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CO12 ROLE OF BIOENTERIC INTRAGASTRIC BALLOON IN THE TREATMENT OF OBESITY IN PEDIATRIC AND ADOLESCENT PATIENTS: PRELIMINARY REPORT
Abstracts of XVI National Congress of SIGENP / Digestive and Liver Disease 41S (2009), S199–S239 been produced. The aim of our study was to assess the normal value for this innovative technique in children without liver disease and assess the performances of the two probes. Methods: A total of 175 children [mean age: 8±3.6 years (CI95%: 7.5–8.6 years)] with: a) no history of liver disease, b) normal liver function test in the last 12 months, c) a liver ultrasound (USS) negative for liver structural alteration and d) a BMI between the 10° and 90° centile for the age underwent a Fibroscan determination using two different probes [adult (M) and pediatric (P)]. All measurements were preceded by a liver USS to confirm the presence of sufficient parenchyma behind the probe. Results: Fibroscan determination was successful in all with a median success rate of 85±17% (CI 95%: 82–87%) for the M versus 80±18% [(CI 95%: 78–83%); IQR: 0.9±0.8] for the P probe (p<0.02). LS (Kpa) was 4.5±1.4 (CI 95%: 4.3–4.7) for the M versus 4.8±1.9 [(CI 95%: 4.6–5.3); IQR: 1±1.1] for the P probe (p<0.01). The distribution of 3rd, 10th, 25th, 50th, 75th, 90th, and 97th centile of LS were as follows: 2.8; 3.3; 3.7; 4.3; 4.9; 5.9 and 7.0 for the M probe and 3.0; 3.3; 3.9; 4.5; 5.6; 6.5 and 8.0 for the S probe. We found a significant difference in the LS measurement with the two probes ranging from –20% to 28% [Mean ±SD: 5.2±5.9% (CI 95%: 4.3–6%)]. Conclusion: Our data show that Fibroscan is feasible in children and LF in children without liver disease may vary from 3.0 to 7.0. The LS measured with the adult probe may significantly differ from that measured with the pediatric probe.
CO11 PRESENTING FEATURES OF PORTAL VEIN THROMBOSIS IN CHILDREN. A MULTICENTER STUDY L. D’Antiga a , L. Riello b , P. Vajro c , G. Indolfi d , M. Resti d , M. Sciveres e , S. Riva e , L. Zancan b a Liver,
GI and Transplantation – Bergamo; b Paediatric Department, University of Padova; c Paediatric Dpt University Federico II – Naples; d Paediatric Dpt Meyer Hospital – Florence; e ISMETT - Palermo
Background Non-cirrhotic portal vein thrombosis (PVT) is one of the main causes of portal hypertension in children. Gastrointestinal bleeding is the most dangerous complication. The treatment can be conservative or surgical but age at presentation, as well as severe associated conditions, may contraindicate bypass surgery. We aimed to describe the presenting features of PVT in Italian children followed at 5 centres during the last two decades. Patients and Methods: We reviewed the notes of patients followed at five centres. We collected demographic data, neonatal history, age and symptoms at presentation, associated conditions. We defined prematurity a gestational age below 37 weeks, severe prematurity below 32 weeks. Results: 48 children (22 males) of current median age of 13.2 years (range 2.9–18.3) presented at 3.1 years (0.2–11.3); however 30% presented after 5 years and 10% after 7 years of age. 58% were preterm, and 27% severely preterm. A venous umbilical catheter was positioned in 58% of the patients. The most common symptom/sign of presentation was splenomegaly (44%), followed by gastrointestinal bleeding (35%), incidental finding (19%), ascites (2%). Severe comorbidities were present in 20% of the patients.
S203
Conclusion: In this cohort of patients, due to severe comorbidities or late presentation, only 50% of patients were ideal candidates for a meso-portal bypass. Considering the variability of left portal vein patency in this condition, a meso-Rex bypass appears to be feasible in less than half children with portal vein thrombosis. Further strategies are needed to treat children with PVT who are not amenable to shunt surgery.
CO12 ROLE OF BIOENTERIC INTRAGASTRIC BALLOON IN THE TREATMENT OF OBESITY IN PEDIATRIC AND ADOLESCENT PATIENTS: PRELIMINARY REPORT O. Adorisio a , F. De Peppo a , E. Ceriati a , P. Marchetti a , G.M. Ubertini b , M. Rivosecchi b a U.O. Chirurgia Pediatrica: IRCCS Ospedale Pediatrico “Bambino Gesù”, Palidoro, Rome, Italy; b U.O. Endocrinologia Pediatrica: IRCCS Ospedale Pediatrico “Bambino Gesù”, Rome, Italy
Background: Obesity represents one of the most important public health problems due to its prevalence and associated with potential complications. The first step consists of combining a low-calorie diet with changes in life-style and temporary drug therapy. Surgery is only reserved to those cases in which medical treatment fails. BioEnterics Intragastric balloon (BIB) are used not only to obtain weight loss in obese patients but also as a means to reduce risk factors associated with obesity prior to bariatric surgery The aim of the study was to assess risks and benefits of BIB for treatment of primary obesity in pediatric patients with BMI > 35 or BMI > 30 with associated comorbility. Methods: The study group included 22 patients (12 male, 10 female), aged from 11.1 to 21.1 years (15.7±7.07), from March 2002 to May 2007. Twenty-five BIB were positioned in 22 patients, and removed after 7.5±2 months (range: 6–11 months). Under general anesthesia BIB was introduced into the gastric cavity following routine esophagogastroscopy to exclude the presence of any contraindications. After positioning at the level of the gastric fundus, BIB was inflated with a mean of 516±61.54 ml of saline (range 500 to 700). The patients were discharged with a restricted caloric food intake (700–1,000 Kcal). Auxological, clinical, and nutritional evaluations were performed every 2 months. Variations in body composition were analysed by dual energy X-ray absorbiometry (DXA). Results: Weight loss after the balloon treatment was 98.09±20.24 a 86.63±20.60 (p<0.005), and mean BMI reduction was 37.80±5.26 a 33.39±6.33 (p<0.005). At 24 months after balloon removal 48.4% of patients maintained their weight loss or kept loosing weight. Non major complications were reported. Only one patient developed halitosis few weeks after the BIB insertion spontaneously solved after the removing. In three patients, BIB treatment was repeated more than twice. Conclusion: To our knowledge, this is the first reported experience of BIB use in padiatric and adolescent patients. In these subjects, BIB may represent an alternative treatment in about half the cases treated for body weight control when other pharmacological or dietary approaches have failed. This study shows that BIB may be effective to control body weight in pediatric patients with morbid obesity, particularly when treatment is started in early childhood.
CO11 PRESENTING FEATURES OF PORTAL VEIN THROMBOSIS IN CHILDREN. A MULTICENTER STUDY L. D’Antiga a , L. Riello b , P. Vajro c , G. Indolfi d , M. Resti d , M. Sciveres e , S. Riva e , L. Zancan b a Liver,
GI and Transplantation – Bergamo; b Paediatric Department, University of Padova; c Paediatric Dpt University Federico II – Naples; d Paediatric Dpt Meyer Hospital – Florence; e ISMETT - Palermo
Background Non-cirrhotic portal vein thrombosis (PVT) is one of the main causes of portal hypertension in children. Gastrointestinal bleeding is the most dangerous complication. The treatment can be conservative or surgical but age at presentation, as well as severe associated conditions, may contraindicate bypass surgery. We aimed to describe the presenting features of PVT in Italian children followed at 5 centres during the last two decades. Patients and Methods: We reviewed the notes of patients followed at five centres. We collected demographic data, neonatal history, age and symptoms at presentation, associated conditions. We defined prematurity a gestational age below 37 weeks, severe prematurity below 32 weeks. Results: 48 children (22 males) of current median age of 13.2 years (range 2.9–18.3) presented at 3.1 years (0.2–11.3); however 30% presented after 5 years and 10% after 7 years of age. 58% were preterm, and 27% severely preterm. A venous umbilical catheter was positioned in 58% of the patients. The most common symptom/sign of presentation was splenomegaly (44%), followed by gastrointestinal bleeding (35%), incidental finding (19%), ascites (2%). Severe comorbidities were present in 20% of the patients.
S203
Conclusion: In this cohort of patients, due to severe comorbidities or late presentation, only 50% of patients were ideal candidates for a meso-portal bypass. Considering the variability of left portal vein patency in this condition, a meso-Rex bypass appears to be feasible in less than half children with portal vein thrombosis. Further strategies are needed to treat children with PVT who are not amenable to shunt surgery.
CO12 ROLE OF BIOENTERIC INTRAGASTRIC BALLOON IN THE TREATMENT OF OBESITY IN PEDIATRIC AND ADOLESCENT PATIENTS: PRELIMINARY REPORT O. Adorisio a , F. De Peppo a , E. Ceriati a , P. Marchetti a , G.M. Ubertini b , M. Rivosecchi b a U.O. Chirurgia Pediatrica: IRCCS Ospedale Pediatrico “Bambino Gesù”, Palidoro, Rome, Italy; b U.O. Endocrinologia Pediatrica: IRCCS Ospedale Pediatrico “Bambino Gesù”, Rome, Italy
Background: Obesity represents one of the most important public health problems due to its prevalence and associated with potential complications. The first step consists of combining a low-calorie diet with changes in life-style and temporary drug therapy. Surgery is only reserved to those cases in which medical treatment fails. BioEnterics Intragastric balloon (BIB) are used not only to obtain weight loss in obese patients but also as a means to reduce risk factors associated with obesity prior to bariatric surgery The aim of the study was to assess risks and benefits of BIB for treatment of primary obesity in pediatric patients with BMI > 35 or BMI > 30 with associated comorbility. Methods: The study group included 22 patients (12 male, 10 female), aged from 11.1 to 21.1 years (15.7±7.07), from March 2002 to May 2007. Twenty-five BIB were positioned in 22 patients, and removed after 7.5±2 months (range: 6–11 months). Under general anesthesia BIB was introduced into the gastric cavity following routine esophagogastroscopy to exclude the presence of any contraindications. After positioning at the level of the gastric fundus, BIB was inflated with a mean of 516±61.54 ml of saline (range 500 to 700). The patients were discharged with a restricted caloric food intake (700–1,000 Kcal). Auxological, clinical, and nutritional evaluations were performed every 2 months. Variations in body composition were analysed by dual energy X-ray absorbiometry (DXA). Results: Weight loss after the balloon treatment was 98.09±20.24 a 86.63±20.60 (p<0.005), and mean BMI reduction was 37.80±5.26 a 33.39±6.33 (p<0.005). At 24 months after balloon removal 48.4% of patients maintained their weight loss or kept loosing weight. Non major complications were reported. Only one patient developed halitosis few weeks after the BIB insertion spontaneously solved after the removing. In three patients, BIB treatment was repeated more than twice. Conclusion: To our knowledge, this is the first reported experience of BIB use in padiatric and adolescent patients. In these subjects, BIB may represent an alternative treatment in about half the cases treated for body weight control when other pharmacological or dietary approaches have failed. This study shows that BIB may be effective to control body weight in pediatric patients with morbid obesity, particularly when treatment is started in early childhood.