Ganesh R, Rao A D, Baladas H G, Leese T
Department of Surgery, Alexandra Hospital, 378 Alexandra Road, Singapore 159964.
Singapore Med J. 2007 Mar;48(3):227-31.
The Bioenteric Intragastric Balloon (BIB, Inamed Health, Santa Barbara, CA, USA) is an endoscopic method for achieving restriction of gastric intake in obese patients. It is less invasive and cheaper than bariatric surgery, but can only be left in the stomach for six months. We report our experience with the BIB in Singapore.
Since its introduction to our hospital in 2004, a prospective database has been kept of all patients undergoing BIB insertion. This database was used to retrieve the information for this study.
20 patients have undergone BIB insertion. Mean patient age was 40 (range, 28-52) years and 85 percent were female. Mean body weight was 79.6 (range, 67.6- 103.7) kg. Mean body mass index (BMI) was 31.5 (range, 27.8-38.8) kilogramme per square metre. Mean excess weight was 21.2 (range, 11.9-37.6) kg. The BIBs were inserted under conscious sedation. BIB intolerance was a major problem and four patients (20 percent) required early BIB removal due to refractive nausea and epigastric discomfort. All remaining BIBs were removed after six months under conscious sedation. The mean maximum weight loss during the six months was 5.9 (range, 1.4-13.4) kg. The mean maximum percentage of excess weight lost was 32.4 (range, 6.7-87). Weight loss was reasonably preserved at the end of the sixmonth period, but by one year, when all the patients had been without BIBs for at least six months, the mean weight loss for the group compared to pre-BIB weight was only 1.5 kg (range, weight gain 5.3 kg to weight loss 9 kg). The mean percentage excess weight loss at one year was 10.9 (range, 15.1 percent weight gain to 31.3 percent weight loss). Only four patients (20 percent) regarded their experience with the BIB as a success.
The BIB is poorly tolerated by Asian patients, even when lower volumes are inserted into the balloon to compensate for the smaller Asian stature. Although temporary weight loss can be achieved, mandatory removal of the BIB at six months results in regain of the lost weight in the majority of patients. Eligible patients (BMI 32.5 and above) should be encouraged to undergo bariatric surgery rather than BIB to achieve long-term reliable weight loss. Patients who are ineligible for bariatric surgery may benefit from BIB, especially if they have severe comorbidities and have failed to lose weight by any other means in a validated weight management programme, but the chance of long-term success is poor.
Bioenteric胃内球囊（BIB，美国加利福尼亚州圣巴巴拉市Inamed Health公司生产）是一种用于限制肥胖患者胃内容量摄入的内镜方法。它比减肥手术侵入性小且成本低，但只能在胃内留置六个月。我们报告在新加坡使用BIB的经验。
自2004年引入我院以来，已对所有接受BIB植入的患者建立了前瞻性数据库。本研究使用该数据库检索信息。
20例患者接受了BIB植入。患者平均年龄为40岁（范围28 - 52岁），85%为女性。平均体重为79.6千克（范围67.6 - 103.7千克）。平均体重指数（BMI）为每平方米31.5千克（范围27.8 - 38.8千克）。平均超重21.2千克（范围11.9 - 37.6千克）。BIB在清醒镇静下植入。BIB不耐受是一个主要问题，4例患者（20%）因顽固性恶心和上腹部不适需要早期取出BIB。所有其余的BIB在六个月后在清醒镇静下取出。六个月期间平均最大体重减轻为5.9千克（范围1.4 - 13.4千克）。超重减轻的平均最大百分比为32.4%（范围6.7 - 87%）。在六个月结束时体重减轻得到合理维持，但到一年时，当所有患者已无BIB至少六个月时，与植入BIB前体重相比，该组患者的平均体重减轻仅为1.5千克（范围，体重增加5.3千克至体重减轻9千克）。一年时超重减轻的平均百分比为10.9%（范围，体重增加15.1%至体重减轻31.3%）。只有4例患者（20%）认为他们使用BIB的经历是成功的。
即使向球囊内注入较小容量以适应亚洲人较小的身材，亚洲患者对BIB的耐受性仍较差。虽然可以实现暂时的体重减轻，但六个月时强制取出BIB导致大多数患者体重反弹。应鼓励符合条件的患者（BMI 32.5及以上）接受减肥手术而非BIB以实现长期可靠的体重减轻。不符合减肥手术条件的患者可能从BIB中获益，特别是如果他们有严重的合并症且在经过验证的体重管理计划中通过任何其他方法都未能减重，但长期成功的机会很小。
