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M1252 Use of Pharmacotherapy for Long-Term Maintenance of Weight Loss Following Explantation of Intragastric Balloon
period (p = 0.026) and %loss in the waist to hip ratio (p = 0.047). Among them, % EBW loss accounted for the largest portion (28.4%) of CRP changes. Conclusions: For Chinese, a male diabetic patients with a high BMI is prone to have an increased CRP level. Reduction in the EBW, regardless of the mode of therapy, is the single most important factor to ameliorate such a high CRP status. Outcomes of different weight reduction procedures for 90 Chinese obese patients
AGA Abstracts
inspect and culture every endoscopic intragastric balloon removed from patients with morbid obesity. PATIENTS - METHODS During the last eighteen months fourteen consecutive balloons were removed from 14 patients (4 male, 10 female, age range 35-56 years). The ballons (BIB, INAMED, USA) were supplied sealed and sterile (according to specifications) and were inserted endoscopically with the standard technique. They were removed either after the planned 6 months period (10 patients, 71.5%) or prematurely (4 patients, 28.5%, with the balloon in situ for at least 4 weeks) if balloon intolerance occurred (in one on patient demand after unplanned pregnancy). Upon removal all balloons were inserted in sterile plastic bags and were sent for culture. Patients demographics, use of PPI's or prokinetics, body weight and BMI before and after removal were also recorded. None of the patients had known history of any disease predisposing to impaired immunocompetence. RESULTS On removal 8 (57%) balloons looked macroscopically abnormal with a fungal colonization pattern (white-yellow surface islets) while 6 (43%) looked normal. On culture, 8 (57%) were positive for fungi (4 candida albicans, 4 candida crusei with 1/4 fluconazole resistant), 9 (64%) were positive for cocci while 3 (21.5%) were sterile. In these positive for cocci, pathogenic strains were isolated in 5 (55.5%) (3 Staph. Aureus and 2 Enteroc. Faecium) while in 4 (44.5%) commensial strains were isolated (2 Staph. Epidermis, 2 Strept. Mitis). Six balloons (43%) were positive for both fungi and cocci. Regarding balloon colonization, no significant differences were noticed between patients demographics, PPI's use, premature balloon removal, BMI or differences in weight loss at the time of removal. All patients with positive cultures were followed-up for 6 months after balloon removal without any clinically significant symptoms related to balloon colonization. CONCLUSION There is a rather high incidence of bacterial and/or fungal colonization of endoscopic intragastric balloons inserted for morbid obesity but without any evidence of clinical significance in immune competent patients. However, its use in immunocompromized patients should be taken into account.
All values are expressed in median with inter-quartile range in parenthesis M1251 Predictive Factors for Body Weight Control and Quality of Life in Obese Patients Treated with Endoscopic Bioenteric Intragastric Balloon Enders K. Ng, Bonnie Y. Tsung, Candice C. Lam, Man Yee Yung, Frances K. Cheung, Philip W. Chiu, Wilfred L. Mui
M1249 Peroral Endoscopic Anastomotic Reduction Improves Intractable Dumping Syndrome in Roux-en-Y Gastric Bypass Patients Gloria Fernandez-Esparrach, David B. Lautz, Christopher C. Thompson
Background: Endoscopic placement of bioenteric intragastric balloon (BIB) is being advocated as a non-invasive treatment option for obesity. However, its efficacy on weight control and quality of life have not been clearly defined. Methods: All patients undergoing endoscopic BIB placement between 2004 and 2007 in our unit were studied. Their baseline demographics, body weight, body mass index (BMI), fasting blood glucose, lipid profile and blood pressure were measured. Quality of life (QoL) of these patients before and 6 months after BIB treatment was assessed with the standardized questionaire SF36 containing 8 domains of physical and emotional components. Percentage change in excess body weight (EBW: defined as actual body weight - ideal body weight) by BIB therapy was analysed against the abovementioned variables using regression model on an intention to treat basis. Results: A total of 160 obese patients (45 men and 115 women) with a mean age (S.D.) of 38.2 (9.5) years had BIB treatment during the 4 years period. 146 patients were able to complete the 6 months of treatment but 14 patients had BIB removed prematurely due to intolerance. Multivariate linear regression analysis revealed that a lower baseline BMI (R=0.5; p<0.001) and an older age (R=0.53; p<0.001)were significantly associated with a better % loss in EBW. Quality of life before the treatment, however, had no impact on the success or failure of the BIB therapy. Paired comparison on the baseline QoL with end of therapy QoL showed that all domains except that for mental health in SF36 had improved significantly, and the improvement correlated well with %loss in EBW. Conclusions: Endoscopic BIB therapy is an effective treatment only for patients with mild obesity. Its efficacy is less obvious in the younger patient. Remarkable improvement in QoL is observed with successful weight control by BIB, but it does not translate to a better mental health in the patients.
Background: Dumping syndrome (DS) is a well described outcome of Roux-en-Y gastric bypass (RYGB). Although it can benefit some patients, a subset will develop intractable DS (IDS) characterized by symptomatic episodes with most meals. We describe the first series of patients treated endoscopically for IDS. Aim: To investigate the efficacy of endoscopic gastrojejunal anastomotic reduction to induce delayed pouch emptying in RYGB patients with IDS. Methods: RYGB patients referred for IDS with a dilated (>2 cm) gastrojejunal anastomosis (GJA) by screening endoscopy were considered for participation. All procedures were performed by a single endoscopist following the same technique. Following the denuding of mucosa at the GJA, endoscopic sutures were placed surrounding the rim of the anastomosis using the Bard EndoCinch suturing system. The sutures were then secured to form tissue plications, reducing the size of the GJA. Fibrin glue was then applied to the sutured areas. Final GJA apertures were measured and the pouch carefully inspected. All patients were followed for evidence of symptomatic relief and complications. Results: Six RYGB patients with IDS and dilated GJA underwent endoscopic anastomotic reduction between July 2005 and July 2007. IDS symptoms reported pre-procedure included: immediate post-prandial nausea and severe diarrhea in all patients, as well as, diaphoresis (n=1), palpitations (n=1), and hypoglycemia (n=1). Five patients reported symptoms severe enough to significantly limit daily activity. The average pre-procedure BMI was 34.5+7.1, with a mean pouch length of 5+1 cm and mean anastomotic diameter of 23+4.5 mm. All procedures were performed without immediate complications. After reduction, the average GJA diameter was 8+0.4 mm (p<0.05). One patient reported hematemesis 2 days post-procedure and was found to have a nonbleeding ulcer with clot, and was treated with a hemostatic clip. No other complications were reported. In all cases, IDS symptoms resolved completely and immediately following the procedure. All patients reported persistent resolution of symptoms at median follow-up of 636 days. All patients also reported weight loss following procedure with subsequent regain in 5 patients. The final mean BMI was 33+6 at the time of followup. Conclusions: This initial series implies that endoscopic anastomotic reduction can be used to symptomatically treat post-RYGB IDS with minimal morbidity and significant resolution of symptoms.
M1252 Use of Pharmacotherapy for Long-Term Maintenance of Weight Loss Following Explantation of Intragastric Balloon Evzen Machytka, Pavel Klvana, Lada Hanuskova, Igor Janik Introduction: The intragastric balloon (BIB) is an effective and safe method for treating obesity at least from the short-term perspective of a few months, although the subsequent development in patients with regard to long-term maintenance of weight loss is currently uncertain. Most of the patients have previously undergone a few unsuccessful attempts to reduce their weight, including pharmacotherapy. Sibutramin is the most frequently used medication in pharmacotherapy for obesity, its major advantage being the long-term success in maintenance of weight loss confirmed by numerous studies. Objective: Use of pharmacotherapy with Sibutramin following the B.I.B. explantation for long-term maintenance of weight loss Methodology: A group of 25 patients with a history of failed therapy using Sibutramin. A six-month course of 10mg Sibutramin immediately after the BIB explantation. Comparison against a control group of 25 patients treated exclusively with BIB without the subsequent pharmacotherapy. Results: The average weight loss following the B.I.B. explantation was 16.49+12,97 kg. Further weight loss on average by 2.36+1,97 kg was detected in patients treated with Sibutramin after 6 months and after further 6 months of monitoring the body weight only increased by 1.76+1,48 kg on average compared to the weight following explantation. The body weight in patients treated exclusively with B.I.B. increased on average by 5.21+2,83 kg 6 months after explantation and by 6.78+4,12 kg after 1 year. The difference is statistically significant.p<0,001 Conclusion: Patients with a history of failed pharmacotherapy using Sibutramin whose weight has been successfully reduced using the intragastric balloon method may benefit from the use of Sibutramin following the BIB explantation and achieve long-term maintenance of weight loss. The combination of endoscopic and pharmacological therapy may become a suitable alternative for treating obesity.
M1250 Improvement of Serum C-Reactive Protein Level in Obese Chinese Patients Undergoing Endoscopic or Laparoscopic Bariatric Procedures Enders K. Ng, Bonnie Y. Tsung, Candice C. Lam, Man Yee Yung, Wilfred L. Mui Background: C-reactive protein (CRP) is an inflammatory-response peptide, which is also a valuable serum marker indicating the cardiovascular risk of obese patients. Bioenteric intragastric balloon (BIB) and bariatric surgery, such as laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric banding (LGB), are now commonly employed interventions for weight reduction in Asia. The aims of this study were to determine the risk factors for increased CRP and the efficacy of various anti-obesity operations in lowering CRP in a group of Chinese obese patients. Methods: All patients undergoing weight reduction procedures in our unit between 2004 and 2007 were considered eligible. They were followed up by physicians on a regular basis with body weight, BMI, eating habit, anthropometric parameters and blood tests recorded by dedicated dietitians and research nurses. Results: 90 patients (49 BIB, 25 LGB and 16 LSG) with complete sets of blood results and demographic data were included. There was a female predominance (68.9%) with a mean age of 37.6(SD = 9.4)years. The median (inter-quartile range) baseline BMI and CRP were 38.4(27.4 to 68.4)kg/ m2 and 4.9(<0.99 to 33.4)mg/l, respectively. Multivariate linear regression analysis identified that a higher baseline BMI, increased fasting blood glucose and a male gender were significantly related to an elevation in serum CRP, whereas age, lipid profiles and waist to hip ratio were not of any predictive value. After a mean treatment period of 9.7(S.D.=5.7) months, both median BMI and serum CRP level were significantly reduced in all three treatment groups (Wilcoxon Signed Ranks Test). LSG resulted in a significantly more %loss in excessive body weight(EBW) than BIB or LGB (Table 1). Stepwise multivariate linear regression revealed that %lost in CRP was independently correlated to %loss of EBW(p = 0.01), treatment
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AGA Abstracts
AGA Abstracts
inspect and culture every endoscopic intragastric balloon removed from patients with morbid obesity. PATIENTS - METHODS During the last eighteen months fourteen consecutive balloons were removed from 14 patients (4 male, 10 female, age range 35-56 years). The ballons (BIB, INAMED, USA) were supplied sealed and sterile (according to specifications) and were inserted endoscopically with the standard technique. They were removed either after the planned 6 months period (10 patients, 71.5%) or prematurely (4 patients, 28.5%, with the balloon in situ for at least 4 weeks) if balloon intolerance occurred (in one on patient demand after unplanned pregnancy). Upon removal all balloons were inserted in sterile plastic bags and were sent for culture. Patients demographics, use of PPI's or prokinetics, body weight and BMI before and after removal were also recorded. None of the patients had known history of any disease predisposing to impaired immunocompetence. RESULTS On removal 8 (57%) balloons looked macroscopically abnormal with a fungal colonization pattern (white-yellow surface islets) while 6 (43%) looked normal. On culture, 8 (57%) were positive for fungi (4 candida albicans, 4 candida crusei with 1/4 fluconazole resistant), 9 (64%) were positive for cocci while 3 (21.5%) were sterile. In these positive for cocci, pathogenic strains were isolated in 5 (55.5%) (3 Staph. Aureus and 2 Enteroc. Faecium) while in 4 (44.5%) commensial strains were isolated (2 Staph. Epidermis, 2 Strept. Mitis). Six balloons (43%) were positive for both fungi and cocci. Regarding balloon colonization, no significant differences were noticed between patients demographics, PPI's use, premature balloon removal, BMI or differences in weight loss at the time of removal. All patients with positive cultures were followed-up for 6 months after balloon removal without any clinically significant symptoms related to balloon colonization. CONCLUSION There is a rather high incidence of bacterial and/or fungal colonization of endoscopic intragastric balloons inserted for morbid obesity but without any evidence of clinical significance in immune competent patients. However, its use in immunocompromized patients should be taken into account.
All values are expressed in median with inter-quartile range in parenthesis M1251 Predictive Factors for Body Weight Control and Quality of Life in Obese Patients Treated with Endoscopic Bioenteric Intragastric Balloon Enders K. Ng, Bonnie Y. Tsung, Candice C. Lam, Man Yee Yung, Frances K. Cheung, Philip W. Chiu, Wilfred L. Mui
M1249 Peroral Endoscopic Anastomotic Reduction Improves Intractable Dumping Syndrome in Roux-en-Y Gastric Bypass Patients Gloria Fernandez-Esparrach, David B. Lautz, Christopher C. Thompson
Background: Endoscopic placement of bioenteric intragastric balloon (BIB) is being advocated as a non-invasive treatment option for obesity. However, its efficacy on weight control and quality of life have not been clearly defined. Methods: All patients undergoing endoscopic BIB placement between 2004 and 2007 in our unit were studied. Their baseline demographics, body weight, body mass index (BMI), fasting blood glucose, lipid profile and blood pressure were measured. Quality of life (QoL) of these patients before and 6 months after BIB treatment was assessed with the standardized questionaire SF36 containing 8 domains of physical and emotional components. Percentage change in excess body weight (EBW: defined as actual body weight - ideal body weight) by BIB therapy was analysed against the abovementioned variables using regression model on an intention to treat basis. Results: A total of 160 obese patients (45 men and 115 women) with a mean age (S.D.) of 38.2 (9.5) years had BIB treatment during the 4 years period. 146 patients were able to complete the 6 months of treatment but 14 patients had BIB removed prematurely due to intolerance. Multivariate linear regression analysis revealed that a lower baseline BMI (R=0.5; p<0.001) and an older age (R=0.53; p<0.001)were significantly associated with a better % loss in EBW. Quality of life before the treatment, however, had no impact on the success or failure of the BIB therapy. Paired comparison on the baseline QoL with end of therapy QoL showed that all domains except that for mental health in SF36 had improved significantly, and the improvement correlated well with %loss in EBW. Conclusions: Endoscopic BIB therapy is an effective treatment only for patients with mild obesity. Its efficacy is less obvious in the younger patient. Remarkable improvement in QoL is observed with successful weight control by BIB, but it does not translate to a better mental health in the patients.
Background: Dumping syndrome (DS) is a well described outcome of Roux-en-Y gastric bypass (RYGB). Although it can benefit some patients, a subset will develop intractable DS (IDS) characterized by symptomatic episodes with most meals. We describe the first series of patients treated endoscopically for IDS. Aim: To investigate the efficacy of endoscopic gastrojejunal anastomotic reduction to induce delayed pouch emptying in RYGB patients with IDS. Methods: RYGB patients referred for IDS with a dilated (>2 cm) gastrojejunal anastomosis (GJA) by screening endoscopy were considered for participation. All procedures were performed by a single endoscopist following the same technique. Following the denuding of mucosa at the GJA, endoscopic sutures were placed surrounding the rim of the anastomosis using the Bard EndoCinch suturing system. The sutures were then secured to form tissue plications, reducing the size of the GJA. Fibrin glue was then applied to the sutured areas. Final GJA apertures were measured and the pouch carefully inspected. All patients were followed for evidence of symptomatic relief and complications. Results: Six RYGB patients with IDS and dilated GJA underwent endoscopic anastomotic reduction between July 2005 and July 2007. IDS symptoms reported pre-procedure included: immediate post-prandial nausea and severe diarrhea in all patients, as well as, diaphoresis (n=1), palpitations (n=1), and hypoglycemia (n=1). Five patients reported symptoms severe enough to significantly limit daily activity. The average pre-procedure BMI was 34.5+7.1, with a mean pouch length of 5+1 cm and mean anastomotic diameter of 23+4.5 mm. All procedures were performed without immediate complications. After reduction, the average GJA diameter was 8+0.4 mm (p<0.05). One patient reported hematemesis 2 days post-procedure and was found to have a nonbleeding ulcer with clot, and was treated with a hemostatic clip. No other complications were reported. In all cases, IDS symptoms resolved completely and immediately following the procedure. All patients reported persistent resolution of symptoms at median follow-up of 636 days. All patients also reported weight loss following procedure with subsequent regain in 5 patients. The final mean BMI was 33+6 at the time of followup. Conclusions: This initial series implies that endoscopic anastomotic reduction can be used to symptomatically treat post-RYGB IDS with minimal morbidity and significant resolution of symptoms.
M1252 Use of Pharmacotherapy for Long-Term Maintenance of Weight Loss Following Explantation of Intragastric Balloon Evzen Machytka, Pavel Klvana, Lada Hanuskova, Igor Janik Introduction: The intragastric balloon (BIB) is an effective and safe method for treating obesity at least from the short-term perspective of a few months, although the subsequent development in patients with regard to long-term maintenance of weight loss is currently uncertain. Most of the patients have previously undergone a few unsuccessful attempts to reduce their weight, including pharmacotherapy. Sibutramin is the most frequently used medication in pharmacotherapy for obesity, its major advantage being the long-term success in maintenance of weight loss confirmed by numerous studies. Objective: Use of pharmacotherapy with Sibutramin following the B.I.B. explantation for long-term maintenance of weight loss Methodology: A group of 25 patients with a history of failed therapy using Sibutramin. A six-month course of 10mg Sibutramin immediately after the BIB explantation. Comparison against a control group of 25 patients treated exclusively with BIB without the subsequent pharmacotherapy. Results: The average weight loss following the B.I.B. explantation was 16.49+12,97 kg. Further weight loss on average by 2.36+1,97 kg was detected in patients treated with Sibutramin after 6 months and after further 6 months of monitoring the body weight only increased by 1.76+1,48 kg on average compared to the weight following explantation. The body weight in patients treated exclusively with B.I.B. increased on average by 5.21+2,83 kg 6 months after explantation and by 6.78+4,12 kg after 1 year. The difference is statistically significant.p<0,001 Conclusion: Patients with a history of failed pharmacotherapy using Sibutramin whose weight has been successfully reduced using the intragastric balloon method may benefit from the use of Sibutramin following the BIB explantation and achieve long-term maintenance of weight loss. The combination of endoscopic and pharmacological therapy may become a suitable alternative for treating obesity.
M1250 Improvement of Serum C-Reactive Protein Level in Obese Chinese Patients Undergoing Endoscopic or Laparoscopic Bariatric Procedures Enders K. Ng, Bonnie Y. Tsung, Candice C. Lam, Man Yee Yung, Wilfred L. Mui Background: C-reactive protein (CRP) is an inflammatory-response peptide, which is also a valuable serum marker indicating the cardiovascular risk of obese patients. Bioenteric intragastric balloon (BIB) and bariatric surgery, such as laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric banding (LGB), are now commonly employed interventions for weight reduction in Asia. The aims of this study were to determine the risk factors for increased CRP and the efficacy of various anti-obesity operations in lowering CRP in a group of Chinese obese patients. Methods: All patients undergoing weight reduction procedures in our unit between 2004 and 2007 were considered eligible. They were followed up by physicians on a regular basis with body weight, BMI, eating habit, anthropometric parameters and blood tests recorded by dedicated dietitians and research nurses. Results: 90 patients (49 BIB, 25 LGB and 16 LSG) with complete sets of blood results and demographic data were included. There was a female predominance (68.9%) with a mean age of 37.6(SD = 9.4)years. The median (inter-quartile range) baseline BMI and CRP were 38.4(27.4 to 68.4)kg/ m2 and 4.9(<0.99 to 33.4)mg/l, respectively. Multivariate linear regression analysis identified that a higher baseline BMI, increased fasting blood glucose and a male gender were significantly related to an elevation in serum CRP, whereas age, lipid profiles and waist to hip ratio were not of any predictive value. After a mean treatment period of 9.7(S.D.=5.7) months, both median BMI and serum CRP level were significantly reduced in all three treatment groups (Wilcoxon Signed Ranks Test). LSG resulted in a significantly more %loss in excessive body weight(EBW) than BIB or LGB (Table 1). Stepwise multivariate linear regression revealed that %lost in CRP was independently correlated to %loss of EBW(p = 0.01), treatment
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AGA Abstracts