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THE EFFICACY OF THE TREATMENT WITH BIOENTERICS INTRAGASTRIC BALLOON (BIB) IS REDUCED IN OBESE PATIENTS WITH BINGE EATING DISORDER (BED)
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Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
placement has been recently introduced as a less invasive treatment. Enteral stents appear to give a better short term relief of symptoms, but a GJ leads to less reinterventions. We investigated a new endoscopic technique to make a GJ in a minimally invasive manner. Material and methods: This prospective multicenter study investigates the feasibility and safety of a GJ using the Cook Endoscopy Magnetic Anastomosis Device™ in patients with GOO due to incurable malignancy. A GJ is created by placing a magnet in the first jejunal loop and a second one in the gastric lumen. A trans-anastomotic self-expandable stent is deployed 8-10 days after the magnet placement. Patients are also evaluated for improvement in tolerance of oral feeding using the GOO Scoring System (GOOSS), the rate of stent migration and the duration of patency of the stented anastomosis. Patients are followed for 180 days, until stent occlusion, recurrence of GOO, surgical resection or death. In total, 40 patients will be enrolled into this pilot study. We report here the short term (30 days) feasibility of this ongoing study. Results: So far, a total of 12 patients have been included (9 males, mean age 63.3 years). The magnets have been successfully placed in 10 patients: in one patient it was not possible to align the magnets, in another a mechanical failure occurred. Two patients died prior to stent placement due to disease progression. An anastomosis was created in 8 patients after a mean of 11.8 days (range 8-21 days). The gastro-jejunal stent was successfully deployed in 7 patients. One placement failed due to stent migration. The overall success rate was 7 out of 12 patients (58%). Complications occurred in 5 patients: 4 stent migration and 1 bacteremia. No perforations, anastomic leakage or hemorrhage were observed. Conclusions: Endoscopic GJ with the Cook Magnetic Anastomosis Device™ is feasible and could be a promising alternative to surgical GJ, although some technical issues need to be resolved. The final results of this study should determine the role of the device in the palliation of patients with malignant gastric outlet obstruction. # R. Therapeutic endoscopy 2. Stenosis palliation
OC.17.6 THE EFFICACY OF THE TREATMENT WITH BIOENTERICS INTRAGASTRIC BALLOON (BIB) IS REDUCED IN OBESE PATIENTS WITH BINGE EATING DISORDER (BED) A. Rossi ∗ ,1 , E. Dell’Amore 2 , F. Pigò 2 , G. Bersani 1 , G. Ricci 2 , G. De Fabritiis 1 , L. Balzani 1 , V. Alvisi 2 1 Malatesta Novello, Cesena; 2 Gastroenterologia, Università di Ferrara, Ferrara
Background and aim: Eating disorders, such as BED, and assessment of abnormal body image are routinely investigated, in clinical settings, with Binge Eating Scales (BES) and Body Uneasiness Test (BUT). This study aims at evaluating if BES and BUT questionnaires are predictive of the efficacy of bariatric treatment with BIB. Material and methods: 47 obese patients (39 females; mean age = 36, range 18-59; mean BMI = 41.6, range 31-71) who underwent bariatric treatment with BIB have been evaluated with BES and BUT questionnaires, before the insertion of the BIB (t0) and after 6 months at the moment of the removal (t6). Patients were divided in two groups: one with BMI reduction <12% (group A) and the other with BMI reduction ≥12% (group B).Group A and B were compared according to the results of BES and BUT questionnaires, in order to assess a statistically significant difference (95% Confidence Interval, p<0.05), before and after bariatric treatment. Results: Group A was composed of 24 patients (mean BMI reduction 3.1±1.9 SD), while group B was composed of 23 (mean BMI reduction 6.8±1.4 SD). At the time t0 there was no difference in the prevalence of BED estimated with BES (4.2% vs 8.7%, in group A and B respectively, p = ns), whereas at the time t6, BES questionnaire showed a statistically significant difference between group A and B (34%; 95%CI: 21%-44% vs 8,7%; 95%CI: 2%-17%; p < 0,05) and with both groups at the time
t0. At the time t0, BUT questionnaire resulted normal in 21% vs 13% in group A and B respectively (p = ns), whereas at the time t6 there was a statistically significant difference between the percentage of normal BUT questionnaire in groups A and B (29%; 95%CI: 17%-40% vs 48%; 95%CI: 34%-59%; p < 0,05) and with both groups at the time t0. Conclusions: Obese patients with BED achieve fewer results with BIB as bariatric treatment. As expected, patients with better BMI % reduction perceive a diminished uneasiness of their body image. However pre-procedural assessment with these tests is not completely useful in order to diagnose BED in these patients, whose identification demands a specialist psychological appraisal. # U. Obesity and Nutrition
OC.18.1 TRANS-GASTRIC THORACOSCOPY VIA A DIAPHRAGMATIC INCISION IN A PORCINE MODEL: A N.O.T.E.S. APPROACH FOR THORACIC SURGERY G.D. De Palma ∗ , S. Siciliano, M. Rega, S. Masone, F. Salvatori, F. Maione, D. Esposito, G. Persico University of Naples Federico II, School of Medicine. Department of Surgery and Advanced Technologies. Center of Technical Innovation In Surgery, Napoli Background and aim: Recently the NOTES approach has been extended to mediastinum by a trans- esophageal access and to the thorax by a trans-vescical endoscopic approach. Our aims were to assess the feasibility and the safety of trans-gastric endoscopic approach to the thoracic cavity, with lung biopsy, in a porcine model. Material and methods: The study was performed in four 20-30 kg female pigs (Sus scrofus domesticus). Following gastric wall incision, the muscular pars of the left diaphragmatic dome was incised along with the parietal pleura and the endoscope advanced into the thoracic cavity. In all animals, a thoracoscopy was performed as well as peripheral lung biopsy At the end of the operation the endoscope was withdrawn from the thoracic cavity after pleural sac decompression and the diaphragmatic incision closed by endoscopic clips under maximal expansion of lungs. The gastric incision was finally closed by endoscopic clips. Animals were sacrificed at the end of the procedure. Results: The gastroscope was easily introduced into the thoracic cavity that allowed us to visualize the pleural cavity and to perform simple surgical procedures such as lung biopsies without complications. There were neither respiratory distress episodes nor surgical complications to report. The postmortem examination revealed a good closure of the diaphragmatic incision. Conclusions: This study demonstrates the feasibility of transgastric thoracoscopy in porcine model. Long-term follow-up of much larger series will be necessary for provision of more reliable answers if this approach should be adopted in the future and eventually translated for humans with advantages for patients. # A. Oesophagus 7. Endoscopic therapies
OC.18.2 NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY: TRANSGASTRIC CHOLECYSTECTOMY IN A SURVIVING PORCINE MODEL A. Arezzo ∗ ,1 , T. Kratt 2 , M. Morino 1 1 Centro
Universitario di Chirurgia Mininvasiva - Università di Torino, Torino; 2 Dept. of Surgery - University of Tuebingen, Tuebingen, Germany Background and aim: Before investigating if Natural Orifices Translumenal Endoscopic Surgery (NOTES) has any future, we have to
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
placement has been recently introduced as a less invasive treatment. Enteral stents appear to give a better short term relief of symptoms, but a GJ leads to less reinterventions. We investigated a new endoscopic technique to make a GJ in a minimally invasive manner. Material and methods: This prospective multicenter study investigates the feasibility and safety of a GJ using the Cook Endoscopy Magnetic Anastomosis Device™ in patients with GOO due to incurable malignancy. A GJ is created by placing a magnet in the first jejunal loop and a second one in the gastric lumen. A trans-anastomotic self-expandable stent is deployed 8-10 days after the magnet placement. Patients are also evaluated for improvement in tolerance of oral feeding using the GOO Scoring System (GOOSS), the rate of stent migration and the duration of patency of the stented anastomosis. Patients are followed for 180 days, until stent occlusion, recurrence of GOO, surgical resection or death. In total, 40 patients will be enrolled into this pilot study. We report here the short term (30 days) feasibility of this ongoing study. Results: So far, a total of 12 patients have been included (9 males, mean age 63.3 years). The magnets have been successfully placed in 10 patients: in one patient it was not possible to align the magnets, in another a mechanical failure occurred. Two patients died prior to stent placement due to disease progression. An anastomosis was created in 8 patients after a mean of 11.8 days (range 8-21 days). The gastro-jejunal stent was successfully deployed in 7 patients. One placement failed due to stent migration. The overall success rate was 7 out of 12 patients (58%). Complications occurred in 5 patients: 4 stent migration and 1 bacteremia. No perforations, anastomic leakage or hemorrhage were observed. Conclusions: Endoscopic GJ with the Cook Magnetic Anastomosis Device™ is feasible and could be a promising alternative to surgical GJ, although some technical issues need to be resolved. The final results of this study should determine the role of the device in the palliation of patients with malignant gastric outlet obstruction. # R. Therapeutic endoscopy 2. Stenosis palliation
OC.17.6 THE EFFICACY OF THE TREATMENT WITH BIOENTERICS INTRAGASTRIC BALLOON (BIB) IS REDUCED IN OBESE PATIENTS WITH BINGE EATING DISORDER (BED) A. Rossi ∗ ,1 , E. Dell’Amore 2 , F. Pigò 2 , G. Bersani 1 , G. Ricci 2 , G. De Fabritiis 1 , L. Balzani 1 , V. Alvisi 2 1 Malatesta Novello, Cesena; 2 Gastroenterologia, Università di Ferrara, Ferrara
Background and aim: Eating disorders, such as BED, and assessment of abnormal body image are routinely investigated, in clinical settings, with Binge Eating Scales (BES) and Body Uneasiness Test (BUT). This study aims at evaluating if BES and BUT questionnaires are predictive of the efficacy of bariatric treatment with BIB. Material and methods: 47 obese patients (39 females; mean age = 36, range 18-59; mean BMI = 41.6, range 31-71) who underwent bariatric treatment with BIB have been evaluated with BES and BUT questionnaires, before the insertion of the BIB (t0) and after 6 months at the moment of the removal (t6). Patients were divided in two groups: one with BMI reduction <12% (group A) and the other with BMI reduction ≥12% (group B).Group A and B were compared according to the results of BES and BUT questionnaires, in order to assess a statistically significant difference (95% Confidence Interval, p<0.05), before and after bariatric treatment. Results: Group A was composed of 24 patients (mean BMI reduction 3.1±1.9 SD), while group B was composed of 23 (mean BMI reduction 6.8±1.4 SD). At the time t0 there was no difference in the prevalence of BED estimated with BES (4.2% vs 8.7%, in group A and B respectively, p = ns), whereas at the time t6, BES questionnaire showed a statistically significant difference between group A and B (34%; 95%CI: 21%-44% vs 8,7%; 95%CI: 2%-17%; p < 0,05) and with both groups at the time
t0. At the time t0, BUT questionnaire resulted normal in 21% vs 13% in group A and B respectively (p = ns), whereas at the time t6 there was a statistically significant difference between the percentage of normal BUT questionnaire in groups A and B (29%; 95%CI: 17%-40% vs 48%; 95%CI: 34%-59%; p < 0,05) and with both groups at the time t0. Conclusions: Obese patients with BED achieve fewer results with BIB as bariatric treatment. As expected, patients with better BMI % reduction perceive a diminished uneasiness of their body image. However pre-procedural assessment with these tests is not completely useful in order to diagnose BED in these patients, whose identification demands a specialist psychological appraisal. # U. Obesity and Nutrition
OC.18.1 TRANS-GASTRIC THORACOSCOPY VIA A DIAPHRAGMATIC INCISION IN A PORCINE MODEL: A N.O.T.E.S. APPROACH FOR THORACIC SURGERY G.D. De Palma ∗ , S. Siciliano, M. Rega, S. Masone, F. Salvatori, F. Maione, D. Esposito, G. Persico University of Naples Federico II, School of Medicine. Department of Surgery and Advanced Technologies. Center of Technical Innovation In Surgery, Napoli Background and aim: Recently the NOTES approach has been extended to mediastinum by a trans- esophageal access and to the thorax by a trans-vescical endoscopic approach. Our aims were to assess the feasibility and the safety of trans-gastric endoscopic approach to the thoracic cavity, with lung biopsy, in a porcine model. Material and methods: The study was performed in four 20-30 kg female pigs (Sus scrofus domesticus). Following gastric wall incision, the muscular pars of the left diaphragmatic dome was incised along with the parietal pleura and the endoscope advanced into the thoracic cavity. In all animals, a thoracoscopy was performed as well as peripheral lung biopsy At the end of the operation the endoscope was withdrawn from the thoracic cavity after pleural sac decompression and the diaphragmatic incision closed by endoscopic clips under maximal expansion of lungs. The gastric incision was finally closed by endoscopic clips. Animals were sacrificed at the end of the procedure. Results: The gastroscope was easily introduced into the thoracic cavity that allowed us to visualize the pleural cavity and to perform simple surgical procedures such as lung biopsies without complications. There were neither respiratory distress episodes nor surgical complications to report. The postmortem examination revealed a good closure of the diaphragmatic incision. Conclusions: This study demonstrates the feasibility of transgastric thoracoscopy in porcine model. Long-term follow-up of much larger series will be necessary for provision of more reliable answers if this approach should be adopted in the future and eventually translated for humans with advantages for patients. # A. Oesophagus 7. Endoscopic therapies
OC.18.2 NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY: TRANSGASTRIC CHOLECYSTECTOMY IN A SURVIVING PORCINE MODEL A. Arezzo ∗ ,1 , T. Kratt 2 , M. Morino 1 1 Centro
Universitario di Chirurgia Mininvasiva - Università di Torino, Torino; 2 Dept. of Surgery - University of Tuebingen, Tuebingen, Germany Background and aim: Before investigating if Natural Orifices Translumenal Endoscopic Surgery (NOTES) has any future, we have to