DISCUSSION
The IGB positioning and retrieval were safe and mortality was absent.
Early removal occurred in6.10% of the patients, mainly due to
intolerance , similar to what was observed by Lopez-Nava et al (2011)
[10]. Balloon leakage was observed in 32 patients (0.54%) and
production of gas enlarging the balloon was observed in 12 (0.20%),
both complications were rapidly diagnosed and IGBs were substituted,
allowing the patients to continue the treatment. One of the patients
with early IGB removal developed Wernick Korsacov Syndrome, as vomits
continued for a long time, after the IGB removal and developed a bulimic
syndrome that was not rapidly diagnosed because the patient abandoned
the treatment with the multidisciplinary team. It is noteworthy that
even in cases of hyperemesis, Wernick Korsakov Syndrome is a rare
complication that can be prevented early [11].
In this series of cases there was just one esophagus perforation during
balloon removal. This happened in a patient that had a high degree of
intolerance after balloon implant, with a high incidence of vomiting
episodes leading to intense esophagitis and fragility of the esophagus
wall. There was four cases of gastric perforation that were successfully
treated by endoscopy after IGB retrieval using Boston
Resolution® hemoclips to close the perforation.
Weight loss has traditionally been the main outcome in IGB treatment and
in our study there was a significant weight loss in all degrees of
overweight. Considering the total group of patients, the mean weight
loss was 19.13 kg, %TWL was 18.42, % EWL was 65.66 and BMI decreased
6.85 kg/m2. These results are similar to those
observed by Nunes et al (2017) [12] (%TWL of 18.9 and decrease in
BMI of 6.76 kg/m2) and are slightly superior to those
observed in several other studies [13-20] and in two meta-analyses
[21, 22]. This greater decrease in body weight could be partly
attributed to the balloon volume. Roman et al (2004) [23], comparing
patients that used IGBs of 500mL and 600mL showed a better result in
weight loss with higher volume and in the present study were used
volumes of 600-700mL, different from others that used IGB volumes
starting at 400mL [13] or 500mL [14, 15].
The percentage of patients that did not achieve success in the treatment
according to a %TWL > 10% was low in the present study
(only 15%), being lower than the 31% observed in the study conducted
by Stimac et al (2011) [24]. While according to a %EWL
> 25% only 7% did not achieve success in IGB treatment,
ranging from 1% in the pre-obesity group to 14% in grade III obesity,
being below than 20-40% suggested by Dumonceau (2008) [25].
In the comparative analyses of participants according to the degree of
overweight, we observed the greatest % EWL in subjects presenting
pre-obesity (131%). Few studies compared the %EWL across individuals
with different levels of BMI at baseline. Fernandes et al (2016)
[26] also observed a significantly higher %EWL in the group with
lower baseline BMI (26 – 30 kg/m2) compared to the
group with higher BMI (> 30 kg/m2) (96%
vs. 41%, respectively). Similarly, Nunes et al. (2017) [12] and
Al-Sabah et al. (2016) [18] observed higher %EWL in the group of
individuals with lower BMI at baseline. Although %EWL was greater in
the subjects presenting pre-obesity, the %TWL was similar across the
different degrees of overweight in our participants. This finding is
similar to the obtained by Nunes et al (2017) [12] and may suggest
that the greater %EWL in individuals presenting lower initial BMI is
attributed to the lowest excess weight observed in these patients at the
beginning of the study.
In the comparative analyses of participants according to gender, the
%EWL was greater in women than in men, but the %TWL was similar. In
our opinion the greater %EWL in women may also be attributed to the
lower excess weight at baseline. Al-Sabah et al (2016) [18] also
observed higher %EWL in women, but they did not compared the %TWL.