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Purpose:
The implantation of a gastric balloon (also known as intragastric balloon) is an established and reversible endoscopic procedure for adiposity therapy. Structural changes of the stomach wall are expected to occur with gastric balloon implantation; however, until now these changes have rarely been investigated.
Methods:
We compared the h...
Contexts in source publication
Context 1
... mean total wall thickness of the group that had implanted gastric balloons was 4.74 ± 0.25 mm and that of the group without previous gastric balloon implantation was 4.45 ± 0.52 mm. No significant difference between the groups could be verified (p > 0.99; Table 1). Figure 1A presents the thickness of the stomach wall with a median of 25/75% percentile (box) and 5/95% percentile (whiskers). ...Context 2
... 1A presents the thickness of the stomach wall with a median of 25/75% percentile (box) and 5/95% percentile (whiskers). However, when examining the stomach wall's individual layers, the main muscle layer of the stomach (tunica muscularis) is clearly thicker (2.94 ± 0.18 mm), even a long time after the explantation of the balloon (8.2 ± 2.9 weeks), than in the control group without gastric balloon implantation (1.95 ± 0.33 mm; p = 0.0297; Table 1). This is shown in Figure 1B for greater clarity with a percentile and median of 5/25/75/95%. ...Context 3
... is shown in Figure 1B for greater clarity with a percentile and median of 5/25/75/95%. The effect of the muscle layer's increase in size is even more obvious when relating the thickness of the tunica muscularis to the total thickness of the stomach wall ( Fig. 1C; Fig. 2; Table 1). Here, in the gastric balloon implantation group, the tunica muscularis takes up approximately 62.12 ± 1.83% of the stomach wall compared to 44.23 ± 5.69% (p = 0.0044) in the group without a previously implanted gastric balloon. ...Context 4
... in the gastric balloon implantation group, the tunica muscularis takes up approximately 62.12 ± 1.83% of the stomach wall compared to 44.23 ± 5.69% (p = 0.0044) in the group without a previously implanted gastric balloon. Here, too, the effect is illustrated with greater clarity with a percentile and median of 5/25/75/95% in Figure 1C (and Table 1). The next question was whether the increase in thickness of the tunica muscularis and its proportion of the stomach wall had been caused by cell proliferation or an increase in connective tissue. ...Context 5
... must therefore be concluded that the increase in tunica muscularis thickness was not caused by proliferation or infiltration of cells. Sirius Red staining of the connective tissue section exhibited a significantly higher proportion of red per tunica muscularis surface in patients after gas- tric balloon implantation than the staining intensity of the group without gastric balloon implantation ( Fig. 2; Fig. 3B; Table 1; p = 0.0132), corresponding to an increased proportion of collagen making up the tissue volume. These results support the hypothesis that this is most likely due to tissue hypertrophy and fibrosis rather than hyperplasia. ...Context 6
... is why we recommended an appropriate period of time between gastric balloon explantation and any subsequent surgical therapy [12]. As our study verified changes in the stomach wall structure (Fig. 1B, C; Fig. 2A-D; Fig. 3B; Table 1) even 8 weeks after the explantation of the gastric balloon, the time period between balloon explantation and surgical therapy should be extended to beyond 2 weeks. ...Context 7
... doing so, an increased thickness of the mucosa wall (mucosa + muscularis mucosa + submucosa) might be correlated with inflammation; of note, they did not determine the thickness of the tunica muscularis [29]. Our histologic examinations of the tunica mucosa did not detect a change in the thickness of the stomach wall of the group after gastric balloon therapy (Table 1), which, according to Yazar et al. [29] contradicts the existence of gastritis at the time of our examination. However, it is likely that the gastritis described within the context of a balloon explantation [11] and which was still verifiable 14 days after the balloon explantation [12], had completely healed after an additional 6 weeks (the time point in our study). ...Context 8
... effect could be verified 8 weeks after removing the irritation from the stomach (gastric balloon). As the increase in tunica muscularis thickness is not explained by an increase in the number of cells ( Fig. 3A; Table 1), but by the increase in collagen fibers ( Fig. 2C, D; Fig. 3B; Table 1), we have to assume this involved a longer-term hypertrophy of the tissue. ...Citations
... Both the IGB and ESG influence weight loss through similar perturbations to gastric sensorimotor function [11][12][13], but it is not known if these overlapping mechanismsor other influences-may contribute to an attenuated weight loss response from these tools used in succession, a phenomenon observed in sleeve gastrectomy following IGB [14]. Furthermore, IGBs induce changes to the gastric tissue, including tissue hypertrophy and fibrosis of the tunica muscularis, as well as increased inflammation [15,16]. Patients treated with IGB before sleeve gastrectomy had a longer length of hospital stay than those undergoing sleeve gastrectomy without prior IGB [16]. ...
... Because patients follow a modified, liquid/low-residue diet for 7 weeks after ESG in our program, this may mask the differences in weight loss between cohorts in the first months [21]. Another explanation may lie in the histologic changes in gastric tissue after IGB, which include gastric wall hypertrophy and fibrosis [15,16]. Plication integrity is critical to the durability of the ESG construct, and submucosal and muscularis fibrosis from IGB may impede mucosal to mucosal apposition from ESG and lead to early sleeve dilation, especially after advancement from the liquid/low-residue diet. ...
... Patients and physicians should be reassured by the safety and technical feasibility of performing an ESG after IGB therapy. While it has been shown that IGB therapy induces gastric wall hypertrophy and fibrosis, this did not lead to notable procedural challenges or adverse events [15,16]. This comports to multiple accounts of surgery being as safe or safer following IGB than without IGB pre-treatment [14,[26][27][28]. ...
Introduction:
The performance characteristics of endoscopic sleeve gastroplasty (ESG) for weight recurrence after intragastric balloon (IGB) are unknown.
Methods:
This is a retrospective propensity score matched study of ESG after IGB (IGB-to-ESG) vs ESG without prior IGB (ESG-only). The primary outcome was total weight loss (TWL) at 12 months. Secondary outcomes included TWL at 3 and 6 months, 12-month excess weight loss (EWL), procedural characteristics, and safety.
Results:
Thirty-nine adults underwent ESG from August 2020 to September 2022 after IGB explantation a median of 24 months (range 2-56 months) prior and a median post-IGB nadir weight increase of 100.0% (range 0 to 3200%). An ESG-only 2:1 age- sex- and BMI- propensity score matched cohort was derived from 649 patients (Pearson's goodness-of-fit: 0.86). TWL for IGB-to-ESG vs. ESG-only was 12.3 ± 13.5% vs. 12.4 ± 3.7% at 3 months (p = 0.97), 10.1 ± 7.1% vs. 15.4 ± 4.6% at 6 months (p < 0.001), and 8.7 ± 7.7% vs. 17.1 ± 5.7% at 12 months (p < 0.001). Twelve-month EWL for IGB-to-ESG vs ESG-only was 27.8 ± 46.9% vs 62.0 ± 21.0% (p < 0.001). There was no difference in mean procedural duration of ESG; however, more sutures were used with IGB-to-ESG vs. ESG-only (7 vs. 6, p < 0.0002). There were no serious adverse events in either cohort.
Conclusion:
ESG after IGB produces safe, acceptable weight loss but with an attenuated effect compared to ESG alone. Further study is required to understand the factors driving this discrepancy.
... [8,9] In particular, the fact that there is no need for a surgical intervention, that it can be applied in a short time and that it can be removed immediately when the patient's comfort deteriorates has allowed GBs to be used effectively in weight loss. [10,11] Although there are side effects such as nausea and vomiting, these effects are quite limited. [12,13] There are basically two types of balloons that are swallowed and applied endoscopically. ...
... At the preoperative office visit, patients with high blood pressure, i.e., systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg [18], were referred to a cardiologist for hypertension (HTN) management. In patients who had an intragastric balloon (IGB), bariatric surgery was postponed until six months after the IGB was removed due to IGB-related stomach ulcers and reversible inflammation of the gastric mucosa [19,20]. Patients who were on antiplatelet or anticoagulants were advised to discontinue them one week before surgery. ...
... It was approved by the Food and Drug Administration (FDA) in 2005 and is known as a safe procedure [33]. But, it has been associated with alteration of stomach wall thickness, mucositis, ulcers, and perforation of the gastric [19,34,35]. Regardless of several predictors that were assessed in previous studies, the association between IGB and early postoperative bleeding has not been investigated yet. ...
Purpose
Identifying the possible predictors of postoperative bleeding is advantageous to reduce healthcare costs and promote patients’ recovery. The aim of this study was to determine early postoperative bleeding predictors after bariatric surgery.
Materials and Methods
This retrospective study was conducted using data from 2260 patients who underwent bariatric surgery. We diagnosed early postoperative bleeding by the following symptoms: abdominal pain, hypotension, tachycardia, hematemesis, melena, decreased hemoglobin level, the need for at least two units of packed red blood cells (PRBCs) transfusion, and reoperation within the first 48 h after surgery.
Results
Our results showed the odds of early postoperative bleeding in laparoscopic Roux-en-Y gastric bypass (LRYGB) were higher than in laparoscopic sleeve gastrectomy (LSG) (OR 3.49, 95% CI 1.79 to 6.80). In addition, prior intragastric balloon (IGB) (OR 3.14, 95% CI 1.18 to 8.34) and oral non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) (OR 5.91, 95% CI 1.79 to 20.63) were positively associated with the occurrence of postoperative bleeding. In contrast, there was an inverse relationship between staple line oversewing and the odds of postoperative bleeding (OR 0.18, 95% CI 0.04 to 0.81). After stratification data based on the type of the surgery, the positive association between IGB and the odds of bleeding was constant in the LRYGB group. In the LSG group, use of non-aspirin NSAIDs was linked to a higher incidence of postoperative bleeding, while oversewing of the staple line lowered the incidence of this event.
Conclusions
Our results demonstrated a positive association between type of procedure, history of IGB, and oral non-aspirin NSIADs use, as well as an inverse relationship between staple line oversewing and the odds of bleeding after bariatric surgery.
Graphical Abstract
... There are also concerns on whether IGB implantation affects subsequent bariatric surgery due to increased antral wall thickness from tissue oedema post-implantation. Nonetheless, appropriate staple height adjustment can be made during subsequent sleeve gastrectomy [28]. Therefore, it is timely to review the role of IGB as the first step before bariatric surgery, and we performed a systemic review and metaanalysis of the safety and effectiveness of IGB as bridging therapy for patients with severe obesity (BMI ≥ 50 kg/m 2 ). ...
Bariatric surgery for patients with severe obesity (body mass index (BMI) ≥ 50kg/m²) is technically challenging. Intragastric balloon (IGB) has been proposed for weight loss before bariatric surgery to reduce surgical risks but its efficacy remains unclear. We conducted a systematic review and meta-analysis of the effectiveness of IGB as bridging therapy and assess potential complications. Amongst 2419 citations, 13 studies were included. IGB resulted in a BMI reduction of 6.60 kg/m² (MD=6.60, 95% CI: 5.06–8.15; I²=72%). The total post-procedural complication rate was 8.13% (95% CI: 4.04–13.17%), with majority being balloon intolerance. Overall, IGB is effective as a bridging therapy with adequate procedural safety profile, but further study is needed to evaluate the risk reduction for bariatric surgery and long-term weight-loss outcomes.
Graphical abstract
