WCIM 2014 SEOUL KOREA 513
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0770 Upper GI Tract
Effect of Intragastric Injection of Botulinum Toxin a for the Treatment of Obesity: A Systematic Review and Meta-Analysis
Chang Seok Bang1, Gwang Ho Baik1, Hyo Sun Kim1, Sang Hyun Park1, Eun Jin Kim1, Jin Bong Kim1, Ki Tae Suk1, Jai Hoon Yoon1, Yeon Soo Kim1, Dong Joon Kim1 Department of Internal Medicine, Hallym University College of Medicine, Korea1
Background: Controversies regarding effect of intragastric injection of botulinum toxin A for the treatment of obesity still remain.
Methods: A systematic literature review was conducted using the core databases (PubMed, EMBASE, and the Cochrane Library). Pre- and post-treatment body weight data were extracted and analyzed using Hedges’s g. The analysis was performed divid- ed by 2 ways which are pre-post comparative approach in botulinum injected group and comparison with placebo injected group. A random effect model was applied. The methodological quality of the enrolled studies was assessed by the Risk of Bias table and Newcastle-Ottawa Scale. Publication bias was evaluated through the funnel plot, trim and fi ll method, Egger’s test, and rank correlation test.
Results: A total of 139 patients was enrolled from 8 studies (91 treated vs. 49 placebo group) and followed up for median 12 weeks (IQR: 6.5-16 weeks). Overall, treatment group was associated with weight loss in a pre-post comparative approach and compared to the placebo group (Hedges’s g: -0.619, 95% CI: -1.090, -0.148, P = 0.01;
Hedges’s g: -0.650, 95% CI: -1.035, -0.265, P = 0.001). Wide area injection including fundus or body rather than the antrum only injection was associated with weight loss.
Multiple injection number (above 10) was associated with weight loss. However, large amount of botulinum (more than 500 IU) was not associated with weight loss. Sensi- tivity analyses showed consistent results. Publication bias was not detected.
Conclusions: In this analysis, intragastric injection of botulinum toxin A is effective for the treatment of obesity.
PS 0771 Upper GI Tract
Stomach 3D Reconstruction and Volume Estimation for Bariatric Endoluminal Gastroplasty
Seung-Joo Nam1, Hoon Jai Chun1, Dokwan Lee2, Yongnam Song2, Seung Han Kim1, Jae Min Lee1, In Kyung Yoo1, Hyuk Soon Choi1, Eun Sun Kim1, Bora Keum1, Yoon Tae Jeen1, Hong Sik Lee1, Chang Duck Kim1, Ho Sang Ryu1
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Korea1, Department of Mechanical Engineering, Korea University, Korea2
Background: The shape of stomach is variable among individuals and conditions, so bariatric procedures need to be individualized. If stomach is infl ated to certain level by endoscopy and internal space is 3D reconstructed, 3D model could be constructed with precision. In this study, we constructed 3D model of stomach by endoscopy.
Methods: We conducted endoscopy for three patients. Stomach was infl ated to the predetermined level and internal dimensions were measured using regularly marked endoscopic guide-wire. 3D model was constructed using this information and the volume was estimated. In addition, we planned simulated sleeve operation and endo- luminal gastroplasty for predetermined volume reduction.
Results: Stomach volume for each subject was calculated. 3D reconstructed stomach of one patient is shown (Fig 1) and the estimated volume of stomach was 3.7 liter.
Resection line for sleeve operation were planned (Fig 2). Expected volume and shape change after the procedure were obtained.
Conclusions: Bariatric procedures are conducted increasingly. Personal stomach volume change after intervention is invaluable parameter for predicting treatment response. Also computerized simulation for optimal procedure is very useful for opera- tors. In the absence of techniques for individualized stomach 3D modeling and volume estimation, this study would be important basic research for future bariatric proce- dures.
PS 0772 Upper GI Tract
The Effi cacy of Carbon Dioxide Insuffl ation in Upper Gastrointestinal Tract Endoscopic Submucosal Dissection: A Randomized, Double-Blind, Controlled Prospective Study
Su Young Kim1, Jun Won Chung1, Dong Kyun Park1, Kwang An Kwon1, Kyoung Oh Kim1, Yoon Jae Kim1
Department of Gastroenterology, Gachon University, Gil Medical Center, Korea1
Background: Endoscopic submucosal dissection (ESD) is performed with using air insuffl ations, and is associated with abdominal discomfort. It is well recognized that carbon dioxide (CO2) is absorbed quickly in the body than air. CO2 insuffl ation is ex- pected to be reduces abdominal discomfort and pain after ESD. This prospective study was designed to assess the effi cacy of CO2 insuffl ation instead of air insuffl ation dur- ing upper gastrointestinal tract ESD.
Methods: From May 2012 to April 2014, a total of 54 consecutive patients were ran- domly assigned to CO2 insuffl ation (CO2 group, n=26) or air insuffl ation (Air group, n=28). Abdominal pain after ESD was chronologically recorded on visual analogue system (VAS) score. Also, we recorded of both group that change of abdominal cir- cumference, the amounts of sedatives, and complication rates.
Results: Baseline patient characteristics (age, gender, tumor size, tumor location, tumor histology) were not different in both groups. The mean procedure time was no statistically signifi cant difference between both groups. Abdominal pain on VAS in the CO2 group vs. Air group was 1.7 vs. 3.3 six hours after the ESD (p=0.015), and 0.8 vs.
2.3 one day after the ESD (p=0.002). In the CO2 group, the abdominal pain on VAS was signifi cantly lower than that of the Air group. Abdominal circumference change, amounts of sedative drugs, complication rates were not statistically different between both groups.
Conclusions: The amounts of sedatives or complication rates, there were no differ- ences in the two groups. However, CO2 insuffl ation during upper gastrointestinal tract ESD is less painful for patients than air insuffl ation.
