Gastric wall changes after intragastric balloon placement: a preliminary experience

Objective: to evaluate the thickness of the gastric wall at the time of intra gastric balloon (IGB) placement, at the time of its withdrawal and one month after withdrawal. Methods: fifteen morbidly obese patients underwent the introduction of IGB under general anesthesia. In all patients, there was infusion of 500ml of distilled water in the balloon for the test. Measurements of the thickness of the gastric wall were made in the antrum, body and proximal body, using a radial echoendoscope with a frequency of 12MHz and maximum zoom, and its own balloon inflated with 5ml of distilled water. Results: the presence of IGB led to increased wall thickness of the gastric body by expanding the muscle layer. These changes were apparently transient, since 30 days after the balloon withdrawal there was a tendency to return of the wall thickness values observed before the balloon insertion. Conclusion: the use of intragastric balloon for the treatment of obesity determines transient increase in the wall thickness of the gastric body caused by expanded muscle layer.


INTRODUCTION
T he use of intra gastric balloon (IGB) for loss of pre- operative weight is a very controversial issue 1,2 .The bariatric surgery teams who use this method for weight loss observed greater difficulty in gastric stapling caused by the apparent thickness increase of the gastric wall after IGBremoval.
We did not find any reference in the searched medical literature on the possible thickening of the gastric wall with the IGBuse, which motivated this research, with the use of endoscopic ultrasound [3][4][5] .
The purpose of this study, therefore, was to check whether there is thickening of the gastric wall with IGBuse, and if so, whether it is total, regional or in a particular layer of the stomach wall, and whether it is permanent or transitional.

METHODS
We conducted a prospective study with 15 morbidly obese patients submitted to the IGB inser-tion.To all we provided an informed consent form, and participation was conditional upon its under- We performed all procedures in the operating room, with the patient under general anesthesia and placed in the left lateral decubitus position.The device used was a radial echoendoscope Fujinon EG 530 RH with frequency of 12 MHz and maximum zoom.The same endoscopist, skilled in the technique, performed all examinations.The intra-gastric balloon used was the BIG MEDICONE ® , and in all patients, the balloon was inflated with 500 ml of distilled water and 5 ml of 2% methylene blue.The radial echoendoscope balloon was inflated with 5 ml of distilled water.We repeated the distance between the incisors and the antrum, body and proximal body used in the first test at the time of balloon withdrawal, as well as at the third examination, 30 days after withdrawal.In all three tests, we measured

RESULTS
Among the 15 patients in the study to date, we examined 11 after 6 months with the balloon, and four within 6 months.Of these 11 patients, we examined eight 1 month after the removal of the balloon.Regardless of the balloon length of stay, we observed an increase in the total thickness of the gastric body wall, represented only by the muscular layer.In patients examined one month after balloon withdrawal, there was a tendency to return to the initial values of the muscular layer thickness (Table 1).

DISCUSSION
The Intragastric Balloon represents an important alternative for the super obese patients with high surgical risk for gastroplasty.Its preoperative use reduces comorbidities responsible for postoperative complications 1 .
The gastric sleeve (GS) is replacing, in our midst, the gastric bypass (GBP) as first choice in obesity surgery.Post GS fistulas represent a serious complication, with a high risk of death.In recent articles, the incidence of fistulae is between 1-7% 6 .The thickening of the stomach wall caused by the balloon presents is a greater risk of fistulae in the Hiss angle.Bariatric surgeons report this thickening, though with difficult perioperative verification.
In our sample, there was confirmation of the intraoperative impression of muscle layer thickening, with a trend to return to normal thickness after one month.
Thisdemonstrates the need to identify the correct time of the GS after placement (and withdrawal)of the intragastric balloon in the super obese patients.

CONCLUSIONS
In our sample,the use of intragastric balloon for the treatment of obesity causes athickness increase of the gastric body wall caused by increased muscle layer.These changes are possibly transitional, there being a tendency to return to the original measures.
standing and signature.The study was approved with the number 12/2012 on the Ethics in Research Committee of the Gaffrée e Guinle University Hospital (HUGG) of the Federal University of the State of Rio de Janeiro (UNIRIO).

ForewordA
B S T R A C TObjective: to evaluate the thickness of the gastric wall at the time of intra gastric balloon (IGB) placement, at the time of its withdrawal and one month after withdrawal.Methods: fifteen morbidly obese patients underwent the introduction of IGB under general anesthesia.In all patients, there was infusion of 500ml of distilled water in the balloon for the test.Measurements of the thickness of the gastric wall were made in the antrum, body and proximal body, using a radial echoendoscope with a frequency of 12MHz and maximum zoom, and its own balloon inflated with 5ml of distilled water.Results: the presence of IGB led to increased wall thickness of the gastric body by expanding the muscle layer.These changes were apparently transient, since 30 days after the balloon withdrawal there was a tendency to return of the wall thickness values observed before the balloon insertion.Conclusion: the use of intragastric balloon for the treatment of obesity determines transient increase in the wall thickness of the gastric body caused by expanded muscle layer.Keywords: Obesity, Morbid.Gastric Balloon.Endosonograph.Bariatric Surgery.Stomach.Rev. Col. Bras.Cir.2016; 43(4): 286-288 Périssé Gastric wall changes after intragastric balloon placement: a preliminary experience the thickness of the mucosal, submucosal, muscular and serous layers.
*in mm (standard deviation)