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Foula MS, Amer NM, Zakaria H, Ismail MH, Alshomimi SJ, Al Bisher HM, Alsaleem H, Almulhim K, Aldabaeab AE, Alratrout H, Alsadery HA, Alarfaj MA, Aljehani YM, El Damati AM. Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review. Obes Surg 2023; 33:2718-2724. [PMID: 37452985 DOI: 10.1007/s11695-023-06716-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. MATERIALS AND METHODS A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically. RESULTS A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications. CONCLUSION IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.
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Affiliation(s)
- Mohammed S Foula
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia.
| | - Nasser M Amer
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hazem Zakaria
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mona H Ismail
- Division of Gastroenterology, Department of Internal Medicine, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Saeed J Alshomimi
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hassan M Al Bisher
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hassan Alsaleem
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Khalifa Almulhim
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abdulaziz E Aldabaeab
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hefzi Alratrout
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Humood A Alsadery
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mosab A Alarfaj
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Yasser M Aljehani
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ahmed M El Damati
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Muacevic A, Adler JR, de Souza TF, Galvão Neto MDP, Grecco E, Waisberg J. Gastric Emptying and Its Correlation With Weight Loss and Body Mass Index in Patients With an Intragastric Balloon: A Prospective Study With Six Years of Follow-Up. Cureus 2022; 14:e32599. [PMID: 36654650 PMCID: PMC9840869 DOI: 10.7759/cureus.32599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background Obesity is the most well-established and prolonged pandemic in modern society. Having a better understanding of the available tools is important to improve weight loss and make the strategies more productive. This study aims to evaluate the effect of intragastric balloon (IGB) on gastric emptying time, its relationship with weight loss after IGB removal, and weight maintenance after six years. Methodology This prospective study analyzed data from patients undergoing IGB placement. A six-years follow-up was performed and data about weight maintenance were collected. We analyzed the impact of the IGB on gastrointestinal motility and its correlation with weight loss. Results Of the 20 patients included in the study, 52.4% were diagnosed with class I obesity and 47.6% with class II obesity. The mean weight of the patients was 96.5 ± 11.9 kg at baseline, 79.6 ± 11.4 kg at the time of IGB removal, 81.8 ± 9.1 kg at six months, and 93.2 ± 14.3 kg six years after IGB removal. The mean difference between the initial weight and that measured immediately after IGB removal was 16.68 ± 5.71 kg. Regarding gastric emptying time, there was a difference in retention on comparing the measurement before balloon placement to that after the balloon was in place (72.9% vs. 86.8%) after one hour of food intake. Comparing two hours after food intake, patients before IGB placement had a 30.6% food retention, while patients with IGB in place had a 69.2% retention. Conclusions In patients with class I or II obesity, the use of an IGB delayed gastric emptying of foods but showed no direct correlation with weight loss. Weight loss achieved after IGB placement was maintained in half of the patients at a six-year follow-up.
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Chapman I, Oberoi A, Giezenaar C, Soenen S. Rational Use of Protein Supplements in the Elderly-Relevance of Gastrointestinal Mechanisms. Nutrients 2021; 13:nu13041227. [PMID: 33917734 PMCID: PMC8068133 DOI: 10.3390/nu13041227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023] Open
Abstract
Protein supplements are increasingly used by older people to maintain nutrition and prevent or treat loss of muscle function. Daily protein requirements in older people are in the range of 1.2 gm/kg/day or higher. Many older adults do not consume this much protein and are likely to benefit from higher consumption. Protein supplements are probably best taken twice daily, if possible soon after exercise, in doses that achieve protein intakes of 30 gm or more per episode. It is probably not important to give these supplements between meals, as we have shown no suppressive effects of 30 gm whey drinks, and little if any suppression of 70 gm given to older subjects at varying time intervals from meals. Many gastrointestinal mechanisms controlling food intake change with age, but their contributions to changes in responses to protein are not yet well understood. There may be benefits in giving the supplement with rather than between meals, to achieve protein intakes above the effective anabolic threshold with lower supplement doses, and have favourable effects on food-induced blood glucose increases in older people with, or at risk of developing, type 2 diabetes mellitus; combined protein and glucose drinks lower blood glucose compared with glucose alone in older people.
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Affiliation(s)
- Ian Chapman
- Adelaide Medical School and Centre of Research Excellence (C.R.E.) in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (I.C.); (A.O.)
| | - Avneet Oberoi
- Adelaide Medical School and Centre of Research Excellence (C.R.E.) in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (I.C.); (A.O.)
| | - Caroline Giezenaar
- Riddett Institute, Massey University, Palmerston North 9430, New Zealand;
| | - Stijn Soenen
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia
- Correspondence: ; Tel.: +61-07-55595-1390
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The Impact of Dietician Support and Behavioural Therapy in Addition to Concomitant Treatment with Intragastric Balloon in Obese Patients. Obes Surg 2019; 30:612-617. [PMID: 31650406 DOI: 10.1007/s11695-019-04228-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND AIMS Patients treated with intragastric balloon (IGB) may benefit from treatment and follow-up by a multidisciplinary team, where the dietician is considered the only essential professional besides the endoscopist. The aim of this study is to evaluate the impact of dietician support and behavioral therapy in terms of weight loss in patients concomitantly treated with IGB while the device is in situ. METHODS Patients with IGB in situ, in period 2005-2018, were invited to undergo a dietician check-up (DC) every 1.5 months, accompanied by cognitive behavioral therapy. Considering their attendance at the dietician check-ups (DCs), patients were categorized as non-compliant (0 DC), partially compliant (1-2 DCs), and highly compliant (≥ 3 DCs). A comparison was made among the three groups regarding % of total body weight loss (%TBWL) and ΔBMI at 180 ± 15 days when the IGB was in situ. RESULTS One hundred eighty-three obese patients treated with fluid-filled IGB were included. Body weight data at 180 ± 15 days during the IGB in situ, as well as attendance at the DCs, were available for 170 out of 183 patients. There was no difference among compliant, partially compliant, and non-compliant patients to DCs regarding %TBWL at 180 ± 15 days (p = 0.17). However, non-compliant patients had a higher ΔBMI at 180 ± 15 days in comparison to those compliant or partially compliant to DCs (p = 0.03). CONCLUSION Despite its undisputed educational role, attendance at DCs does not seem to correlate with an additional weight loss while the IGB is in situ.
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Müller V, Fikatas P, Gül S, Noesser M, Fuehrer KT, Sauer I, Pratschke J, Zorron R. NEW TECHNIQUE FOR OBESITY SURGERY: INTERNAL GASTRIC PLICATION TECHNIQUE USING INTRAGASTRIC SINGLE-PORT (IGS-IGP) IN EXPERIMENTAL MODEL. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 30:60-64. [PMID: 28489173 PMCID: PMC5424691 DOI: 10.1590/0102-6720201700010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/10/2017] [Indexed: 12/16/2022]
Abstract
Background: Bariatric surgery is currently the most effective method to ameliorate co-morbidities as consequence of morbidly obese patients with BMI over 35 kg/m2. Endoscopic techniques have been developed to treat patients with mild obesity and ameliorate comorbidities, but endoscopic skills are needed, beside the costs of the devices. Aim: To report a new technique for internal gastric plication using an intragastric single port device in an experimental swine model. Methods: Twenty experiments using fresh pig cadaver stomachs in a laparoscopic trainer were performed. The procedure was performed as follow in ten pigs: 1) volume measure; 2) insufflation of the stomach with CO2; 3) extroversion of the stomach through the simulator and installation of the single port device (Gelpoint Applied Mini) through a gastrotomy close to the pylorus; 4) performance of four intragastric handsewn 4-point sutures with Prolene 2-0, from the gastric fundus to the antrum; 5) after the performance, the residual volume was measured. Sleeve gastrectomy was also performed in further ten pigs and pre- and post-procedure gastric volume were measured. Results: The internal gastric plication technique was performed successfully in the ten swine experiments. The mean procedure time was 27±4 min. It produced a reduction of gastric volume of a mean of 51%, and sleeve gastrectomy, a mean of 90% in this swine model. Conclusion: The internal gastric plication technique using an intragastric single port device required few skills to perform, had low operative time and achieved good reduction (51%) of gastric volume in an in vitro experimental model.
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Affiliation(s)
- Verena Müller
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Panagiotis Fikatas
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Safak Gül
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Maximilian Noesser
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Kirs Ten Fuehrer
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Igor Sauer
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Johann Pratschke
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Ricardo Zorron
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
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Giezenaar C, Trahair LG, Rigda R, Hutchison AT, Feinle-Bisset C, Luscombe-Marsh ND, Hausken T, Jones KL, Horowitz M, Chapman I, Soenen S. Lesser suppression of energy intake by orally ingested whey protein in healthy older men compared with young controls. Am J Physiol Regul Integr Comp Physiol 2015; 309:R845-54. [PMID: 26290103 PMCID: PMC4666943 DOI: 10.1152/ajpregu.00213.2015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/13/2015] [Indexed: 02/07/2023]
Abstract
Protein-rich supplements are used widely for the management of malnutrition in young and older people. Protein is the most satiating of the macronutrients in young. It is not known how the effects of oral protein ingestion on energy intake, appetite, and gastric emptying are modified by age. The aim of the study was to determine the suppression of energy intake by protein compared with control and underlying gastric-emptying and appetite responses of oral whey protein drinks in eight healthy older men (69-80 yr) compared with eight young male controls (18-34 yr). Subjects were studied on three occasions to determine the effects of protein loads of 30 g/120 kcal and 70 g/280 kcal compared with a flavored water control-drink (0 g whey protein) on energy intake (ad libitum buffet-style meal), and gastric emptying (three-dimensional-ultrasonography) and appetite (0-180 min) in a randomized, double-blind, cross-over design. Energy intake was suppressed by the protein compared with control (P = 0.034). Suppression of energy intake by protein was less in older men (1 ± 5%) than in young controls (15 ± 2%; P = 0.008). Cumulative energy intake (meal+drink) on the protein drink days compared with the control day increased more in older (18 ± 6%) men than young (1 ± 3%) controls (P = 0.008). Gastric emptying of all three drinks was slower in older men (50% gastric-emptying time: 68 ± 5 min) than young controls (36 ± 5 min; P = 0.007). Appetite decreased in young, while it increased in older (P < 0.05). In summary, despite having slower gastric emptying, elderly men exhibited blunted protein-induced suppression of energy intake by whey protein compared with young controls, so that in the elderly men, protein ingestion increased overall energy intake more than in the young men.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Laurence G Trahair
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Rachael Rigda
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Amy T Hutchison
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Christine Feinle-Bisset
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Natalie D Luscombe-Marsh
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia; Commonwealth Scientific and Industrial Research Organisation Animal, Food and Health Sciences, Adelaide, Australia; and
| | - Trygve Hausken
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia; Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Karen L Jones
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South-Australia, Australia;
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Abstract
Unhealthy diet and lack of physical exercise are responsible for fat accumulation in the liver, which may lead to liver disease. Histologically, the severity of the disease has two stages: nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). NAFLD is defined by the presence of steatosis with no evidence of cellular injury such as hepatocyte ballooning. NASH is a distinct entity from NAFLD, and is characterized by the presence of inflammation with hepatocytes damage, with or without fibrosis. While several therapeutic strategies have been proposed to improve this condition, the present review aims to discuss nonmedicinal interventions used to reduce liver involvement or to prevent the disease altogether. The authors investigated dietary patterns and vitamin deficiencies associated with NAFLD, and their role in enhancing disease severity. Additionally, they reviewed the role of exercise and the use of interventions, such as as intragastric balloon and bariatric surgery, for improving disease progression. The authors propose monitoring disease progression or repair by following changes in cytoadipokine levels.
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