Intragastric balloon as a novel modality for weight loss in patients with cirrhosis and morbid obesity awaiting liver transplantation

被引:35
作者
Choudhary N.S. [1 ]
Puri R. [2 ]
Saraf N. [1 ]
Saigal S. [1 ]
Kumar N. [1 ]
Rai R. [1 ]
Rastogi A. [1 ]
Goja S. [1 ]
Bhangui P. [1 ]
Ramchandra S.K. [1 ]
Raut V. [1 ]
Sud R. [2 ]
Soin A. [1 ]
机构
[1] Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon
[2] Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurgaon
关键词
Liver transplantation; Living donor liver transplantation; Obesity; Surgery;
D O I
10.1007/s12664-016-0643-2
中图分类号
学科分类号
摘要
Introduction: In extreme obesity, bariatric surgery or weight loss by lifestyle modification is often not possible because of presence of decompensated cirrhosis. Endoscopic intragastric balloon placement may be used as minimal invasive technique to promote weight loss and make them better candidates for liver transplantation surgery; however, there is no literature in this regard. Methods: Patients with body mass index (BMI) >40 kg/m2 or BMI between 35 and 40 (with a low graft to recipient weight ratio) were considered for weight reduction modalities including dietary counseling and intragastric balloon placement when feasible. Results: Intragastric balloon placement was done in six males and two females, age 46 ± 5 years, BMI 43.5 ± 6.9 kg/m2. All patients (except one with hepatocellular carcinoma) had decompensated liver disease, mean Child score was 8.5 ± 1.6. Five of them had successful liver transplantation (three deceased and two living donor liver transplantation) after weight loss, while three are waiting. All these five patients had uneventful post-transplant course. All patients had transient vomiting except one, in whom volume of balloon was decreased due to persistent vomiting. All patients except one had weight loss. None of patients had any serious complications. Three of five patients maintained weight loss post-transplant also. Conclusion: Intragastric balloon placement is a useful modality for promoting short-term weight loss and thereby making morbidly obese recipients fit for liver transplantation surgery. © 2016, Indian Society of Gastroenterology.
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页码:113 / 116
页数:3
相关论文
共 16 条
[1]
Nair S., Verma S., Thuluvath P.J., Obesity and its effect on survival in patients undergoing orthotopic liver transplantation in the United States, Hepatology, 35, pp. 105-109, (2002)
[2]
Dick A.A., Spitzer A.L., Seifert C.F., Et al., Liver transplantation at the extremes of body mass index, Liver Transpl, 15, pp. 968-997, (2009)
[3]
LaMattina J.C., Foley D.P., Fernandez L.A., Et al., Complications associated with liver transplantation in the obese recipient, Clin. Transpl, 26, pp. 910-918, (2012)
[4]
Thuluvath P.J., Yoo H.Y., Thompson R.E., A model to predict survival at one month, one year, and five years after liver transplantation based on pretransplant clinical characteristics, Liver Transpl, 9, pp. 527-532, (2003)
[5]
Sawyer R.G., Pelletier S.J., Pruett T.L., Increased early morbidity and mortality with acceptable long-term function in severely obese patients undergoing liver transplantation, Clin. Transpl, 13, pp. 126-130, (1999)
[6]
Nair S., Cohen D.B., Cohen M.P., Tan H., Maley W., Thuluvath P.J., Postoperative morbidity, mortality, costs, and long-term survival in severely obese patients undergoing orthotopic liver transplantation, Am J Gastroenterol, 96, pp. 842-845, (2001)
[7]
Schaeffer D.F., Yoshida E.M., Buczkowski A.K., Et al., Surgical morbidity in severely obese liver transplant recipients—a single Canadian centre experience, Ann Hepatol, 8, pp. 38-40, (2009)
[8]
Hakeem A.R., Cockbain A.J., Raza S.S., Et al., Increased morbidity in overweight and obese liver transplant recipients: a single-center experience of 1325 patients from the United Kingdom, Liver Transpl, 19, pp. 551-562, (2013)
[9]
Agopian V.G., Kaldas F.M., Hong J.C., Et al., Liver transplantation for nonalcoholic steatohepatitis: the new epidemic, Ann Surg, 256, pp. 624-633, (2012)
[10]
Mosko J.D., Nguyen G.C., Increased perioperative mortality following bariatric surgery among patients with cirrhosis, Clin Gastroenterol Hepatol, 9, pp. 897-901, (2011)