A Systematic Review on Intragastric Balloons and TransPyloric Shuttle in Obesity Treatment

Öz

Endoscopic bariatric procedures in the treatment of obesity have become widespread in recent years. In this systematic review, it was aimed to assess the role of intragastric balloons and transpyloric shuttle in the treatment of obesity. A comprehensive search was conducted using the search terms “Intragastric Balloon” and “TransPyloric Shuttle” in PubMed, Cochrane Library and Web of Science databases from 1st of December to 25th of December in 2020. Twenty-seven clinical studies (24 studies on intragastric balloons and 3 studies on transpyloric shuttle) were assessed. It is clear that both methods have significant positive effects on obesity-related comorbidities and weight loss. These techniques also have potential to reduce comedications in patients with type 2 diabetes mellitus and obesity. The most important differences between intragastric balloons and transpyloric shuttle are in the severity and frequency of the complications they cause. While the most common complications related to intragastric balloons are vomiting, nausea, bloating, and abdominal pain, the most common complications due to transpyloric shuttle are gastroduodenal ulcers, gastroesophageal reflux disease, and sore throat. In addition, one of the most important finding is that the type and structure of the balloon, as well as the application period and position of the balloon in the stomach, may cause changes in the adverse and practical effects of intragastric balloons. As a conclusion, intragastric balloon application is a relatively effective short term treatment and relatively safe endoscopic technique used in patients with obesity to improve comorbidities accompanying obesity, but with risks of adverse events. On the other hand, the safety profile of the transpyloric shuttle still needs to be improved.

Anahtar Kelimeler

• Gastric balloon
• obesity management
• endoscopic gastrointestinal surgery

Obezite Tedavisinde İntragastrik Balonlar ve TransPyloric Shuttle Üzerine Sistematik Bir İnceleme

Öz

Endoskopik bariatrik prosedürlerin obezite tedavisinde kullanımı son yıllarda yaygınlaşmaya başlamıştır. Bu sistematik derlemede, obezite tedavisinde intragastrik balon ve transpilorik shuttle uygulamalarının rolünün değerlendirilmesi amaçlanmıştır. 1 Aralık 2020 – 25 Aralık 2020 tarihleri arasında PubMed, Cochrane Library ve Web of Science veri tabanlarında “Intragastric Balloon” ve “TransPyloric Shuttle” arama terimleri kullanılarak kapsamlı bir arama yapılmıştır. Toplam yirmi yedi klinik çalışma (intragastrik balonlarla ilgili 24 ve transpilorik shuttle ile ilgili 3 çalışma) değerlendirilmiştir. Her iki yöntemin de ağırlık kaybı ve obeziteye bağlı komorbiditeler üzerine önemli olumlu etkilerinin olduğu açıktır. Bu tekniklerin ayrıca tip 2 diyabet ve obezitesi olan hastalarda ilaç kullanımını azaltma potansiyeli de bulunmaktadır. İntragastrik balon ve transpilorik shuttle uygulamaları arasındaki en önemli fark, neden oldukları komplikasyonların sıklığı ve şiddetidir. İntragastrik balonlar ile ilişkili en sık görülen komplikasyonlar bulantı, kusma, karın ağrısı ve şişkinlik iken, transpilorik shuttle ile ilişkili en sık görülen komplikasyonlar gastroduodenal ülserler, gastroözofageal reflü hastalığı ve boğaz ağrısıdır. Tüm bunlara ek olarak elde edilen en önemli bulgulardan birisi de balonların tipinin ve yapısının yanı sıra, balonun uygulama süresi ve midedeki pozisyonunun da intragastrik balonların olumsuz ve pratik etkilerinde değişikliklere neden olabileceği sonucudur. Sonuç olarak, intragastrik balon uygulaması, obeziteye eşlik eden komorbiditeleri iyileştirmek için obez hastalarda kullanılan, ancak yan etki riskleri olan ve nispeten kısa süreli etkili bir endoskopik tekniktir. Diğer yandan, transpilorik shuttle tekniğinin güvenlik profilinin iyileştirilmesi gerekmektedir.

Anahtar Kelimeler

• Gastrik balon
• obezite yönetimi
• endoskopik gastrointestinal cerrahi

Kaynakça

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