Simultaneous Intra-gastric Balloon Removal and Laparoscopic Sleeve Gastrectomy for the Super-Super Obese Patients—a Prospective Feasibility Study

Abstract

Simultaneous balloon removal and sleeve gastrectomy in the super-super obese patients is feasible as a single-stage procedure with good perioperative outcomes.

American Society for Gastrointestinal Endoscopy–European Society of Gastrointestinal Endoscopy guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity

“…For the subgroup with class III obesity, 31 observational studies and RCTs (interventional arms only) were used to inform this PICO (IGB studies 55 56 61 65 66 67 68 69 70 71 72 73 , EGR studies 57 74 , AT studies 48 52 75 , and DJBL studies 50 51 58 59 63 76 77 78 79 80 81 82 83 84 ). Of these, 26 studies were used to assess safety 48 50 51 52 57 58 59 63 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 , 20 studies for percentage of TWL 48 50 51 52 55 56 57 59 61 65 66 67 68 69 71 72 73 74 75 81 , and 10 studies for the changes in HbA1c 50…”

“…For the subgroup with class III obesity, 20 observational studies (n = 2776) informed the outcomes of percentage of TWL at 6 to 12 months 48 50 51 52 55 56 57 59 61 65 66 67 68 69 71 72 73 74 75 81 and 10 studies (n = 815) for HbA1c reduction at 12 months 50 51 58 59 79 80 81 82 83 84 . The pooled TWL at 6 to 12 months was 13.1 % (95 % CI, 10.8–15.4) ( Supplementary Fig.…”

“…Therefore, the panel decided to use a conservative cutoff for this patient population with a starting BMI of 27 kg/m 2 with at least 1 comorbidity. For the class III obesity category, all IGB and EGR studies 55 56 57 61 65 66 67 68 69 70 71 72 73 74 only included patients with class III obesity, whereas AT and DJBL studies 48 50 51 52 58 59 75 79 80 81 82 83 84 included both class III and class II ± class I obesity. Although some studies had a cutoff for the highest BMI at 50 or 55 kg/m 2 48 50 51 52 55 56 57 58 59 61 63 69 70 74 76 77 78 79 80 81 82 83 84 , some did not and recruited patients with BMIs up to 70 or 78 kg/m 2 65 66 67 68 71 72 73 75 82 .…”

Bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m2: a systematic review and meta-analysis

“…The exact duration of preoperative LLCD that patients were on before surgery was not specified in either of the studies. Insertion of IGB consisted of inflation of the balloon with saline and methylene blue to 600 ml with removal in approximately 5 months [13] or removal no sooner than 6 months [14]. The studies included had homogenous indications for bridging interventions, which included BMI > 50.0-59.9 kg/m 2 or BMI > 60 kg/m 2 .…”

“…Currently, there are several bridging and two-step procedures being utilized to ensure the success of bariatric procedures [6,[12][13][14][15][16][17][18][19][20][21][22]. These include preoperative intragastric balloon (IGB) insertion [12][13][14], liquid low-calorie diets (LLCD) [15,16], first-step restrictive bariatric procedures such as laparoscopic sleeve gastrectomy (LSG), or medical therapies (e.g., liraglutide, naltrexone) prior to malabsorptive surgery [17][18][19][20][21][22]. This initial step can vary widely between surgeons' and institutions' preferences with no clear consensus regarding the best option.…”