1. Intragastric Balloon Placement for the Management of Obesity: Improving Patient Selection
Adolfo Leyva-Alvizo MD FACS1, Eduardo Gonzalez MD FACS1, Francisco X. Treviño MD1, Roberto Alatorre MD2, Maria Luisa Martinez RD3
1 Instituto de Cirugía - Escuela de Medicina, Tecnológico de Monterrey
2 General Surgery Resident - Escuela de Medicina, Tecnológico de Monterrey
3 Instituto de Bienestar Integral – Escuela de Medicina, Tecnológico de Monterrey 3
INTRODUCTION
Intragastric balloon placement has been an available procedure in Mexico during the past decade or more. As a Bariatric Clinic, we encourage patients with lower BMIs to apply to Nutrition and Patient Support Groups before considering a procedure in them. The intragastric balloon has been an attractive procedure to this population because its reversibility, its ambulatory basis, its feasibility in lower BMI patients and unfortunately in our country, because of the lower price. Its final price as a package of procedure + RD visits during 6 months equals the price of a gastric plication or non-adjustable banding still very common in our area.
OBJECTIVE
Determine the best group of patients suitable for endoscopic balloon placement according to their BMI based in a series of 152 cases.
MATERIALS AND METHODS
152 patients with BMIs from 27 to 71 were included in this study. OrberaTM Intragastric balloon was filled with 550 to 700 cc plus 3 cc of Methylene Blue, placed endoscopically with sedation on an ambulatory setting in all but 1 patient (BMI 71-no sedation, just oral local anesthetic). All patients were treated 12 hours before with Omeprazole, Buthylhyoscine and Meclizine, and for 2 to 5 days after as well depending on the symptoms. All of them were removed endoscopically 6-12 months after, this range varied because of patients refusal to get the balloon removed. All of them were followed at least monthly by Registered Dietitian and monitored twice during this period by a surgeon in our team to detect abnormal symptoms. A final satisfaction survey was applied prior to removal with scores 1-5, being 1: not satisfied-will not reccomend and 5: completely satisfied-will reccomend.
RESULTS
I.- BMI below 30 (n %), were the group with worst tolerance and lower weight loss (9.78 kg avg), 2 premature extractions in this group, 5 readmissions to the clinic to treat symptoms via IV fluids & meds. Satisfaction score (1-5) was 1.8.
II.- Between (n %) the avg weight loss was 14.7 kg. No premature extractions, 1 readmission. Satisfaction score was 3.9.
III.- Between (n %), the avg weight loss was of 17.3 kg. No premature extractions, 2 readmissions, satisfaction score was 2.6.
IV.- BMI 50 And up (n9-5.92%), had avg weight loss of 27.1 kg. 1 rupture at 4 months in patient with severe gastritis, blue urine. Satisfaction score was 3.1
No other complications other than the previously discussed, no mortality.
DISCUSSION
We found that the patients in group 1(below 30 BMI), were the least satisfied and in the comments area they all felt with poor outcome according to the money spent.
Patients in group 3 (35-50 BMI) some had good weight loss but expected to lose more (non-realistic goal), while others used the balloon as a bridge considering restrictive surgery. We still think is a useful tool in patients with this BMI.
All patients in group 4 were aware their weight loss won´t be enough but considered a balloon because of its price-risks-reversability.
CONCLUSION
Patients with BMI between are the group with best response, we dont reccomend it below BMI 30, And above 35 BMI, weight loss is not enough but helps in inoperable patients for other reasons, or as a bridge for further restrictive surgery.