Efficacy and Safety of Endoscopic Balloon Placement for Weight Loss in Patients With Cirrhosis Awaiting Liver Transplantation.
Efficacy and Safety of Endoscopic Balloon Placement for Weight Loss in Patients With Cirrhosis Awaiting Liver Transplantation.
复制标题
内镜下球囊放置对于等待肝移植的肝硬化患者减肥的功效和安全性。
DOI：
10.1002/lt.26074
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Abu
中科院分区：
文献类型：
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作者：
Watt,KymberlyD;Heimbach,JulieK;Rizk,Monika;Jaruvongvanich,Pete;Sanchez,William;Port,John;Venkatesh,SudhakarK;Bamlet,Heather;Tiedtke,Kathryn;Malhi,Harmeet;AcostaCardenas,Andres;Grothe,Karen;Clark,Matthew;Mundi,ManpreetS;Abu
液体填充胃内球囊（IGB）用于肝移植（LT）等待名单上的肝硬化患者体重减轻的有效性和安全性尚不清楚。我们招募了体重指数>35 kg/m2的稳定代偿患者，这些患者在内镜下IGB放置的等待名单上最多6个月。共8例患者（7例男性），平均年龄± SD，56 ± 4.6岁，终末期肝病模型-钠（MELD‐Na）评分为14.1 ± 3.4，体重减轻（146 ± 22.2 kg vs 127 ± 21.6 kg [P= 0.005]，植入IGB后6个月时为130 ± 24.6 kg [P= 0.014]），在IGB就位的情况下总体重减轻12.2% ± 8.8%，6个月时总体重减轻10.9% ± 8.9%。体脂从48.6% ± 5.8%下降到40.6% ± 6.4%（P= 0.001），瘦体重从51.3% ± 6%增加到59.4% ± 6.4%（P= 0.001）。MELD-Na评分无变化（P= 0.770）。早期球囊回收归因于出血症状（n = 2）和肝脏失代偿（n = 1）。发生马洛里韦斯撕裂（n = 3），但无门脉高压出血。3例患者发生肝失代偿和/或肝细胞癌（HCC）。共4例LT ±袖状胃切除术患者保持总体体重减轻。在4名未接受移植的患者中，2名出现体重反弹。IGB导致等待LT的肝硬化患者的短期体重减轻，体脂减少而无瘦体重减轻。不良反应是常见的。失代偿和HCC确实发生，与体重减轻的关系不确定，因此需要仔细选择患者并密切随访。
The efficacy and safety of a fluid‐filled intragastric balloon (IGB) for weight loss in patients with cirrhosis on the liver transplantation (LT) waiting list is unknown. We enrolled stable compensated patients with body mass index >35 kg/m2and on the waiting list for IGB placement endoscopically for a maximum of 6 months. A total of 8 patients (7 men) aged mean ± SD, 56 ± 4.6 years with Model for End‐Stage Liver Disease–sodium (MELD‐Na) scores 14.1 ± 3.4 experienced weight reduction (146 ± 22.2 kg versus 127 ± 21.6 kg [P= 0.005] with IGB in place and 130 ± 24.6 kg [P= 0.014] at 6 months), with a total body weight loss of 12.2% ± 8.8% with IGBs in place and 10.9% ± 8.9% at 6 months. Body fat decreased from 48.6% ± 5.8% to 40.6% ± 6.4% (P= 0.001) and lean mass increased from 51.3% ± 6% to 59.4% ± 6.4% (P= 0.001). No change in MELD‐Na scores occurred (P= 0.770). Early balloon retrieval was attributed to accommodative symptoms (n = 2) and liver decompensation (n = 1). Mallory Weiss tears (n = 3), but no portal hypertensive bleeding, occurred. Liver decompensation and/or hepatocellular carcinoma (HCC) developed in 3 patients. A total of 4 patients with LT ± sleeve gastrectomy maintained overall weight loss. Of 4 patients who did not receive transplants, 2 experienced weight regain. IGB results in short‐term weight loss in patients with cirrhosis awaiting LT, with body fat loss without lean mass loss. Adverse effects were common. Decompensation and HCC did occur, with uncertainty of the relation to weight loss, and thus careful patient selection and close follow‐up are required.