Buscar en
Gastroenterología y Hepatología (English Edition)
Toda la web
Inicio Gastroenterología y Hepatología (English Edition) Gastric perforation by intragastric balloon in a patient with Nissen fundoplicat...
Journal Information
Vol. 41. Issue 9.
Pages 583-584 (November 2018)
Vol. 41. Issue 9.
Pages 583-584 (November 2018)
Letter to the Editor
Full text access
Gastric perforation by intragastric balloon in a patient with Nissen fundoplication. Response of the Spanish Bariatric Endoscopy Group
Perforación gástrica por balón intragástrico en paciente con funduplicatura de Nissen. Respuesta del Grupo Español de Endoscopia Bariátrica
Visits
949
Eduardo Espinet-Colla,
Corresponding author
eespinet@idexeus.es

Corresponding author.
, Javier Nebreda-Duránb, Gontrand López-Nava Brevierec, Coordinators of the Spanish Working Group for the Endoscopic Treatment of Metabolism and Obesity (GETTEMO)
a Unidad de Endoscopia Digestiva y Bariátrica, Hospital Universitario Dexeus, Barcelona, Spain
b Unidad de Endoscopia Digestiva y Bariátrica, Clínica Diagonal, Esplugues de Llobregat, Barcelona, Spain
c Unidad de Endoscopia Bariátrica, Hospital Universitario HM Sanchinarro, Madrid, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text
Dear Editor,

We read with great interest the scientific letter published in your journal by Dr Ríos et al. entitled “Gastric perforation by intragastric balloon in a patient with Nissen fundoplication”.1 We at the Grupo Español de Trabajo para el Tratamiento Endoscópico del Metabolismo y la Obesidad (GETTEMO) [Spanish Working Group for the Endoscopic Treatment of Metabolism and Obesity], support and appreciate the documenting of incidents detected with each of the procedures. There is no doubt that this multicentre cohort contributes towards advances in bariatric endoscopy, helping to provide us with increasingly effective and safer treatments to recommend to our patients.

However, we feel that we should take this opportunity to make a number of points:

  • 1.

    For a number of years now there has been a large amount of literature and evidence to support the intragastric balloon as a well-tolerated and safe procedure, with low overall rates of incidents (2.5%) and major complications (0.84%), a virtually non-existent need for repeat surgery (0.07%) and mortality rates close to 0%.2,3 As these rates vary according to the type of balloon, we believe that the authors should qualify this aspect (it is not correct to say “Apollo or MedSil Orbera-type balloon”).

  • 2.

    Currently, the most effective treatment in the long term in morbid obesity is surgery. However, in patients with morbid obesity, the intragastric balloon is also indicated as a bridge to surgery (particularly when BMI>50kg/m2), or when the patient refuses surgery or it is contraindicated. As has been documented for years and we recently highlighted in the article published in 2017 by the Grupo Español de Endoscopia Bariátrica [Spanish Bariatric Endoscopy Group], “Multicenter study on the safety of bariatric endoscopy”,2 previous gastric surgery, such as the Nissen procedure in this case, is one of the absolute contraindications for intragastric balloons.3,4 We therefore agree with the authors that the balloon should not have been implanted given the previous Nissen procedure, but not that the patient's degree of obesity was a contraindication.

  • 3.

    Nissen-type surgery reduces elasticity and gastric accommodation and increases rigidity and fundic fibrosis. When the fundoplication is competent, the ability to vomit and belch decreases, which can lead to a greater incidence of gastric dilation. All this can increase the risk of ischaemia and necrosis of the wall, and perforation.

  • 4.

    We do not believe that there can be any justification for the statement, “in our case the patient was not warned of the risk”. The current recommendation in bariatric endoscopy is that the endoscopist should always warn and inform about this type of risk, with that information also being provided in writing in a specific Informed Consent form.3,4

  • 5.

    It is surprising that in the resolving of the complication there is no mention of any assessment by the endoscopist responsible, and that a gynaecological surgeon appears as the first signatory. We think perhaps this was because the problem was resolved surgically in a different centre from where the balloon was implanted. We would stress here that any centre performing bariatric endoscopy should have an emergency department with a specialist endoscopist and surgeon capable of quickly and efficiently resolving any complications.4,5

  • 6.

    Last of all, it would be interesting to find out if this atypical case went beyond being purely a medical issue and whether or not there is any legal claim or lawsuit involving any of the parties involved.

Conflicts of interest

Dr Espinet-Coll works with Apollo Endosurgery and Dr López-Nava works with Apollo Endosurgery and ReShape Medical, but there are no conflicts of interest for this letter.

Acknowledgements

Grupo Español de Trabajo para el Tratamiento Endoscópico del Metabolismo y la Obesidad (GETTEMO) [Spanish Working Group for the Endoscopic Treatment of Metabolism and Obesity].

References
[1]
A. Ríos, B. Febrero, J.M. Rodríguez.
Perforación gástrica por balón intragástrico en paciente con funduplicatura de Nissen.
Gastroenterol Hepatol, 41 (2018), pp. 251-252
[2]
E. Espinet, J. Nebreda, G. López-Nava, J. Ducóns García, M. Rodríguez-Téllez, J. Crespo García, et al.
Multicenter study on the safety of bariatric endoscopy.
Rev Esp Enferm Dig, 109 (2017), pp. 350-357
[3]
M.G. Neto, L.B. Silva, E. Grecco, L.G. de Quadros, A. Teixeira, T. Souza, et al.
Brazilian Intragastric Balloon Consensus Statement (BIBC): practical guidelines based on experience of over 40,000 cases.
Surg Obes Relat Dis, 28 (2017),
pii:S1550-7289(17)30962-0
[4]
E. Espinet-Coll, G. López-Nava, J. Nebreda, C. Marra-López Valenciano, R. Turró Arau, J.M. Esteban López-Jamar, et al.
Documento Español de Consenso en Endoscopia Bariátrica.
(in press)
[5]
A. García Ruiz De Gordejuela, Z. Madrazo González, A. Casajoana Badia, A. Muñoz-Campaña, F.J. Cuesta-González, J. Pujol-Gebelli.
Descripción de la asistencia en urgencias de pacientes intervenidos de cirugía bariátrica en un centro de referencia.
Rev Esp Enferm Dig, 107 (2015), pp. 23-28

Please cite this article as: Espinet-Coll E, Nebreda-Durán J, López-Nava Breviere G, Coordinadores del Grupo Español de Trabajo para el Tratamiento Endoscópico del Metabolismo y la Obesidad (GETTEMO). Perforación gástrica por balón intragástrico en paciente con funduplicatura de Nissen. Respuesta del Grupo Español de Endoscopia Bariátrica. Gastroenterol Hepatol. 2018;41:583–584.

Copyright © 2018. Elsevier España, S.L.U.. All rights reserved
Article options
Tools
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos