Personalization of Endoscopic Bariatric and Metabolic Therapies Based on Physiology: a Prospective Feasibility Study with a Single Fluid-Filled Intragastric Balloon.
Gastric emptying
Intolerance
Intragastric balloon
Obesity
Personalized medicine
Weight loss
Journal
Obesity surgery
ISSN: 1708-0428
Titre abrégé: Obes Surg
Pays: United States
ID NLM: 9106714
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
pubmed:
15
4
2020
medline:
15
4
2021
entrez:
15
4
2020
Statut:
ppublish
Résumé
The intragastric balloon (IGB) is commonly used for weight loss. Identifying patients who are most likely to tolerate and benefit from IGB therapy will optimize outcomes. Our aims were to prospectively utilize a gastric emptying study to predict intolerance and treatment response with a single fluid-filled IGB and to develop a physiologic prediction model with a treatment algorithm. A total of 32 patients had a gastric emptying study before and 2-3 months after placement of an IGB. Multiple logistic regression analyses were performed to calculate likelihood ratios and to develop a physiologic prediction model. Patients in the higher gastric retention quartile at baseline had a 6.2-time higher likelihood ratio for early balloon removal secondary to intolerance (p = 0.013). Utilizing baseline gastric emptying to predict intolerance to the IGB may have prevented 75% of early removal cases. Decreased gastric emptying at 3 months after balloon placement was significantly correlated with percent total body weight loss (%TWBL) at 6 and 12 months (p = 0.01 and p = 0.014, respectively). At 6 months after IGB, patients with no change in their gastric emptying at 3 months lost significantly less weight compared with those with increased gastric retention (median %TBWL = 9.0% [4.5-14.7] versus 17.3% [12.2-24.4], p = 0.016). Utilizing gastric emptying as a physiologic predictor of intolerance and response to the single fluid-filled IGB can improve outcomes. This pilot feasibility trial ushers in the era of personalized endoscopic bariatric therapies to maximize patients' tolerance, cost-effectiveness, and meaningful weight loss.
Sections du résumé
BACKGROUND
The intragastric balloon (IGB) is commonly used for weight loss. Identifying patients who are most likely to tolerate and benefit from IGB therapy will optimize outcomes. Our aims were to prospectively utilize a gastric emptying study to predict intolerance and treatment response with a single fluid-filled IGB and to develop a physiologic prediction model with a treatment algorithm.
MATERIALS AND METHODS
A total of 32 patients had a gastric emptying study before and 2-3 months after placement of an IGB. Multiple logistic regression analyses were performed to calculate likelihood ratios and to develop a physiologic prediction model.
RESULTS
Patients in the higher gastric retention quartile at baseline had a 6.2-time higher likelihood ratio for early balloon removal secondary to intolerance (p = 0.013). Utilizing baseline gastric emptying to predict intolerance to the IGB may have prevented 75% of early removal cases. Decreased gastric emptying at 3 months after balloon placement was significantly correlated with percent total body weight loss (%TWBL) at 6 and 12 months (p = 0.01 and p = 0.014, respectively). At 6 months after IGB, patients with no change in their gastric emptying at 3 months lost significantly less weight compared with those with increased gastric retention (median %TBWL = 9.0% [4.5-14.7] versus 17.3% [12.2-24.4], p = 0.016).
CONCLUSION
Utilizing gastric emptying as a physiologic predictor of intolerance and response to the single fluid-filled IGB can improve outcomes. This pilot feasibility trial ushers in the era of personalized endoscopic bariatric therapies to maximize patients' tolerance, cost-effectiveness, and meaningful weight loss.
Identifiants
pubmed: 32285333
doi: 10.1007/s11695-020-04581-6
pii: 10.1007/s11695-020-04581-6
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3347-3353Références
Afshin A, Forouzanfar MH, Collaborators GBDO, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.
doi: 10.1056/NEJMoa1614362
Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011–2012. Jama. 2014;311:806–14.
doi: 10.1001/jama.2014.732
Gasoyan H, Tajeu G, Halpern MT, et al. Reasons for underutilization of bariatric surgery: the role of insurance benefit design. Surg Obes Relat Dis. 2018;
Westerveld D, Yang D. Through thick and thin: identifying barriers to bariatric surgery, weight loss maintenance, and tailoring obesity treatment for the future. Surg Res Pract. 2016;2016:8616581.
pubmed: 27314062
pmcid: 4893581
Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376:1492.
doi: 10.1056/NEJMra1514009
Vargas EJ, Rizk M, Bazerbachi F, et al. Medical devices for obesity treatment: endoscopic bariatric therapies. Med Clin North Am. 2018;102:149–63.
doi: 10.1016/j.mcna.2017.08.013
Abu Dayyeh BK, Edmundowicz S, Thompson CC. Clinical practice update: expert review on endoscopic bariatric therapies. Gastroenterology. 2017;152:716–29.
doi: 10.1053/j.gastro.2017.01.035
Bonazzi P, Petrelli MD, Lorenzini I, et al. Gastric emptying and intragastric balloon in obese patients. Eur Rev Med Pharmacol Sci. 2005;9:15–21.
pubmed: 16457125
Gomez V, Woodman G, Abu Dayyeh BK. Delayed gastric emptying as a proposed mechanism of action during intragastric balloon therapy: Results of a prospective study. Obesity. 2016;24:1849–53.
doi: 10.1002/oby.21555
Vijayvargiya P, Jameie-Oskooei S, Camilleri M, et al. Association between delayed gastric emptying and upper gastrointestinal symptoms: a systematic review and meta-analysis. Gut. 2018;
Ribeiro da Silva J, Proenca L, Rodrigues A, et al. Intragastric balloon for obesity treatment: safety, tolerance, and efficacy. GE Port J Gastroenterol. 2018;25:236–42.
doi: 10.1159/000485428
Vargas EJ, Pesta CM, Bali A, et al. Single fluid-filled intragastric balloon safe and effective for inducing weight loss in a real-world population. Clin Gastroenterol Hepatol. 2018;16:1073–80. e1071
doi: 10.1016/j.cgh.2018.01.046
Khayyam U, Sachdeva P, Gomez J, et al. Assessment of symptoms during gastric emptying scintigraphy to correlate symptoms to delayed gastric emptying. Neurogastroenterol Motil. 2010;22:539–45.
pubmed: 20082665
pmcid: 4078258
Mitura K, Garnysz K. Tolerance of intragastric balloon and patient’s satisfaction in obesity treatment. Wideochir Inne Tech Maloinwazyjne. 2015;10:445–9.
pubmed: 26649094
pmcid: 4653252
Camilleri M, Chedid V, Ford AC, et al. Gastroparesis. Nat Rev Dis Primers. 2018;4:41.
doi: 10.1038/s41572-018-0038-z
Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008;103:753–63.
doi: 10.1111/j.1572-0241.2007.01636.x
Szarka LA, Camilleri M, Vella A, et al. A stable isotope breath test with a standard meal for abnormal gastric emptying of solids in the clinic and in research. Clin Gastroenterol Hepatol. 2008;6:635–43. e631
doi: 10.1016/j.cgh.2008.01.009
Chial HJ, Camilleri C, Delgado-Aros S, et al. A nutrient drink test to assess maximum tolerated volume and postprandial symptoms: effects of gender, body mass index and age in health. Neurogastroenterol Motil. 2002;14:249–53.
doi: 10.1046/j.1365-2982.2002.00326.x
Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–54.
doi: 10.1016/j.gie.2009.10.027
Courcoulas A, Abu Dayyeh BK, Eaton L, et al. Intragastric balloon as an adjunct to lifestyle intervention: a randomized controlled trial. Int J Obes. 2017;41:427–33.
doi: 10.1038/ijo.2016.229
Halawi H, Camilleri M, Acosta A, et al. Relationship of gastric emptying or accommodation with satiation, satiety, and postprandial symptoms in health. Am J Physiol Gastrointest Liver Physiol. 2017;313:G442–7.
doi: 10.1152/ajpgi.00190.2017
Farina MG, Baratta R, Nigro A, et al. Intragastric balloon in association with lifestyle and/or pharmacotherapy in the long-term management of obesity. Obes Surg. 2012;22:565–71.
doi: 10.1007/s11695-011-0514-y
van Can J, Sloth B, Jensen CB, et al. Effects of the once-daily GLP-1 analog liraglutide on gastric emptying, glycemic parameters, appetite and energy metabolism in obese, non-diabetic adults. Int J Obes. 2014;38:784–93.
doi: 10.1038/ijo.2013.162
Bharucha AE, Camilleri M, Veil E, et al. Comprehensive assessment of gastric emptying with a stable isotope breath test. Neurogastroenterol Motil. 2013;25:e60–9.
doi: 10.1111/nmo.12054
House A, Champion MC, Chamberlain M. National survey of radionuclide gastric emptying studies. Can J Gastroenterol. 1997;11:317–21.
doi: 10.1155/1997/959482
Jackson SJ, Leahy FE, McGowan AA, et al. Delayed gastric emptying in the obese: an assessment using the non-invasive (13)C-octanoic acid breath test. Diabetes Obes Metab. 2004;6:264–70.
doi: 10.1111/j.1462-8902.2004.0344.x