O balão intragástrico nas formas graves de obesidade

N. Almeida*, D. Gomes¹, C. Gonçalves², C. Gregório¹, D. Brito¹, J. Carlos Campos³, H. Gouveia¹, D. Freitas¹

 

Resumo

Introdução: Nos doentes com obesidade mórbida o balão intragástrico (BIG) pode ser uma ponte para a cirurgia ou uma terapêutica temporária nos não candidatos à mesma.

Objectivo: Avaliar a eficácia do BIG em doentes com obesidade severa.

Doentes e Métodos: Em 2003/2004 foram colocados 17 BIG Bioenterics® preenchidos com soro fisiológico e azul-demetileno [volume médio-508,8 ml (450-600)] em 17 doentes [11 mulheres; média etária-49,2 (27-69 anos); Índice de Massa Corporal médio-55,6 (40,2-74,2 Kg/m2)], acompanhados previamente em consultas de Nutrição e/ou Endocrinologia. Já tinham sido submetidos a medidas higieno-dietéticas e/ou farmacológicas, com sucesso limitado. Observadas co-morbilidades em 13 (76,5%).

Resultados: Oito (47%) doentes apresentaram náuseas/vómitos nas 24-72h seguintes situação que se manteve em 4 (23,5%), condicionando desidratação e insuficiência renal aguda pré-renal, obrigando à remoção precoce do balão (0,5 a 4 meses). Nos restantes doentes o BIG foi removido aos 6 meses (num aos 10). Todos os doentes perderam peso (5-70 Kg); perda média-19,6 Kg (p<0,001). Sem casos de rotura espontânea. Seis (35,3%) foram posteriormente operados.

Conclusões: O BIG é um método eficaz na redução de peso em indivíduos com obesidade mórbida. As náuseas e os vómitos são as complicações mais comuns. Embora desejável nem sempre se consegue a transposição para a cirurgia.

 

Summary

Introduction: In patients with morbid obesity the intragastric balloon (IGB) can be a “bridge” to surgery or a temporary treatment in patients who are not candidates for surgery.

Objective: Evaluate IGB efficacy in morbidly obese patients.

Patients and Methods: In 2003/2004 seventeen IGB Bioenterics ® filled with normal saline and methylene blue were placed in 17 patients [11 women, median age was 49.2 (27-69 years); median body mass index was 55.6 (40.2-74.2 Kg/m2)], followed by nutritionists and/or endocrinologists. They had previously tried dietetic and/or pharmacological measures with limited results. Co-morbidities were present in 13 (76.5%).

Results: Eight (47%) patients presented nausea/vomiting in the first 24-72h that persisted in 4 (23.5%) leading to dehydration and pre-renal insufficiency and forcing premature removal of the balloon (0.5 to 4 months). In the other patients, the device was removed at 6 months treatment (in 1 patient at 10 months). All patients suffered weight loss (5-70 Kg); median loss-19.6 Kg (p<0.001). No cases of spontaneous deflation/displacement occurred. Six (35.3%) underwent bariatric surgery.

Conclusions: The IGB is a useful method for weight loss in morbidly obese patients. Nausea and vomiting are the most common complications. Although desirable, subsequent surgery is not always performed.

 

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*Correspondência:

Nuno Almeida

Serviço de Gastrenterologia

Hospitais da Universidade de Coimbra

Avenida Bissaya Barreto e Praceta Mota Pinto

3000-075 Coimbra

Tel.: 239400438; Fax: 239482805

e-mail: nuno.p.almeida@clix.pt

 

(1) Serviço de Gastrenterologia, HUC, Coimbra, Portugal.

(2) Serviço de Gastrenterologia, Hospital de Santo André, Leiria, Portugal.

(3) Serviço de Cirurgia 2, HUC, Coimbra, Portugal.

 

Recebido para publicação: 15/12/2005

Aceite para publicação: 26/07/2006