Long-term follow-up of gastric stimulation for obesity: The mestre 8-year experience
Long-term follow-up of gastric stimulation for obesity: The mestre 8-year experience
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DOI：
10.1007/bf03342133
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发表时间：
2004-09-01
期刊：
影响因子：
2.9
通讯作者：
Cigaina, V
中科院分区：
文献类型：
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作者：
Cigaina, V
背景：10年的胃刺激经验证明了它的前景，特别是因为它可以在没有药物或副作用的情况下实现和保持体重减轻。我们报告了自1995年以来共65例接受植入式胃刺激器（IGS(R)）的患者。方法：65例患者接受IGS并监测体重减轻及合并症。胃食管反流病（GERD）通过内镜检查和症状评估。对4例患者进行了植入前、植入后和IGS激活后的急性动态心电图研究。在器械植入前和激活后分别给予76 g葡萄糖口服葡萄糖耐量试验（OGTT）。对19例使用Tc99的患者在植入前和植入后6个月进行胃排空测试。使用间接量热法在激活前、植入后6个月和植入后12个月这3个不同的时间点研究了15例患者的静息能量消耗（REE）。血压测量使用电子手腕装置，以克服由于手臂脂肪造成的潜在伪影。结果：IGS患者体重明显减轻，无副作用，血压明显快速改善。几乎所有的胃食管反流患者报告在胃起搏期间症状缓解。OGTT在刺激后7个月对胰岛素的反应得到改善。胃排空和REE测试不太确定，很大程度上是因为患者亚群小。结论：虽然胃刺激的确切机制尚不完全清楚，但IGS的植入似乎与体重减轻、高血压患者血压改善（降低）以及胃反流患者症状减轻或消除有关。这种有希望的减肥疗法值得进一步研究，特别是因为它的有趣的结果与合并症。
Background: 10 years experience with gastric stimulation demonstrates promise, in particular because weight loss is achieved and maintained without drugs or side-effects. We report on a total of 65 patients who have received an Implantable Gastric Stimulator (IGS(R)) since 1995.Methods: 65 patients have received an IGS and were monitored for weight loss as well as co-morbidities. Gastroesophageal Reflux Disease (GERD) was assessed by endoscopy and symptoms were evaluated. An acute Holter study was performed on 4 patients pre-implant, post-implant, and post-activation of the IGS. Oral glucose tolerance test (OGTT) using a 76-g bolus of oral dextrose was done before device implantation and after-activation. Gastric emptying was tested on 19 of the patients using Tc99, both pre-implant and 6 months post-implant. Resting Energy Expenditure (REE) was studied in 15 patients using indirect calorimetry at 3 different points in time: pre-activation, 6 months post-implant, and 12 months post-implant. Blood pressure was measured using an electronic wrist device to overcome potential artifacts due to arm fat.Results: IGS patients lost significant weight with no side-effects and experienced significant and rapid improvements in blood pressure. Almost all of the GERD patients reported symptomatic relief during gastric pacing. OGTT demonstrated improved response to insulin at 7 months post-stimulation. The gastric emptying and REE tests were less conclusive, to a great extent because of the small sub-population of patients.Conclusion: While the exact mechanisms of gastric stimulation remain incompletely understood, it appears that the implantation of an IGS is associated with weight loss, an improvement (decrease) in blood pressure in hypertensive patients, and a reduction or elimination of symptoms in those who had GERD. This promising weight loss therapy warrants further study, in particular because of its intriguing results with co-morbidities.