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Sa1590 Endoscopic Vertical Gastroplasty, a Novel Technique for Treatment of Obese. Fifty Cases. Preliminary Report
Abstracts
low complication rate, and effective in the super-obese, either as a long-term therapy or a bridge therapy to bariatric surgery.
Sa1588 Eight Year Experience With Endoscopic Management of Eroded Gastric Bands Umit B. Dogan*1, Mustafa S. AKIN2, Mehmet B. Dal3 1 Gastroenterology, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey; 2Gastroenterology, Gaziosmanpasa University, Faculty of Medicine, Tokat, Turkey; 3General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey Background/Aim: Intragastric band migration is a major long-term complication of gastric banding: its frequency ranges from 0.6-11% and always requires removal of the band. We review our eight year experience with endoscopic removal of eroded gastric bands. Methods: 110 morbidly obese patients underwent adjustable gastric banding between 2005 and 2013. Band or tube erosion occurred in 14 patients (12.7%). In addition, 10 such patients were referred to our department from other hospitals. To remove the migrated band, we used an endoscopic approach with a device designed to cut the band: the Gastric Band Cutter (AMI, Agency for Medical Innovation). Symptoms, time to erosion, interval between diagnosis and treatment, and complications of treatment were reviewed. Results: Erosions occurred with 16 of the A.M.I. soft gastric bands and 8 of the MiniMizer extra adjustable gastric bands. The median time interval from the initial gastric band placement to the diagnosis of band erosion was 40 months (range, 18-67 months), and the mean time from diagnosis to band removal was 4 months (range, 0-24 months). Upper abdominal pain was the most common symptom (37.5%). Port site infection (25%) and loss of restriction and weight regain (33.3%) were other common symptoms. In 23 of the 24 patients, we used the gastric band cutter to remove the band endoscopically. It was able to cut the band successfully in all cases except one, where twisting of the cutting wire required conversion from endoscopy to laparotomy. In two cases, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In one patient, we had to do surgery for intragastric penetration of the connecting tube broken close to the band. The median duration of endoscopic removal of the gastric band was 25 min (range 15-40 min). Our success rate was 87% in the single session with no complication. Conclusion: The Gastric Band Cutter was successful in dividing the band in all cases except one, although we could not always complete the procedure endoscopically. Endoscopic removal of a migrated band with the gastric band cutter appears to be effective and safe method for band erosion.
Sa1589 Gastric Balloon Treatment of 539 Overweight Patients. Research, Statistics, Problems, Complications, Successes, Failures and Long-Term Effects. Uyak, Medical One Hamburg/ Germany Deniz Uyak* Gastroenterology, Mang Medical One Hamburg, Hamburg, Germany We have had10 years of experience from 2003 to 2013 with gastric balloon treatment. Of 539 overweight patients BMI more than 27 were at Medical One in Germany. We have studied statistics and long-term effects, successes and failures, problems, complications and research. We conducted a hormone study between 2010-2011 at Medical One HAMBURG. Our question was: Is insulin resistance the preliminary stage of the metabolic syndrome and obesity?We looked at the results of treatment of borderline obesity, (87patients), obesity1st (168 Patients), obesity 2nd (187 Patients), obesity 3rd (97 Patients) degree and the difference between females and males. Results: Research: 5.8% of the patients were not resistant to insulin before treatment with the gastric balloon. 61.6% of the patients showed no resistance to insulin after weight loss. Statistics: We treated 539 Patients (416 female 77.18% and 123 male 22.82%). The average age was 40.16, average weight before treatment 102.69 kg, after 6 months treatment 92.36 kg. The average weight loss was 10, 33 kg, average waist girth reduction 9.83 cm, average BMI 3.89.. Maximum weight loss was 39.0 kg; maximum waist girth loss was 44 cm. There was no big difference in weight loss between women and men. The treatment lasted for 6.85 months. Problems and complications: 389 balloons removed. Early removal (in the first 3 weeks) in 11 cases 2.82 % (6 patients with psychological problems, 3 patients severe symptomsof vomiting, 1 patient showed renal insufficiency,1 patient diabetic gastropathy and renal insufficiency. 4 female patients became pregnant. In pregnant patients the balloon was removed 2, 3 and 6 months after becoming pregnant, 1 patient 3 months after delivery. It has few technical problems. There were no serious complications and no fatalities Successes and failures: 200 Patients (80%) of 250 who had more than 10% weight loss (successful), 50 Patients (20%) were failures.(6% lost no weight, 14% lost less than 10%). Successes in borderline obesity were 60%, obesity1st degree 90%, obesity 2nd 89% and obesity 3rd 62%. Long-term Effects: Three years after explantation (removal) long-term effects showed 18 (58.06%) from 31 patients have retained their weight and 13 (41.84%) have renewed weight gain. Conclusions: Intragastric balloon treatment is safe and effective for inducing an average of 10.33 kg weight loss and an average of 9.83 cm waist girth loss in six months and reducing metabolic parameters such as insulin resistance in obese patients. It has few technical problems, no serious complications and no fatalities. It does not interfere with pregnancy and shows good results after 3 years. Gastric balloon is not a cure for obesity, only a symptomatic treatment of obesity. Our goal, as always, had to lie in the research of obesity. KEY WORDS: gastric balloon treatment, insulin resistance, overweight
Sa1590 Endoscopic Vertical Gastroplasty, a Novel Technique for Treatment of Obese. Fifty Cases. Preliminary Report Roberto Fogel*, Vivian Fogel, Jenny Izarra Hospital de Clinicas Caracas, Aventura, FL
Figure. Gastric band cutter and endoscopic view of metallic tube (black arrow), cutting wire passed around the band (white arrow) and the intragastric cut band before and after extraction. (1) Handgrip with a tourniquet, (2) Cutting wire, (3) metallic tube.
www.giejournal.org
Introduction: Obesity and its associated comorbidities, have reached epidemic proportions. Bariatric surgery for severe obesity, performed either laparoscopically or open, has provided significant health benefits to patients. While these surgical procedures are presently the gold standard, they are not devoid of potentially severe complications. Emerging technologies have opened the door for endoscopic approaches to reproduce some of the benefits of weight loss surgery. We present our data from January 2012 to November 2013. Methods: Included are the first 50 patients treated with the U.S. Food and Drug administration-approved commercially available endoscopic suturing device (Overstitch; Apollo Endosurgery, Austin, TX) by performing an endoscopic vertical gastroplasty (EVG). We performed transoral endoscopic gastric volume reduction with a non absorbable 2-0 suture, by placing free-hand, full-thickness, closed spaced interrupted sutures through the gastric wall: these sutures extended from the antrum to the gastro-esophageal junction. Patients included 36 females and 14 males, ages ranging from 16 to 61 years; 8 patients had a BMI O 35 and 42 patients with BMI ! 35. All procedures were performed under general anesthesia. The median procedure time was 110 min. Complications included mild bleeding in 15 that did not require any intervention, and self-limited abdominal pain in one. All patients were discharged the same day. Results: During established follow up at 1, 3, 6 and 12 months, the average weight loss in pounds was 20.46 (nZ48), 35.13 (nZ39), 38.18 (nZ32) and 36.12 (nZ18), respectively. Conclusion: EVG appears to be an effective and safe method in the short-term treatment of obesity
Volume 79, No. 5S : 2014 GASTROINTESTINAL ENDOSCOPY AB265
low complication rate, and effective in the super-obese, either as a long-term therapy or a bridge therapy to bariatric surgery.
Sa1588 Eight Year Experience With Endoscopic Management of Eroded Gastric Bands Umit B. Dogan*1, Mustafa S. AKIN2, Mehmet B. Dal3 1 Gastroenterology, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey; 2Gastroenterology, Gaziosmanpasa University, Faculty of Medicine, Tokat, Turkey; 3General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey Background/Aim: Intragastric band migration is a major long-term complication of gastric banding: its frequency ranges from 0.6-11% and always requires removal of the band. We review our eight year experience with endoscopic removal of eroded gastric bands. Methods: 110 morbidly obese patients underwent adjustable gastric banding between 2005 and 2013. Band or tube erosion occurred in 14 patients (12.7%). In addition, 10 such patients were referred to our department from other hospitals. To remove the migrated band, we used an endoscopic approach with a device designed to cut the band: the Gastric Band Cutter (AMI, Agency for Medical Innovation). Symptoms, time to erosion, interval between diagnosis and treatment, and complications of treatment were reviewed. Results: Erosions occurred with 16 of the A.M.I. soft gastric bands and 8 of the MiniMizer extra adjustable gastric bands. The median time interval from the initial gastric band placement to the diagnosis of band erosion was 40 months (range, 18-67 months), and the mean time from diagnosis to band removal was 4 months (range, 0-24 months). Upper abdominal pain was the most common symptom (37.5%). Port site infection (25%) and loss of restriction and weight regain (33.3%) were other common symptoms. In 23 of the 24 patients, we used the gastric band cutter to remove the band endoscopically. It was able to cut the band successfully in all cases except one, where twisting of the cutting wire required conversion from endoscopy to laparotomy. In two cases, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In one patient, we had to do surgery for intragastric penetration of the connecting tube broken close to the band. The median duration of endoscopic removal of the gastric band was 25 min (range 15-40 min). Our success rate was 87% in the single session with no complication. Conclusion: The Gastric Band Cutter was successful in dividing the band in all cases except one, although we could not always complete the procedure endoscopically. Endoscopic removal of a migrated band with the gastric band cutter appears to be effective and safe method for band erosion.
Sa1589 Gastric Balloon Treatment of 539 Overweight Patients. Research, Statistics, Problems, Complications, Successes, Failures and Long-Term Effects. Uyak, Medical One Hamburg/ Germany Deniz Uyak* Gastroenterology, Mang Medical One Hamburg, Hamburg, Germany We have had10 years of experience from 2003 to 2013 with gastric balloon treatment. Of 539 overweight patients BMI more than 27 were at Medical One in Germany. We have studied statistics and long-term effects, successes and failures, problems, complications and research. We conducted a hormone study between 2010-2011 at Medical One HAMBURG. Our question was: Is insulin resistance the preliminary stage of the metabolic syndrome and obesity?We looked at the results of treatment of borderline obesity, (87patients), obesity1st (168 Patients), obesity 2nd (187 Patients), obesity 3rd (97 Patients) degree and the difference between females and males. Results: Research: 5.8% of the patients were not resistant to insulin before treatment with the gastric balloon. 61.6% of the patients showed no resistance to insulin after weight loss. Statistics: We treated 539 Patients (416 female 77.18% and 123 male 22.82%). The average age was 40.16, average weight before treatment 102.69 kg, after 6 months treatment 92.36 kg. The average weight loss was 10, 33 kg, average waist girth reduction 9.83 cm, average BMI 3.89.. Maximum weight loss was 39.0 kg; maximum waist girth loss was 44 cm. There was no big difference in weight loss between women and men. The treatment lasted for 6.85 months. Problems and complications: 389 balloons removed. Early removal (in the first 3 weeks) in 11 cases 2.82 % (6 patients with psychological problems, 3 patients severe symptomsof vomiting, 1 patient showed renal insufficiency,1 patient diabetic gastropathy and renal insufficiency. 4 female patients became pregnant. In pregnant patients the balloon was removed 2, 3 and 6 months after becoming pregnant, 1 patient 3 months after delivery. It has few technical problems. There were no serious complications and no fatalities Successes and failures: 200 Patients (80%) of 250 who had more than 10% weight loss (successful), 50 Patients (20%) were failures.(6% lost no weight, 14% lost less than 10%). Successes in borderline obesity were 60%, obesity1st degree 90%, obesity 2nd 89% and obesity 3rd 62%. Long-term Effects: Three years after explantation (removal) long-term effects showed 18 (58.06%) from 31 patients have retained their weight and 13 (41.84%) have renewed weight gain. Conclusions: Intragastric balloon treatment is safe and effective for inducing an average of 10.33 kg weight loss and an average of 9.83 cm waist girth loss in six months and reducing metabolic parameters such as insulin resistance in obese patients. It has few technical problems, no serious complications and no fatalities. It does not interfere with pregnancy and shows good results after 3 years. Gastric balloon is not a cure for obesity, only a symptomatic treatment of obesity. Our goal, as always, had to lie in the research of obesity. KEY WORDS: gastric balloon treatment, insulin resistance, overweight
Sa1590 Endoscopic Vertical Gastroplasty, a Novel Technique for Treatment of Obese. Fifty Cases. Preliminary Report Roberto Fogel*, Vivian Fogel, Jenny Izarra Hospital de Clinicas Caracas, Aventura, FL
Figure. Gastric band cutter and endoscopic view of metallic tube (black arrow), cutting wire passed around the band (white arrow) and the intragastric cut band before and after extraction. (1) Handgrip with a tourniquet, (2) Cutting wire, (3) metallic tube.
www.giejournal.org
Introduction: Obesity and its associated comorbidities, have reached epidemic proportions. Bariatric surgery for severe obesity, performed either laparoscopically or open, has provided significant health benefits to patients. While these surgical procedures are presently the gold standard, they are not devoid of potentially severe complications. Emerging technologies have opened the door for endoscopic approaches to reproduce some of the benefits of weight loss surgery. We present our data from January 2012 to November 2013. Methods: Included are the first 50 patients treated with the U.S. Food and Drug administration-approved commercially available endoscopic suturing device (Overstitch; Apollo Endosurgery, Austin, TX) by performing an endoscopic vertical gastroplasty (EVG). We performed transoral endoscopic gastric volume reduction with a non absorbable 2-0 suture, by placing free-hand, full-thickness, closed spaced interrupted sutures through the gastric wall: these sutures extended from the antrum to the gastro-esophageal junction. Patients included 36 females and 14 males, ages ranging from 16 to 61 years; 8 patients had a BMI O 35 and 42 patients with BMI ! 35. All procedures were performed under general anesthesia. The median procedure time was 110 min. Complications included mild bleeding in 15 that did not require any intervention, and self-limited abdominal pain in one. All patients were discharged the same day. Results: During established follow up at 1, 3, 6 and 12 months, the average weight loss in pounds was 20.46 (nZ48), 35.13 (nZ39), 38.18 (nZ32) and 36.12 (nZ18), respectively. Conclusion: EVG appears to be an effective and safe method in the short-term treatment of obesity
Volume 79, No. 5S : 2014 GASTROINTESTINAL ENDOSCOPY AB265