Ultrasound-guided insertion of the Elipse® gastric balloon: technical details, learning curve, and perioperative outcome in 36 cases

Journal of Ultrasound - Tập 23 - Trang 593-597 - 2020
Andrea Salmi1,2, Francesco Greco1,3, Elena Belleri1
1Medicalspa Outpatient Clinic, Brescia, Italy
2Liver Unit, San Camillo Hospital, Brescia, Italy
3Bariatric and Metabolic Surgery Unit, Fondazione Poliambulanza, Brescia, Italy

Tóm tắt

Our aim is to demonstrate the feasibility of real-time ultrasound-assisted insertion of the Elipse® intragastric balloon for the treatment of overweight and obese patients. A plastic gastric phantom filled with water was created to mimic the gastric lumen and to test the operator’s ability to recognize the capsule containing the balloon inside. In the clinical phase, we tested the operator’s ability to recognize the swallowed capsule and its progressive filling in the gastric lumen by means of ultrasound in 36 consecutive patients with a mean body mass index of 35 in an outpatient setting. The ultrasound hyperechoic signal of the capsule in the gastric lumen was visible early on and was confirmed after the injection of a few milliliters of saline solution in the capsule with a cyst-like shape. The insertion of the balloon was successful in all cases at the first attempt, and the complete filling was monitored in real-time without the need for fluoroscopy. Postprocedure symptoms were limited to the first 24–48 h and were controlled by symptomatic therapy; endoscopic removal of the balloon because of painful distal gastric migration was necessary in one case after 3 months. After a learning curve, we were able to demonstrate the placement of the balloon capsule inside the fundus of the stomach under ultrasound guidance without fluoroscopy in all patients in an outpatient setting.

Tài liệu tham khảo

Lau DC, Teoh H (2013) Benefits of modest weight loss on the management of type 2 diabetes mellitus. Can J Diabetes 37:128 National Institute for Health and Care Excellence (2006) Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children 37(2):128–134 WHO (2000) Obesity: preventing and managing the global epidemic Report of a WHO consultation. World Health Organ Tech Rep Ser 894:i Mathus-Vliegen EM (2014) Endoscopic treatment: the past, the present and the future. Best Pract Res Clin Gastroenterol 28:685 Geliebter A (1988) Gastric distension and gastric capacity in relation to food intake in humans. Physiol Behav 44:665 Bonazzi P, Petrelli MD, Lorenzini I et al (2005) Gastric emptying and intragastric balloon in obese patients. Eur Rev Med Pharmacol Sci 9:15 Su HJ, Kao CH, Chen WC et al (2013) Effect of intragastric balloon on gastric emptying time in humans for weight control. Clin Nucl Med 38:863 Machytka E, Chuttani R, Bojkova M, Kupka T, Buzga M, Stecco K, Levy S, Gaur S (2016) Elipse™, a procedureless gastric balloon for weight loss: a proof-of-concept pilot study. Obes Surg 26(3):512 Machytka E, Gaur S, Chuttani R, Bojkova M, Kupka T, Buzga M, Giannakou A, Ioannis K, Mathus-Vliegen E, Levy S, Raftopoulos I (2017) Elipse, the first procedureless gastric balloon for weight loss: a prospective, observational, open-label, multicenter study. Endoscopy 49(2):154–160. https://doi.org/10.1055/s-0042-119296 Raftopoulos I, Giannakou A (2017) The Elipse balloon, a swallowable gastric balloon for weight loss not requiring sedation, anesthesia or endoscopy: a pilot study with 12-month outcomes. Surg Obes Relat Dis 7:1174–1182 Ienca R, Al Jarallah M, Caballero A, Giardiello C, Rosa M, Kolmer S, Sebbag H, Hansoulle J, Quartararo G, Zouaghi SAS, Juneja G, Murcia S, Turro R, Pagan A, Badiuddin F, Dargent J, Urbain P, Paveliu S, di Cola RS, Selvaggio C, Al KM (2020) Obes Surg. https://doi.org/10.1007/s11695-020-04640-y Vantanasiri K, Matar R, Beran A, Jaruvongvanich V (2020) The efficacy and safety of a procedureless gastric balloon for weight loss: a systematic review and meta-analysis. Obes Surg. https://doi.org/10.1007/s11695-020-04522-3 EFSUMB Newsletter section (2006) The minimum training recommendations for the practice of medical ultrasound. Ultraschall in der Medizin/Eur J Ultrasound 27(1):79–105 Nieben OG, Harboe H (1982) Intragastric balloon as an artificial bezoar for treatment of obesity. Lancet 1(8265):198–199 Gleysteen JJ (2016) A history of intragastric balloons. Surg Obes Relat Dis 12:430–435 Alsabah S, Al Haddad E, Ekrouf S, Almulla A, Al-Subaie S, Al KM (2018) The safety and efficacy of the procedureless intragastric balloon. Surg Obes Relat Dis 14:311–317 Jamal MH, Almutairi R, Elabd R, AlSabah SK, Alqattan H, Altaweel T (2019) The Safety and efficacy of procedureless gastric balloon: a study examining the effect of elipse intragastric balloon safety, short and medium term effects on weight loss with 1-year follow-up post-removal. Obes Surg 29(4):1236–1241. https://doi.org/10.1007/s11695-018-03671-w Al-Subaie S, Khalifa S, Buhaimed W, Al-Rashidi S (2017) A prospective pilot study of the efficacy and safety of elipse intragastric balloon: a single-center, single-surgeon experience. Int J Surg 48:16–22. https://doi.org/10.1016/j.ijsu.2017.10.001Epub 2017 Oct 6 Colli A, Prati D, Fraquelli M, Segato S, Vescovi PP, Colombo F, Balduini C, Della Valle S, Casazza G (2015) The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study. PLoS ONE 10(3):e0122181. https://doi.org/10.1371/journal.pone.0122181.eCollection2015 Andrea S, Giovanna L, Pietro C, Luca F (2017) Teaching echoscopy for the early diagnosis of ascites in cirrhosis: assessment of an objective structured clinical examination (OSCE). J Ultrasound 20(2):123–126. https://doi.org/10.1007/s40477-017-0250-9.eCollection2017Jun Hofer M, Kamper L, Sadlo M, Sievers K, Heussen N (2011) Evaluation of an OSCE assessment tool for abdominal ultrasound courses. Ultraschall Med 32(2):184–190. https://doi.org/10.1055/s-0029-1246049