New Hope for Morbid Obesity

May 22, 2002

NEW YORK (MedscapeWire) May 23 — Two approaches to morbid obesity presented on May 20 and May 22 at Digestive Disease Week in San Francisco, California, offer new hope of limiting this burgeoning epidemic. One study suggests that bariatric surgery is as safe in adolescents as it is in adults. The other indicates that an intragastric balloon may help improve outcome or obviate the need for surgery in patients failing medication and counseling.

"Severe obesity is increasing rapidly in adolescents and is associated with significant comorbidity and social stigmatization," write Harvey J. Sugerman and colleagues from Richmond, Virginia.

Of 32 adolescents meeting National Institutes of Health (NIH) adult criteria for bariatric surgery over a 20-year period, 3 had gastroplasty, 16 had gastric bypass, 3 had distal gastric bypass, and 10 had long-limb gastric bypass. There were no postoperative deaths or leaks. Early complications included 1 pulmonary embolus, 1 major wound infection, 4 minor wound problems, 3 stomal stenoses that were dilated endoscopically, and 4 marginal ulcers treated with acid suppression. Late complications included 1 bowel obstruction, 4 incisional hernias, and 1 sudden death 6 years after surgery. Two patients needed revisional surgery, 1 for malnutrition and 1 for inadequate weight loss.

At 1 year, most comorbidities resolved except for 2 cases of hypertension, 2 of gastroesophageal reflux disease, and 7 of degenerative joint disease. Improved self-image facilitated marriage in 8 patients, college graduation in 5, and current college attendance in 2.

"Bariatric surgery in adolescents is safe and associated with significant weight loss, correction of obesity comorbidity as well as improved self-image and socialization," the authors write. "These data strongly support surgery for these unfortunate individuals in whom it may be difficult to obtain insurance coverage based upon the 1991 NIH Consensus Conference Statement."

In a separate study by Feryal Ilkova and colleagues from Istanbul, Turkey, 17 patients, aged 20 to 67 years, had endoscopic insertion of an intragastric balloon (BioEnterics, BIB, USA). In 2 patients, weight loss was sufficient to allow balloon removal at 3 months, and the remaining patients had the balloon removed at 6 months. There were no apparent complications. Mean body mass index decreased from 42.3 before balloon insertion to 33.81 after balloon removal ( P < .0001).

"The intragastric balloon is a safe and effective noninvasive method in the treatment of morbid obesity," the authors write. "It can be suggested to the patients unresponsive to diet and medical therapy before surgery."

DDW Annual Meeting: Abstracts 100609, 100427. May 20 and May 22, 2002.

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