Intragastric balloon for weight loss: results in 100 individuals followed for at least 2.5 years

BACKGROUND AND STUDY AIMS

To determine long-term outcome after treatment with an intragastric balloon for 6 months, with no structured weight maintenance program offered after balloon removal.

PATIENTS AND METHODS

100 consecutive overweight/obese individuals (mean body mass index [BMI] 35.0 +/- 5.6 kg/m (2)) were prospectively followed after endoscopic implantation of a saline-filled intragastric balloon; 97 completed final follow-up at a mean of 4.8 +/- 1.6 years. Successful intragastric balloon therapy was defined as weight loss at 6 months of > or = 10 % of weight at baseline, that remained > or = 10 % until 2.5 years, without bariatric surgery. All analyses followed intention-to-treat principles.

RESULTS

At 6 months, mean weight loss was 12.6 +/- 8.3 kg, 63 individuals had > or = 10 % baseline weight loss; no severe morbidity was detected. During the first and second years following intragastric balloon removal, mean body mass increased by 4.2 +/- 6.8 and 2.3 +/- 6.0 kg, respectively ( P < 0.001 for both year-on-year comparisons). At 2.5 years, intragastric balloon therapy had been successful in 24 participants. At final follow-up (4.8 +/- 1.6 years), 28 had > or = 10 % baseline weight loss, 35 had undergone bariatric surgery (60 % had preoperative mass higher than baseline), and 3 were lost to follow-up; the 34 remaining had lost 1.5 +/- 5.8 kg compared with baseline. During follow-up, 13 had a second intragastric balloon implanted and 13 took sibutramine for short periods.

CONCLUSION

Intragastric balloon therapy was relatively innocuous and associated with successful weight loss and maintenance at 2.5 years in a quarter of participants. It represents a valid option for weight loss.

[Spontaneous intrahepatic haemorrhage due to peliosis hepatis]

Liver vascular lesions may occur in women on oral contraceptives. We report here spontaneous liver haemorrhage caused by peliosis hepatis, occuring in a 47-year old patient. She used oral contraceptives for many years. A computerized tomography and a magnetic resonance of the abdomen revealed a subcapsular liver hematoma without hemoperitoneum. Treatment consisted of supportive care with favourable clinical outcome. This observation point out a severe complication of peliosis hepatis. The authors review the etiology, diagnosis, complications, treatment and potential role of estrogen/progesterone supplementation as an etiological factor, in peliosis hepatis.

Complications of endoscopic retrograde cholangiopancreatography during live endoscopy workshop demonstrations

BACKGROUND AND STUDY AIMS

Endoscopy workshops are thought to be associated with larger numbers of complications than routine clinical treatment. In this study, patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) during live demonstrations were compared with matched patients treated in an ERCP unit.

PATIENTS AND METHODS

Patients who underwent ERCP during workshops over a 12-year period were reviewed. The control for each patient was the next patient admitted to the same ERCP unit with similar indications. Possible delays before treatment, ERCP indications, the use of general anesthesia, standard endoscopic and special treatments, success and complication rates for ERCP, prolonged hospitalization periods, and financial benefits for patients were assessed.

RESULTS

A total of 168 workshop patients and 168 control patients were compared. ERCP was delayed in 18 patients to allow treatment during the workshops. General anesthesia was used in 87.5 % of the workshop patients, in comparison with 44 % of the control patients (P < 0.001). The duration of the endoscopies and radiation exposure did not differ, and the endoscopic treatments carried out also did not differ significantly, with the exception of cholangiopancreatoscopy (7 % in the workshop group versus 0 %; P < 0.01). The success and complication rates were similar in the workshop and control patients, as was the duration of hospitalization. Among the patients treated during workshops, 45 % benefited financially, as they were not charged for stents or other devices.

CONCLUSIONS

These results suggest that, in this setting, ERCP performed during live demonstrations is safe and raises no major ethical problems.

[Diagnostic strategies for ischemic enteropathies]

Mesenteric ischemia is a life threatening event instead of colic ischemia which recovers in 90% of cases. Three points will be investigated: chronic mesenteric ischemia; acute mesenteric ischemia; colic ischemia.

Grading dysplasia in colorectal adenomas by means of the quantitative binding pattern determination of Arachis hypogaea, Dolichos biflorus, Amaranthus caudatus, Maackia amurensis, and Sambucus nigra agglutinins

The current study deals with the setting up of a new tool that enables the benign versus the malignant nature of colorectal adenomas to be determined accurately. The 2 objectives are to determine (1) whether adenomas should, or should not, be included in a 2- or a 3-tier grading system, and (2) whether severe dysplasias and carcinomas in situ share common or different biological characteristics. The levels of expression of different types of glycoconjugates were characterized in a series of 166 colorectal specimens, including 14 normal, 90 dysplastic, and 62 cancerous cases. The glycoconjugate expressions were demonstrated for 5 lectins, namely, Arachis hypogaea (PNA), Dolichos biflorus (DBA), Amaranthus caudatus (ACA), Maackia amurensis (MAA) and Sambucus nigra (SNA). The glycoconjugates demonstrated by these 5 lectins belong to the family of the Thomsen-Friedenreich antigens. The binding patterns of the 5 lectins were quantitatively determined by means of computer-assisted microscopy. The quantitative data were submitted to discriminant analyses. Our results show that the specific glycochemical staining patterns could be identified unambiguously and without misclassification between benign (normal and low dysplasia) and malignant (ie, either as moderate/severe dysplasia, carcinoma in situ, or cancer) cases. The data also strongly suggested that (1) dysplasias seem to be distinguishable in 2 instead of 3 groups, that is, low versus moderate/severe (high); and (2) moderate/severe dysplasias are biologically distinct from carcinomas in situ. The methodology developed can be applied directly in routine diagnosis to identify moderate/severe dysplasia specimens already exhibiting features common to carcinomas, and which therefore should be treated consistently in view of the fact that our data strongly suggest that most moderate/severe dysplasias are still benign, whereas carcinomas in situ are real carcinomatous lesions.

Use of image cytometry to classify biliary and ampullary adenocarcinomas

OBJECTIVE

To create an objective classification system to perform TNM classification of ampullary adenocarcinoma and cholangiocarcinoma using image cytometric data derived from Feulgen-stained tumor nuclei.

STUDY DESIGN

Surgically resected cases of ampullary adenocarcinoma and cholangiocarcinoma with established TNM classifications were selected on the basis of available formalin-fixed, paraffin-embedded tissue. Fifteen numerical variables related to morphometric, densitometric and textural features of each tumor nucleus were recorded. We employed a methodology based on multivariate statistical tools to characterize the association of morphonuclear variables with TNM classification. The first step consisted of identifying and selecting representative nuclei of each T class. From this "purified" data set an objective classification system was created. The classification system was assessed using internal and external validation.

RESULTS

Employing ANOVA, all 15 variables were significantly associated with T classification, 11 of 15 with N and 4 with M. Multivariate analysis was employed to distinguish between T1, T2 and T3 lesions. Our methodology correctly classified 76% of T1 nuclei, 47% of T2 nuclei and 84% of T3 nuclei. Heterogeneity within an individual tumor was defined in 61% of cases included in the training set. Complete concordance between pathologic classification and the classification system was observed in 71% of an independent validation.