopia Bariátrica / Gastric perforation by intragastric balloon in a patient with Nissen fundoplication. Response of the Spanish Bariatric Endoscopy Group

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Impactación antral y parada cardiorrespiratoria. Complicaciones del balón intragástrico / Antral impaction and cardiorespiratory arrest. Complications of the intragastric balloon

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Lesiones gástricas premalignas en familiares en primer grado de pacientes con cáncer gástrico evaluados en la consulta de gastroenterología de dos hospitales universitarios de Caracas / Premalignant gastric lesions in first-degree relatives of gastric cancer patients evaluated in the gastroenterology at two university hospitals in Caracas

Las alteraciones morfológicas de la mucosa gástrica que predisponen al desarrollo de cáncer gástrico son atrofia, metaplasia y displasia. Diversos factores etiológicos han sido estudiados, destacándose el parentesco en primer grado con una probabilidad de presentar cáncer gástrico 2 veces más que la población general. Diagnosticar lesiones gástricas premalignas en familiares de pacientes con cáncer gástrico, evaluados en las consultas de Gastroenterología del Hospital Vargas de Caracas y Hospital Militar "Dr. Carlos Arvelo". Se realizó un estudio descriptivo, prospectivo, longitudinal, desde Octubre 2008 a Mayo 2009. Se incluyeron 75 individuos con edades comprendidas entre 18 y 80 años, familiares en primer grado de pacientes con cáncer gástrico, a los cuales se les practicó endoscopia digestiva superior con toma de biopsia. En 51 pacientes femeninos (68%) y 24 (32%) masculinos, se encontraron los siguientes hallazgos endoscópicos: endoscopia normal 52%, gastropatía crónica 33%, úlcera gástrica 5,33%, pólipos gástricos 3,33% y úlcera duodenal 1,33%. El estudio histológico determinó que la atrofia estuvo presente en 25 pacientes (33,3%), metaplasia intestinal en 17 pacientes (22,67%), displasia en 4 pacientes (5,33%), la mitad de ellas de alto grado y 1 (1,33%) indefinido para displasia. Conclusión y recomendación: En el grupo estudiado se encontró un 42,6% de lesiones gástricas premalignas, de las cuales el 5,33% correspondió a displasia, ninguno de estos con lesiones endoscópicas de malignidad; lo que nos hace recomendar de rutina en todos los servicios de gastroenterología del país un programa de pesquisa en familiares en primer grado de pacientes de cáncer gástrico...

Morphological alterations of the gastric mucosa that predispose to the development of gastric cancer are atrophy, metaplasia and dysplasia. Various etiologic factors have been studied, especially in first degree relatives,with a probability of gastric cancer double than that of the general population. To diagnose premalignant gastric lesions in relatives of patients with gastric cancer evaluated in the Gastroenterology consultation of "Hospital Vargas de Caracas", and "Hospital Militar Dr. Carlos Arvelo". A descriptive, prospective, longitudinal study was made, from October 2008 to May 2009. We included 75 individuals aged 18 to 80 years in first degree relatives of patients with gastric cancer, who underwent upper gastrointestinal endoscopy with biopsy guided. We found 51 (68%) female and 24 (32%) male, with these endoscopic findings: normal in 52% of the patients, with chronic gastropathy 37, 33%, gastric ulcer in 5,3%, gastric polyps in 3,33% and duodenal ulcer in 1,33%. The histological study found that atrophy was present in 25 (33.3%) patients, intestinal metaplasia in 17 (22, 67%) and dysplasia in 4(5, 33%) and 1(1,33%) indefinite to dysplasia. In this group of patients it was found a 42.6% of premalignant gastric lesions, of which 5.33% corresponded to dysplasia. Neither one had endoscopic malignant lesions. We recommend as a routine in all Gastroenterology Divisions in the country a program of screening in first degree families of patients of gastric cancer...

Efectividad, seguridad y tolerancia del balón intragástrico asociado a una dieta hipocalórica para la reducción de peso en pacientes obesos / No disponible

Introducción: la implantación de un balón intragástrico (BI)por vía endoscópica asociado a una dieta hipocalórica es una alternativaen el tratamiento de la obesidad. El objetivo de nuestroestudio es evaluar su efectividad, seguridad y tolerancia.Material y métodos: se incluyen de manera prospectiva 38pacientes sin contraindicaciones para la implantación del BI, desdemarzo de 2004 hasta enero de 2007. La retirada del balón serealizó 6 meses después de la implantación. Evaluamos el peso eíndice de masa corporal (IMC) tras la retirada del balón, a los 6 y12 meses postretirada, así como la tolerancia y aparición de complicacionesdurante el tratamiento. Tras la retirada del balón serealizó un cuestionario a cada paciente evaluando la percepciónsubjetiva al tratamiento.Resultados: después de 6 meses de tratamiento la pérdida depeso media fue de 14,10 kg (0-46) y la reducción media del IMCfue de 5,23 kg/m2 (0-18). A los 12 meses postretirada del balónel 48,4% de pacientes mantiene o sigue perdiendo peso. Los síntomasprecoces más frecuentes fueron náuseas (71,1%) y vómitos(57,9%), con buena respuesta a tratamiento sintomático. Presentaroncomplicaciones 7 pacientes (18,4%): intolerancia digestivaen 4 pacientes, requiriendo retirada precoz del balón en 3 deellos; esofagitis moderada en 2 pacientes; y perforación gástricacomplicada con shock séptico y exitus en 1 paciente.Conclusiones:1. El balón intragástrico asociado a una dieta hipocalórica puedeconsiderarse un tratamiento efectivo, seguro y bien toleradopara el tratamiento de pacientes con obesidad mórbida.2. La pérdida de peso se mantiene en casi la mitad de los pacientesal año tras la retirada del balón

Introduction: the endoscopic placement of an intragastricballoon (IGB) in association with a low-calorie diet is an option forthe treatment of obesity. The aim of the present study was to evaluateits effectiveness, safety, and tolerance.Material and methods: thirty-eight patients with no contraindicationsfor IGB were included in this prospective study fromMarch 2004 to January 2007. Balloon removal was performed 6months later. Weight and body mass index (BMI) were evaluatedafter IGB removal and at 6 months and 1 year thereafter. Toleranceand complications during treatment were evaluated. Patientsfilled out a questionnaire to evaluate their subjective perception oftreatment.Results: mean weight loss after 6 months on balloon treatmentwas 14.10 kg (0-46), and mean BMI reduction was 5.23kg/m2 (0-18). At 12 months after balloon removal 48.4% of patientsmaintained their weight loss or kept loosing weight. Mostcommon early symptoms included nausea (71.1%) and vomiting(57.9%) with a good response to symptomatic treatment. Complicationswere seen in 7 patients (18.4%): digestive intolerance in 4patients, with early removal in 3 of them; moderate esophagitis in2 patients; and gastric perforation complicated with septic shockand death in 1 patient.Conclusions:1. IGB in association with low-calorie diet is an effective, safe,and well tolerated treatment for morbid obese patients.2. Almost half of patients maintained their weight loss after one year from balloon removal (AU)

Esteatoepatite não alcoólica induzida por rápida perda de peso em uso de balão intragástrico: um relato de caso / Non-alcoholic steatohepatitis induced by fast weight loss during the use of intragastric balloon: a case report

A obesidade é uma doença crônica, atualmente considerada uma epidemia global. Está associada a várias co-morbidades clínicas, entre elas a doença esteatótica hepática não alcoólica (DEHNA), e sua complicação, a esteatoepatite não alcoólica (EHNA). Apresentamos um caso de uma paciente de 58 anos com obesidade refratária ao tratamento clínico, submetida à colocação do balão intragástrico (BIG), que evoluiu com um quadro de esteatoepatite não alcoólica, associada a rápida perda de peso.

Obesity is a chronic disease that has been considered an epidemic nowadays. It is associated to much co-morbidity, such as non-alcoholic fatty liver disease (NAFLD) and its complication, steatohepatitis. We report a case of a 58-year-old obese patient refractory to clinical treatment who was submitted to the use of intragastric balloon (BIB), developing steatohepatitis induced by fast weight loss.