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What Are Endoscopic Bariatric Therapies?
FROM THE ACADEMY Question of the Month
What Are Endoscopic Bariatric Therapies?
T
HE HIGH PREVALENCE OF overweight and obesity in the United States negatively affects the health of the population. Obesity increases the risk of various diseases, including diabetes mellitus, hypertension, coronary heart disease, sleep apnea, stroke, gatroesophageal reflux disease, gall bladder disease, certain types of malignancy, and nonalcoholic fatty liver diseases.1,2 Reducing obesity in the United States has become a public health priority.1,2 Current approaches to therapeutic weight loss include dietary approaches, lifestyle intervention, pharmacology, and surgery. There is a huge unmet need for minimally invasive, safe and effective therapies for obesity. Endoscopic bariatric therapies can help fill this gap between pharmacotherapy and bariatric surgery (3,4). Endoscopic bariatric therapy is gaining acceptance as more effective and less invasive than bariatric surgery. In addition, it can be used as an adjunctive therapy for patients with obesity who are unable to manage the disease with lifestyle interventions alone, or used prior to bariatric surgery.2-4 Endoscopic bariatric therapy can consist of any of the following procedures: intragastric balloon (IGB) placement, endoscopic sleeve gastroplasty, gastric-bypass revision, and aspiration therapy.2,4 There has been a resurgence in the use of IGBs for the treatment of weight management. IGBs are space-
This article was written by Wendy Marcason, RDN, of the Academy of Nutrition and Dietetics’ Knowledge Center Team, Chicago, IL. Academy members can contact the Knowledge Center by sending an e-mail to [email protected] http://dx.doi.org/10.1016/j.jand.2016.11.017
336
occupying devices, placed using an endoscope and recommended to be removed after 6 months. Intragastric balloons may induce gastric distention, delay gastric empting, and potentially may alter hormones, thereby inducing satiety.2-4 The first intragastric balloon was the Garren-Edwards Bubble introduced in the mid 1980s.2-4 It was approved by the US Food and Drug Administration (FDA) for temporary use as a weight loss device. The Garren-Edwards Bubble was withdrawn from the market in 1992 because of numerous complications and disappointing weight loss results. The FDA did not approve the use of another IGB system until 2015. During the 20-year interim, a number of intragastric balloon systems were engineered and used in many other countries. Recent innovations in the balloon materials and methods for delivery and extraction, combined with a clinical need, have created renewed interest in the use of the gastric balloons.3 This past fall the FDA approved a new swallowable intragastric balloon system for the treatment of obesity. This system involves a balloon folded within a capsule that is swallowed and then inflated. Three capsules are swallowed within a 3-month period and removed after 6 months. Regardless of the type of balloon and duration of use, there is often a need for aggressive symptom control in the early period (after the balloon is inserted) with anti-nausea medications and proton pump inhibitors.4 Although many patients may experience nausea and vomiting in the immediate postinsertion period, with medical management these symptoms generally do not persist past the first week.2,3 In addition, gastro esophageal reflux and dehydration may occur. Serious adverse events, such as bowel obstruction and perforation, are uncommon but have been reported.2-4
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
There are no scientific evidencebased guidelines regarding diet progression after the insertion of a balloon. Progression of a diet is generally from liquids, purée to solid foods within a 2- to 3-week timeframe, and varies depending on the physician’s or a center’s practices.5 Individual modification is essential based on any client’s adverse symptoms. Endoscopic bariatric therapies have ushered in a new paradigm in the management of obesity.4 Collaboration with other professionals is essential to provide all skills required for the development, implementation, and evaluation of these interventions to address obesity.3 Thus, rather than acting independently, registered dietitian nutritionists and nutrition and dietetic technicians, registered, need to be active members of an interdisciplinary team to deal with the complexity of weight management. These relationships will include traditional health care partners, such as physicians, pharmacists, and psychologists.1,3,4
References 1.
Raynor HA, Champagne CM. Position of the Academy of Nutrition and Dietetics: Interventions for the treatment of overweight and obesity in adults. J Acad Nutr Diet. 2016;116(1):129-147.
2.
Kim SH, Chun HJ, Choi HS, Kim ES, Keum B, Jeen YT. Current status of intragastric balloon for obesity treatment. World J Gastroenterol. 2016;22(24):5495-5504.
3.
Ali MR, Moustarah F, Kim JJ; American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. American Society for Metabolic and Bariatric Surgery position statement on intragastric balloon therapy endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Obes Relat Dis. 2016;12(3):462-467.
4.
Goyal D, Watson RR. Endoscopic bariatric therapies. Curr Gastroenterol Rep. 2016;18(6):26.
5.
Tele-Forum Weight Management Dietetic Practice Group—Bariatric Subunit Endoscopic-Bariatric-Therapies-7.11.16teleforum. http://wmdpg.org/member-services/ subunits/bariatric-surgery/. Accessed November 22, 2016.
ª 2017 by the Academy of Nutrition and Dietetics.
What Are Endoscopic Bariatric Therapies?
T
HE HIGH PREVALENCE OF overweight and obesity in the United States negatively affects the health of the population. Obesity increases the risk of various diseases, including diabetes mellitus, hypertension, coronary heart disease, sleep apnea, stroke, gatroesophageal reflux disease, gall bladder disease, certain types of malignancy, and nonalcoholic fatty liver diseases.1,2 Reducing obesity in the United States has become a public health priority.1,2 Current approaches to therapeutic weight loss include dietary approaches, lifestyle intervention, pharmacology, and surgery. There is a huge unmet need for minimally invasive, safe and effective therapies for obesity. Endoscopic bariatric therapies can help fill this gap between pharmacotherapy and bariatric surgery (3,4). Endoscopic bariatric therapy is gaining acceptance as more effective and less invasive than bariatric surgery. In addition, it can be used as an adjunctive therapy for patients with obesity who are unable to manage the disease with lifestyle interventions alone, or used prior to bariatric surgery.2-4 Endoscopic bariatric therapy can consist of any of the following procedures: intragastric balloon (IGB) placement, endoscopic sleeve gastroplasty, gastric-bypass revision, and aspiration therapy.2,4 There has been a resurgence in the use of IGBs for the treatment of weight management. IGBs are space-
This article was written by Wendy Marcason, RDN, of the Academy of Nutrition and Dietetics’ Knowledge Center Team, Chicago, IL. Academy members can contact the Knowledge Center by sending an e-mail to [email protected] http://dx.doi.org/10.1016/j.jand.2016.11.017
336
occupying devices, placed using an endoscope and recommended to be removed after 6 months. Intragastric balloons may induce gastric distention, delay gastric empting, and potentially may alter hormones, thereby inducing satiety.2-4 The first intragastric balloon was the Garren-Edwards Bubble introduced in the mid 1980s.2-4 It was approved by the US Food and Drug Administration (FDA) for temporary use as a weight loss device. The Garren-Edwards Bubble was withdrawn from the market in 1992 because of numerous complications and disappointing weight loss results. The FDA did not approve the use of another IGB system until 2015. During the 20-year interim, a number of intragastric balloon systems were engineered and used in many other countries. Recent innovations in the balloon materials and methods for delivery and extraction, combined with a clinical need, have created renewed interest in the use of the gastric balloons.3 This past fall the FDA approved a new swallowable intragastric balloon system for the treatment of obesity. This system involves a balloon folded within a capsule that is swallowed and then inflated. Three capsules are swallowed within a 3-month period and removed after 6 months. Regardless of the type of balloon and duration of use, there is often a need for aggressive symptom control in the early period (after the balloon is inserted) with anti-nausea medications and proton pump inhibitors.4 Although many patients may experience nausea and vomiting in the immediate postinsertion period, with medical management these symptoms generally do not persist past the first week.2,3 In addition, gastro esophageal reflux and dehydration may occur. Serious adverse events, such as bowel obstruction and perforation, are uncommon but have been reported.2-4
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
There are no scientific evidencebased guidelines regarding diet progression after the insertion of a balloon. Progression of a diet is generally from liquids, purée to solid foods within a 2- to 3-week timeframe, and varies depending on the physician’s or a center’s practices.5 Individual modification is essential based on any client’s adverse symptoms. Endoscopic bariatric therapies have ushered in a new paradigm in the management of obesity.4 Collaboration with other professionals is essential to provide all skills required for the development, implementation, and evaluation of these interventions to address obesity.3 Thus, rather than acting independently, registered dietitian nutritionists and nutrition and dietetic technicians, registered, need to be active members of an interdisciplinary team to deal with the complexity of weight management. These relationships will include traditional health care partners, such as physicians, pharmacists, and psychologists.1,3,4
References 1.
Raynor HA, Champagne CM. Position of the Academy of Nutrition and Dietetics: Interventions for the treatment of overweight and obesity in adults. J Acad Nutr Diet. 2016;116(1):129-147.
2.
Kim SH, Chun HJ, Choi HS, Kim ES, Keum B, Jeen YT. Current status of intragastric balloon for obesity treatment. World J Gastroenterol. 2016;22(24):5495-5504.
3.
Ali MR, Moustarah F, Kim JJ; American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. American Society for Metabolic and Bariatric Surgery position statement on intragastric balloon therapy endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Obes Relat Dis. 2016;12(3):462-467.
4.
Goyal D, Watson RR. Endoscopic bariatric therapies. Curr Gastroenterol Rep. 2016;18(6):26.
5.
Tele-Forum Weight Management Dietetic Practice Group—Bariatric Subunit Endoscopic-Bariatric-Therapies-7.11.16teleforum. http://wmdpg.org/member-services/ subunits/bariatric-surgery/. Accessed November 22, 2016.
ª 2017 by the Academy of Nutrition and Dietetics.