Comparative analysis of post-procedural symptom patterns after intragastric balloon and endoscopic sleeve gastroplasty

Abstract

Aim: Endoscopic bariatric and metabolic therapies (EBMTs) offer minimally invasive approaches for obesity management, with intragastric balloon (IGB) and endoscopic sleeve gastroplasty (ESG) being amongst the most prominent interventions. While both are effective, their comparative impact on post-procedural gastric symptoms remains underexplored.

Methods: Single-center retrospective study was designed to evaluate the incidence of post-procedure symptoms in patients undergoing IGB and ESG. Incidence and severity of gastric symptoms were assessed using visual analog scales at various time points. Weight outcomes and medication usage were also recorded. Changes at different time points (baseline, one and four months) were compared by means of Mann-Whitney U Test. Bivariate correlations were carried out through Pearson correlation.

Results: Thirty patients undergoing IGB placement and 13 patients undergoing ESG were included in the analysis. ESG group showed a significant reduction in BMI at four months compared to IGB (32.2 ± 4.2 vs. 34.4 ± 5.3, P = 0.05). ESG demonstrated significantly lower rates of post-procedural gastric symptoms compared to IGB, including nausea, regurgitation, vomiting, and abdominal cramps and greater satiety (P < 0.001) in the early postoperative period. Medication usage differed between groups, with higher usage of antispasmodics and antiemetics among IGB patients during the first week (P < 0.001). Symptom severity correlated with the need for antiemetics and antispasmodics.

Conclusion: This study provides insights into the management of gastric symptoms following two prominent EBMTs. While both endoscopic interventions offer viable options for obesity management, ESG emerges as a favorable choice due to its significantly lower incidence of early post-procedural gastric symptoms. Further research is warranted to refine symptom management strategies and elucidate differences in symptom profiles between IGB and ESG procedures, ultimately aiming to optimize treatment efficacy and patient satisfaction in the field of endoscopic obesity interventions.

Keywords

Nausea / vomiting / intragastric balloon / endoscopic sleeve gastroplasty / bariatric endoscopy

References

[1] ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee; Abu Dayyeh BK; Kumar N, Edmundowicz SA, et al. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies.Gastrointest Endosc2015;82:425-38.e5

[2] Mingrone G.Type 2 diabetes mellitus in 2013: a central role of the gut in glucose homeostasis.Nat Rev Endocrinol2014;10:73-4

[3] Moura D,De Moura EGH.Effectiveness of intragastric balloon for obesity: A systematic review and meta-analysis based on randomized control trials.Surg Obes Relat Dis2016;12:420-9

[4] Castagneto-Gissey L.Insulin sensitivity and secretion modifications after bariatric surgery.J Endocrinol Invest2012;35:692-8

[5] Kotinda APST,Ribeiro IB.Efficacy of intragastric balloons for weight loss in overweight and obese adults: a systematic review and meta-analysis of randomized controlled trials.Obes Surg2020;30:2743-53

[6] Singh S,Khan A,Ryan MB.Safety and efficacy of endoscopic sleeve gastroplasty worldwide for treatment of obesity: a systematic review and meta-analysis.Surg Obes Relat Dis2020;16:340-51 PMCID:PMC7009311

[7] de Miranda Neto AA,Ribeiro IB.Efficacy and safety of endoscopic sleeve gastroplasty at mid term in the management of overweight and obese patients: a systematic review and meta-analysis.Obes Surg2020;30:1971-87

[8] Trang J,Miller A.Incidence of nausea and vomiting after intragastric balloon placement in bariatric patients - A systematic review and meta-analysis.Int J Surg2018;57:22-9

[9] Hee R, Van Wiemeersch S, Lasters B, Weyler J. Use of anti-emetics after intragastric balloon placement: experience with three different drug treatments.Obes Surg2003;13:932-7

[10] Singh S,Khan A.Intragastric balloon versus endoscopic sleeve gastroplasty for the treatment of obesity: a systematic review and meta-analysis.Obes Surg2020;30:3010-29 PMCID:PMC7720242

[11] Rugo HS,Rizzi G.Efficacy of NEPA (netupitant/palonosetron) across multiple cycles of chemotherapy in breast cancer patients: A subanalysis from two phase III trials.Breast2017;33:76-82

[12] Abdelhamid SA.A prospective controlled study to assess the antiemetic effect of midazolam following intragastric balloon insertion.J Anaesthesiol Clin Pharmacol2014;30:383-6 PMCID:PMC4152680

[13] Clark-Snow RA,Börjeson S.Fixed combination antiemetic: a literature review on prevention of chemotherapy-induced nausea and vomiting using netupitant/palonosetron.Clin J Oncol Nurs2018;22:E52-63

[14] Cada DJ,Baker DE.Netupitant/Palonosetron.Hosp Pharm2015;50:310-25 PMCID:PMC4589884

[15] Alqahtani A,Mahmoud AE,Elahmedi M.Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients.Gastrointest Endosc2019;89:1132-8

[16] Castagneto-Gissey L,Russo MF.Impact of COVID-19 outbreak on emergency surgery and emergency department admissions: an Italian level 2 emergency department experience.Br J Surg2020;107:e374-5 PMCID:PMC7405032

[17] De Luca M, Zappa MA, Zese M, et al; Panel and Evidence Review Team for the Italian Guidelines on Surgical Treatment of Obesity. Development of the italian clinical practice guidelines on bariatric and metabolic surgery: design and methodological aspects.Nutrients2022;15:189 PMCID:PMC9823862

[18] Eisenberg D,Aarts E.2022 American society of metabolic and bariatric surgery (ASMBS) and international federation for the surgery of obesity and metabolic disorders (IFSO): indications for metabolic and bariatric surgery.Surg Obes Relat Dis2022;18:1345-56 PMCID:PMC9834364

[19] Raftopoulos I.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 Dis2017;13:1174-82

[20] Machytka E,Chuttani R.Elipse, the first procedureless gastric balloon for weight loss: a prospective, observational, open-label, multicenter study.Endoscopy2017;49:154-60

[21] Sharaiha RZ,Saumoy M.Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients.Clin Gastroenterol Hepatol2017;15:504-10

[22] Sartoretto A,Hill C.Endoscopic sleeve gastroplasty (ESG) is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption: a large, international multicenter study.Obes Surg2018;28:1812-21

[23] Lopez-Nava G,Vargas EJ.Endoscopic sleeve gastroplasty for obesity: a multicenter study of 248 patients with 24 months follow-up.Obes Surg2017;27:2649-55

[24] Abu Dayyeh BK,Camilleri M.Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals.Clin Gastroenterol Hepatol2017;15:37-43.e1

[25] López-Nava Breviere G,Fernández-Corbelle JP.Endoscopic sleeve gastroplasty (the Apollo method): a new approach to obesity management.Rev Esp Enferm Dig2016;108:201-6