GUSTAVO L CARVALHO, MD PhD, FLÁVIO A JNIOR, MD, MASAICHI OKASAKI, MD, JOSÉ S SILVA, STUDENT, DIEGO L LIMA, STUDENT, EDUARDO C CHAVES, STUDENT, REBECA G ROCHA, STUDENT, ADRIANO C SALES, STUDENT, RAFAELA L GOUVEIA, STUDENT, CAMILA R CR. UNIPECLIN, Faculty of Medical Sciences, University of Pernambuco; Recife; Brazil
BACKGROUND: Although bariatric surgery is the fastest and most effective way to lose and control weight, in this study, a new safer and faster intragastricballoon procedure was also employed to treat obese and non obese patients. OBJECTIVE: To report improvements made in the technique for office placement and removal of Silicone Intragastric Balloons (SIB).METHOD: Between June 2006 and August 2010, 201 obese patients (151 women, average weight 94.55; ± 21.9) underwent treatment for obesity using 222 SIBs. All SIBs were successfully placed and retrieved by way of office endoscopy under normal sedation. General anesthesia was not necessary, thereby greatly decreasing the risks and costs. For this purpose, a new Silicone Intragastric Balloon was developed (SILIMED ®). Placement was carried out by attaching the SIB with a polypectomy snare and inserting it under direct vision. The SIBs were released at the stomach fundus and filled with a solution of saline, iodine contrast and methylene blue (470-850ml). Retrieval was performed by positioning an overtube in the patient’s esophagus. A hole was made in the SIB using a needle or endo-scissors, and a catheter was inserted. The entire contents of the balloon were suctioned completely. A snare was used to retract the empty SIB. The SIB was inserted into the overtube and both were removed together. RESULTS: All 222 balloons were satisfactorily placed. Of the 222 balloons, 148 have since been removed, 11 because of intolerance, 6 through balloon perforation, and 132 at the end of the 6-month course of treatment. All patients left the office within one hour after the insertion or removal procedures, and were satisfied with the procedure and the sedation. The day after SIB placement, eight patients needed to stay in hospital for 12-48 hours, to control nausea and vomiting. Five balloons were spontaneously eliminated asymptomatically. The average weight loss among the 132 patients who finished the 6-month course of treatment was 11.36 (± 5.8) kg, and the average excessive weight loss (EWL%) was 49.5 (± 68.5) %. CONCLUSION: These novel techniques have made SIB placement and removal an office procedure, which is fast, safe, and cost-effective.
Program Number: P078