Totté E, Hendrickx L, Pauwels M, Van Hee R
Academic Surgical Center Stuivenberg, Lange Beeldenkenstraat 267, B-2060 Antwerp, Belgium.
Obes Surg. 2001 Aug;11(4):519-23. doi: 10.1381/096089201321209459.
A new intragastric balloon is available for weight reduction.
Patients consulting for a weight reduction plan and refusing any kind of actual surgery, or suffering from obesity but not meeting the IFSO standards for surgery, were offered the possibility of weight reduction by the BioEnterics intragastric balloon (BIB). A preoperative questionnaire was completed by all patients, inquiring about medical history, co-morbidity factors, dietary habits, previous treatments for weight and social, psychological, relational and economic impact of the obesity. BIB placement was done on an inpatient basis, under general anesthesia. Inflation was standardized at 500 ml saline. Intravenous antiemetic and spasmolytic drugs were given to control post-insertion nausea for 24 hours, and oral medication was administered on the patient's discharge. A standard 800 calorie diet was prescribed after dietitian's consultation. Extraction of the balloon was left to the patient's discretion at 3 or maximum 6 months after placement. Patients choosing for the maximal period received a formal invitation to extract the balloon. Evaluation of weight reduction was done at extraction and by questionnaire.
126 patients (5 M, 121 F) with mean age of 35.6 years (20-62) were included after preoperative evaluation. Mean preoperative BMI was 37.7 kg/m2 (26.7-57.7 kg/m2), with a mean initial excessive weight of 35.3 kg (8.8-96.4 kg) and mean initial % excess weight of 32.2 (6.3-102). 69 patients were eligible for review; mean excess weight loss after 3 months was 48.6% and after 6 months 50.8%. Mean weight loss was 15.4 kg (0-35 kg). 76.8% of the patients (41/69) complained of severe nausea and vomiting lasting an average of 1 week (1 day-6 months), resulting in 3 patients in early removal of the balloon (at 1 day, 1 week, 1 month after placement respectively). 2 patients suffered gastric perforation presenting as acute peritonitis 3 and 4 months after placement and were operated. Extraction of the balloon was performed in 3 patients after 3 months and in 66 patients after 6 months. In 11 patients (22%), esophagitis was present (8 grade 1, 2 grade II, 1 grade III), and one patient showed diffuse gastric erosion. One patient required removal of the balloon by rigid esphagoscopy following technical failure of the endoscopic extraction device. 45 patients replied to the mailed, questionnaire; 15% (7/45) were very satisfied, 13% (6/45) satisfied, 22% (10/45) reasonably satisfied, 8.8% (4/45) unsatisfied and 40% very unsatisfied. Degree of satisfaction correlated poorly with weight loss. Results may be better with close continuous guidance by a counselor.
BIB as a means of weight reduction in the obese patient led to a 50.8% loss of excess weight after 6 months. Although severe morbidity can occur, the BIB provides a means for short-term weight reduction in conjunction with dietary measures.
一种新型胃内球囊可用于减重。
咨询减重计划且拒绝任何实际手术，或患有肥胖症但不符合国际肥胖与代谢病外科学会（IFSO）手术标准的患者，可选择使用BioEnterics胃内球囊（BIB）进行减重。所有患者均完成术前问卷，询问病史、合并症因素、饮食习惯、既往体重治疗情况以及肥胖对社会、心理、人际关系和经济的影响。BIB放置在住院患者身上，在全身麻醉下进行。充气量标准化为500毫升生理盐水。静脉给予止吐和解痉药物以控制置入后24小时的恶心，患者出院时给予口服药物。在营养师会诊后规定标准的800卡路里饮食。球囊取出由患者自行决定，在放置后3个月或最长6个月进行。选择最长时间的患者会收到取出球囊的正式邀请。在取出时通过问卷对减重情况进行评估。
经过术前评估，纳入了126例患者（5例男性，121例女性），平均年龄35.6岁（20 - 62岁）。术前平均体重指数（BMI）为37.7千克/平方米（26.7 - 57.7千克/平方米），平均初始超重35.3千克（8.8 - 96.4千克），平均初始超重百分比为32.2（6.3 - 102）。69例患者符合复查条件；3个月后平均超重减轻48.6%，6个月后为50.8%。平均体重减轻15.4千克（0 - 35千克）。76.8%的患者（41/69）抱怨严重恶心和呕吐，平均持续1周（1天 - 6个月），导致3例患者提前取出球囊（分别在放置后1天、1周、1个月）。2例患者在放置后3个月和4个月出现胃穿孔，表现为急性腹膜炎并接受手术。3例患者在3个月后取出球囊，66例患者在6个月后取出。11例患者（22%）存在食管炎（8例为1级，2例为II级，1例为III级），1例患者出现弥漫性胃糜烂。1例患者在内镜取出装置技术失败后通过硬式食管镜取出球囊。45例患者回复了邮寄的问卷；15%（7/45）非常满意，13%（6/45）满意，22%（10/45）还算满意，8.8%（4/45）不满意，40%非常不满意。满意度与体重减轻的相关性较差。在咨询师密切持续指导下结果可能会更好。
BIB作为肥胖患者的一种减重手段，6个月后超重减轻了50.8%。尽管可能发生严重并发症，但BIB结合饮食措施为短期减重提供了一种方法。
