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Obezite tedavisinde intragastrik balon yöntemi güvenli ve etkili mi?

Yıl 2019, Cilt: 4 Sayı: 1, 25 - 28, 15.03.2019
https://doi.org/10.25000/acem.477680

Öz

Amaç: Obezite
tedavi yöntemlerinden bariatrik cerrahi, invazif ve maliyetli bir yaklaşım olup
kalıcı yan etkilere sahipken, göreceli daha az maliyetli medikal tedavinin sistemik
yan etkileri söz konusu olabilir. İntragastrik balon (IGB) uygulaması ise medikal
tedavi ve bariatrik cerrahi arasında minimal invazif ve geçici bir yöntemdir.
Bu çalışmanın amacı, IGB uygulamasının etkinliğini ve güvenliğini değerlendirmektir. 

Yöntemler:
Çalışmaya 2015 – 2017 yılları arasında IGB tedavisi uygulanan 39 hasta dahil
edildi. İşlem öncesi ve sonrası vücut kitle indeksi (VKİ), fazla kilonun kayıp
oranı, balonun hastalar tafından tolere edilebilmesi ve gelişen komplikasyonlar
değerlendirildi.

Bulgular: İşlem
öncesi ortanca vücut kitle indeksi (VKİ) değeri 33.2 kg/m2 olan 39 hastanın
33’ü (%84,6) kadındı. İşlemi tolere edemeyen 3 hastanın (%7,6) balonu 1., 5. ve
25. günlerde çıkarıldı. Tedavinin ortanca süresi 8 aydı (1 gün-17 ay).
Balonları ilk 6 ayda çıkarılan hastalarda fazla kilonun kayıp oranı %22,8 iken,
6 aydan uzun kalanlarda bu oran %41,6 idi. Balon çıkarılması sonrası VKİ
ortanca değeri 28.3 kg/m2 olarak bulundu. Sadece bir hastada (%2,5)
spontan IGB rüptürü ve balonun defekasyonla atılması görüldü.







Sonuç: IGB uygulaması başarısız diyet ve
egzersiz denemeleri olan ve bariatrik cerrahi yapılmayacak hastalara güvenli ve
etkili bir yöntem olarak önerilebilir.

Kaynakça

  • 1. Gaur S, Levy S, Mathus-Vliegen L, Chuttani R. Balancing risk and reward: a critical review of the intragastric balloon for weight loss. Gastrointest Endosc. 2015;81:1330–6.
  • 2. Lau DC, Teoh H. Benefits of modest weight loss on the management of type 2 diabetes mellitus. Can J Diabetes. 2013;37:128–34.
  • 3. Obesity: The Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children [Internet]. Centre for Public Health Excellence at NICE (UK); National Collaborating Centre for Primary Care (UK). London: National Institute for Health and Clinical Excellence (UK); 2006. https://www.ncbi.nlm.nih.gov/pubmed/22497033
  • 4. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894: i-xii, 1-253.
  • 5. Dastis NS, François E, Deviere J, Hittelet A, Ilah Mehdi A, Barea M, et al. Intragastric balloon for weight loss: results in 100 individuals followed for at least 2.5 years. Endoscopy. 2009;41:575-80.
  • 6. Mathus-Vliegen EM. Endoscopic treatment: the past, the present and the future. Best Pract Res Clin Gastroenterol. 2014;28:685-702.
  • 7. Ling H, Lenz TL, Burns TL, Hilleman DE. Reducing the risk of obesity: defining the role of weight loss drugs. Pharmacotherapy. 2013;33:1308-21.
  • 8. Mathus-Vliegen EM, Tytgat GN. Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc. 2005;61:19-27.
  • 9. Martins Fernandes FA Jr, Carvalho GL, Lima DL, Rao P, Shadduck PP, Montandon ID, et al. Intragastric Balloon for Overweight Patients. JSLS. 2016;20:pii: e2015.00107.
  • 10. Stanford FC, Kyle TK, Claridy MD, Nadglowski JF, Apovian CM. The influence of an individual's weight perception on the acceptance of bariatric surgery. Obesity. 2015;23:277-81.
  • 11. Göttig S, Weiner RA, Daskalakis M. Preoperative weight reduction using the intragastric balloon. Obes Facts. 2009;2:20-3.
  • 12. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083-96.
  • 13. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129:102-38.
  • 14. Moura D, Oliveira J, De Moura EG, Bernardo W, Galvão Neto M, Campos J, et al. Effectiveness of intragastric balloon for obesity: A systematic review and meta-analysis based on randomized control trials. Surg Obes Relat Dis. 2016;12:420-9.
  • 15. Kotzampassi K, Grosomanidis V, Papakostas P, Penna S, Eleftheriadis E. 500 intragastric balloons: what happens 5 years thereafter? Obes Surg. 2012;22:896-903.
  • 16. Wing RR. Behavioral approaches to the treatment of obesity. In: Handbook of Obesity: Clinical Applications, 2nd Ed, Bray GA, Bouchard C [Eds], Marcel Dekker, New York, 2004.
  • 17. Hartmann-Boyce J, Johns DJ, Jebb SA, Aveyard P. Effect of behavioural techniques and delivery mode on effectiveness of weight management: systematic review, meta-analysis and meta-regression. Obes Rev. 2014;15:598-609.
  • 18. Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011;34:841-59.
  • 19. Alfredo G, Roberta M, Massimiliano C, Michele L, Nicola B, Adriano R. Long-term multiple intragastric balloon treatment--a new strategy to treat morbid obese patients refusing surgery: prospective 6-year follow-up study. Surg Obes Relat Dis. 2014;10:307-11.
  • 20. Genco A, Cipriano M, Bacci V, Maselli R, Paone E, Lorenzo M, et al. Intragastric balloon followed by diet vs intragastric balloon followed by another balloon: a prospective study on 100 patients. Obes Surg. 2010;20:1496-500.
  • 21. Yap Kannan R, Nutt MR. Are intra-gastric adjustable balloon systems safe? A case series. Int J Surg Case Rep. 2013;4:936-8.
  • 22. Roman S, Napoléon B, Mion F, Bory RM, Guyot P, D'Orazio H, et al. Intragastric balloon for "non-morbid" obesity: a retrospective evaluation of tolerance and efficacy. Obes Surg. 2004;14:539-44.
  • 23. PMA P140008: FDA Summary of Safety and Effectiveness Data. http://www.accessdata.fda.gov/cdrh_docs/pdf14/P140008b.pdf [Accessed on January 25, 2016].
  • 24. PMA P140012: FDA Summary of Safety and Effectiveness Data. http://www.accessdata.fda.gov/cdrh_docs/pdf14/P140012b.pdf [Accessed on January 25, 2016].
  • 25. Dumonceau JM. Evidence-based review of the Bioenterics intragastric balloon for weight loss. Obes Surg. 2008;18:1611-7.
  • 26. Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg. 2008;18:841-6.
  • 27. Marshall JC. Gastrointestinal flora and its alterations in critical illness. Curr Opin Clin Nutr Metab Care. 1999;2:405-11.
  • 28. Zilberstein B, Quintanilha AG, Santos MA, Pajecki D, Moura EG, Alves PR, et al. Digestive tract microbiota in healthy volunteers. Clinics. 2007;62:47-54.
  • 29. Rajablou M, Ganz RA, Batts KP. Candida infection presenting as multiple ulcerated masses. Gastrointest Endosc. 2007;65:164-6.
  • 30. Pasqualotto AC, Nedel WL, Machado TS, Severo LC. A comparative study of risk factors and outcome amongout patient-acquired and nosocomial candidaemia. J Hosp Infect. 2005;60:129-34.
  • 31. Wang K, Lin HJ, Perng CL, Tseng GY, Yu KW, Chang FY, Lee SD. The effect of H2-receptor antagonist and proton pump inhibitor on microbial proliferation in the stomach. Hepatogastroenterology. 2004;51:1540-3.
  • 32. Kotzampassi K, Vasilaki O, Stefanidou C, Grosomanidis V. Candida albicanscolonization on an intragastric balloon. Asian J Endosc Surg. 2013;6:214-6.
  • 33. Yorke E, Switzer NJ, Reso A, Shi X, de Gara C, Birch D, et al. Intragastric Balloon for Management of Severe Obesity: a Systematic Review. Obes Surg. 2016;26:2248-54.
  • 34. Genco A, Maselli R, Frangella F, Cipriano M, Forestieri P, Delle Piane D, et al. Intragastric balloon for obesity treatment: results of a multicentric evaluation for balloons left in place for more than 6 months. Surg Endosc. 2015;29:2339-43.

Intragastric balloon therapy for obesity: Is it safe and effective?

Yıl 2019, Cilt: 4 Sayı: 1, 25 - 28, 15.03.2019
https://doi.org/10.25000/acem.477680

Öz

Aim: Bariatric
surgery is a costly and invasive method with permanent effects and medications
for treatment of obesity is less costly but may cause systemic side effects.
Intragastric balloon (IGB) therapy is a minimal invasive and temporary option
between medical therapy and bariatric surgery. The aim of this study is to
evaluate the safety and efficiency of intragastric balloon application and
present our results.

Methods: 39
patients who underwent IGB therapy between 2015 and 2017 were included in the
study. IGB was advanced into the stomach, and then the balloon was filled with
saline and methylene blue solution. The patients were assessed by a nutritionist
during the follow-up period and after balloon removal they were evaluated for
results.

Results: Of 39
patients, 33 were female and the median body mass index (BMI) was 33.2 kg/m2
before the procedure. Three patients (7.6%) could not tolerate the balloon;
therefore balloon extraction was performed on the day 1, 5 and 25. Median
duration of therapy was 8 months (1 day-17 months). While excessive weight loss
(EWL) ratio was 22.8% in patients whose balloon was removed in 6 months, EWL
ratio was 41.6% in patients whose balloon remained more than 6 months. The
median BMI after balloon removal was 28.3 kg/m2. The only
complication was spontaneous IGB deflation and excretion transanally.







Conclusion: Intragastric balloon therapy may be
recommended as a safe and effective option for the patients who have had failed
attempts of diet and exercise and will not undergo bariatric surgery.

Kaynakça

  • 1. Gaur S, Levy S, Mathus-Vliegen L, Chuttani R. Balancing risk and reward: a critical review of the intragastric balloon for weight loss. Gastrointest Endosc. 2015;81:1330–6.
  • 2. Lau DC, Teoh H. Benefits of modest weight loss on the management of type 2 diabetes mellitus. Can J Diabetes. 2013;37:128–34.
  • 3. Obesity: The Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children [Internet]. Centre for Public Health Excellence at NICE (UK); National Collaborating Centre for Primary Care (UK). London: National Institute for Health and Clinical Excellence (UK); 2006. https://www.ncbi.nlm.nih.gov/pubmed/22497033
  • 4. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894: i-xii, 1-253.
  • 5. Dastis NS, François E, Deviere J, Hittelet A, Ilah Mehdi A, Barea M, et al. Intragastric balloon for weight loss: results in 100 individuals followed for at least 2.5 years. Endoscopy. 2009;41:575-80.
  • 6. Mathus-Vliegen EM. Endoscopic treatment: the past, the present and the future. Best Pract Res Clin Gastroenterol. 2014;28:685-702.
  • 7. Ling H, Lenz TL, Burns TL, Hilleman DE. Reducing the risk of obesity: defining the role of weight loss drugs. Pharmacotherapy. 2013;33:1308-21.
  • 8. Mathus-Vliegen EM, Tytgat GN. Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc. 2005;61:19-27.
  • 9. Martins Fernandes FA Jr, Carvalho GL, Lima DL, Rao P, Shadduck PP, Montandon ID, et al. Intragastric Balloon for Overweight Patients. JSLS. 2016;20:pii: e2015.00107.
  • 10. Stanford FC, Kyle TK, Claridy MD, Nadglowski JF, Apovian CM. The influence of an individual's weight perception on the acceptance of bariatric surgery. Obesity. 2015;23:277-81.
  • 11. Göttig S, Weiner RA, Daskalakis M. Preoperative weight reduction using the intragastric balloon. Obes Facts. 2009;2:20-3.
  • 12. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083-96.
  • 13. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129:102-38.
  • 14. Moura D, Oliveira J, De Moura EG, Bernardo W, Galvão Neto M, Campos J, et al. Effectiveness of intragastric balloon for obesity: A systematic review and meta-analysis based on randomized control trials. Surg Obes Relat Dis. 2016;12:420-9.
  • 15. Kotzampassi K, Grosomanidis V, Papakostas P, Penna S, Eleftheriadis E. 500 intragastric balloons: what happens 5 years thereafter? Obes Surg. 2012;22:896-903.
  • 16. Wing RR. Behavioral approaches to the treatment of obesity. In: Handbook of Obesity: Clinical Applications, 2nd Ed, Bray GA, Bouchard C [Eds], Marcel Dekker, New York, 2004.
  • 17. Hartmann-Boyce J, Johns DJ, Jebb SA, Aveyard P. Effect of behavioural techniques and delivery mode on effectiveness of weight management: systematic review, meta-analysis and meta-regression. Obes Rev. 2014;15:598-609.
  • 18. Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011;34:841-59.
  • 19. Alfredo G, Roberta M, Massimiliano C, Michele L, Nicola B, Adriano R. Long-term multiple intragastric balloon treatment--a new strategy to treat morbid obese patients refusing surgery: prospective 6-year follow-up study. Surg Obes Relat Dis. 2014;10:307-11.
  • 20. Genco A, Cipriano M, Bacci V, Maselli R, Paone E, Lorenzo M, et al. Intragastric balloon followed by diet vs intragastric balloon followed by another balloon: a prospective study on 100 patients. Obes Surg. 2010;20:1496-500.
  • 21. Yap Kannan R, Nutt MR. Are intra-gastric adjustable balloon systems safe? A case series. Int J Surg Case Rep. 2013;4:936-8.
  • 22. Roman S, Napoléon B, Mion F, Bory RM, Guyot P, D'Orazio H, et al. Intragastric balloon for "non-morbid" obesity: a retrospective evaluation of tolerance and efficacy. Obes Surg. 2004;14:539-44.
  • 23. PMA P140008: FDA Summary of Safety and Effectiveness Data. http://www.accessdata.fda.gov/cdrh_docs/pdf14/P140008b.pdf [Accessed on January 25, 2016].
  • 24. PMA P140012: FDA Summary of Safety and Effectiveness Data. http://www.accessdata.fda.gov/cdrh_docs/pdf14/P140012b.pdf [Accessed on January 25, 2016].
  • 25. Dumonceau JM. Evidence-based review of the Bioenterics intragastric balloon for weight loss. Obes Surg. 2008;18:1611-7.
  • 26. Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg. 2008;18:841-6.
  • 27. Marshall JC. Gastrointestinal flora and its alterations in critical illness. Curr Opin Clin Nutr Metab Care. 1999;2:405-11.
  • 28. Zilberstein B, Quintanilha AG, Santos MA, Pajecki D, Moura EG, Alves PR, et al. Digestive tract microbiota in healthy volunteers. Clinics. 2007;62:47-54.
  • 29. Rajablou M, Ganz RA, Batts KP. Candida infection presenting as multiple ulcerated masses. Gastrointest Endosc. 2007;65:164-6.
  • 30. Pasqualotto AC, Nedel WL, Machado TS, Severo LC. A comparative study of risk factors and outcome amongout patient-acquired and nosocomial candidaemia. J Hosp Infect. 2005;60:129-34.
  • 31. Wang K, Lin HJ, Perng CL, Tseng GY, Yu KW, Chang FY, Lee SD. The effect of H2-receptor antagonist and proton pump inhibitor on microbial proliferation in the stomach. Hepatogastroenterology. 2004;51:1540-3.
  • 32. Kotzampassi K, Vasilaki O, Stefanidou C, Grosomanidis V. Candida albicanscolonization on an intragastric balloon. Asian J Endosc Surg. 2013;6:214-6.
  • 33. Yorke E, Switzer NJ, Reso A, Shi X, de Gara C, Birch D, et al. Intragastric Balloon for Management of Severe Obesity: a Systematic Review. Obes Surg. 2016;26:2248-54.
  • 34. Genco A, Maselli R, Frangella F, Cipriano M, Forestieri P, Delle Piane D, et al. Intragastric balloon for obesity treatment: results of a multicentric evaluation for balloons left in place for more than 6 months. Surg Endosc. 2015;29:2339-43.
Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Orjinal Makale
Yazarlar

Onur Bayraktar 0000-0003-2946-9569

Abdullah Alp Özçelik Bu kişi benim 0000-0001-8976-862X

Ahmet Ragıp Öktemgil Bu kişi benim 0000-0001-8781-731X

Barış Bayraktar Bu kişi benim 0000-0002-4111-0885

Yayımlanma Tarihi 15 Mart 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 4 Sayı: 1

Kaynak Göster

Vancouver Bayraktar O, Özçelik AA, Öktemgil AR, Bayraktar B. Intragastric balloon therapy for obesity: Is it safe and effective?. Arch Clin Exp Med. 2019;4(1):25-8.