{"id":4375,"date":"2016-08-15T09:30:31","date_gmt":"2016-08-15T09:30:31","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/complicacoes-de-balao-intragastricos\/"},"modified":"2024-05-14T23:42:25","modified_gmt":"2024-05-14T23:42:25","slug":"complicacoes-de-balao-intragastricos","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/complicacoes-de-balao-intragastricos\/","title":{"rendered":"Complica\u00e7\u00f5es do Bal\u00e3o Intrag\u00e1strico"},"content":{"rendered":"

Desde o inicio de sua utiliza\u00e7\u00e3o na d\u00e9cada de 80, ainda numa forma bastante rudimentar, o bal\u00e3o intrag\u00e1strico proporciona bons resultados. Entretanto, no in\u00edcio da experi\u00eancia, as complica\u00e7\u00f5es eram frequentes e preocupantes.<\/p>\n

Com os constantes estudos realizados e o aperfei\u00e7oamento do material do bal\u00e3o, o n\u00famero e gravidade das complica\u00e7\u00f5es ca\u00edram significativamente ao longo dos anos. Entretanto, a difus\u00e3o mundial e crescente utiliza\u00e7\u00e3o do m\u00e9todo, trouxeram novas formas de complica\u00e7\u00f5es e aumentaram as antigas ocorr\u00eancias.<\/p>\n

Dessa forma \u00e9 muito importante que os m\u00e9dicos endoscopistas e das demais \u00e1reas que acompanham estes pacientes, conhe\u00e7am e saibam manejar suas complica\u00e7\u00f5es.<\/p>\n

Faremos um breve tour pelas complica\u00e7\u00f5es mais comuns do BIG<\/strong><\/h2>\n

N\u00e1useas e v\u00f4mitos:<\/strong> as complica\u00e7\u00f5es menores e tamb\u00e9m as mais comuns s\u00e3o as de ocorr\u00eancia precoce, ou seja, nos primeiros 3 a 5 dias p\u00f3s implante do acess\u00f3rio. N\u00e1useas e v\u00f4mitos, acompanhados ou n\u00e3o de dor abdominal e de graus variados ocorrem em cerca de 70% dos casos segundo meta-an\u00e1lise publicada em 2015 (Zheng, Wang et al. 2015). Importante ressaltar que os dados apresentados s\u00e3o semelhantes a experi\u00eancia de nosso grupo com cerca de 1500 bal\u00f5es implantados.<\/p>\n

Entre os pacientes que apresentam os sintomas descritos, cerca de 7 \u2013 15% necessitar\u00e3o de medica\u00e7\u00e3o e hidrata\u00e7\u00e3o endovenosa. Apesar de muito comum, esses sintomas merecem aten\u00e7\u00e3o especial j\u00e1 que al\u00e9m de serem a maior causa de retirada precoce do acess\u00f3rio, pode acarretar complica\u00e7\u00f5es graves como desidrata\u00e7\u00e3o, dist\u00farbios hidroeletrol\u00edticos e insufici\u00eancia renal aguda, potencialmente fatais. Alguns estudos mostram taxa de retirada precoce por esse tipo de sintomas de at\u00e9 20% (De Castro, Morales et al. 2010).<\/p>\n

Sangramento:<\/strong> Relatos de pequenos sangramentos durante os primeiros dias s\u00e3o corriqueiros entre m\u00e9dicos com algum volume de procedimentos, mas quando persistentes, os v\u00f4mitos podem causar les\u00f5es como s\u00edndrome de Mallory-Weiss com sangramento maci\u00e7o e necessidade de terap\u00eautica endosc\u00f3pica. Outra causa rara, mas que n\u00e3o podemos deixar de pensar em casos de HDA em pacientes com BIG \u00e9 a les\u00e3o de Dieulafoy. Nos \u00faltimos 3 anos foram relatados 4 casos dessa patologia em pacientes em uso do bal\u00e3o intrag\u00e1strico no estado de S\u00e3o Paulo.<\/p>\n

Solu\u00e7os:<\/strong> ainda com pouca descri\u00e7\u00e3o na literatura, mas de grande incomodo para o paciente, s\u00e3o os solu\u00e7os. Raros pacientes apresentam crises de solu\u00e7os que podem durar minutos at\u00e9 dias e nesses casos o manejo \u00e9 bastante complicado, sendo usados medica\u00e7\u00f5es variadas inclusive benzodiazep\u00ednicos para debelar o sintoma.<\/p>\n

Impacta\u00e7\u00e3o no antro:<\/strong> mais comum nos primeiros meses ap\u00f3s implante. Quando impactado, o bal\u00e3o ocasiona o represamento do conte\u00fado provocando distens\u00e3o abdominal, dor , n\u00e1useas, v\u00f3mitos at\u00e9 com pequenas quantidades de l\u00edquido, pirose retroesternal, podendo cursar at\u00e9 com broncoaspira\u00e7\u00e3o. Essa complica\u00e7\u00e3o \u00e9 importante pois frequentemente causa a retirada precoce do acess\u00f3rio.<\/p>\n

\"Bal\u00e3o<\/a>

Bal\u00e3o impactado no antro com muito res\u00edduos<\/p><\/div>\n

Hiperinsufla\u00e7\u00e3o espont\u00e2nea<\/strong>:, complica\u00e7\u00e3o rara, que simula a impacta\u00e7\u00e3o antral. A causa ainda n\u00e3o est\u00e1 bem determinada, mas a principal hip\u00f3tese \u00e9 a coloniza\u00e7\u00e3o f\u00fangica e\/ou bacteriana. Os sintomas s\u00e3o muito semelhantes aos descritos quando da impacta\u00e7\u00e3o antral, entretanto a troca do acess\u00f3rio se faz necess\u00e1ria quando diagnosticado, e em muitos casos o mesmo paciente pode apresentar nova hiperinsufla\u00e7\u00e3o do bal\u00e3o.<\/p>\n

\"Hiperinsufla\u00e7\u00e3o<\/a>

Hiperinsufla\u00e7\u00e3o espont\u00e2nea<\/p><\/div>\n

Coloniza\u00e7\u00e3o f\u00fangica:<\/strong> ainda n\u00e3o se sabe exatamente as raz\u00f5es que levam a forma\u00e7\u00e3o de uma camada muitas vezes grosseira de fungos sobre o bal\u00e3o, a hip\u00f3tese atualmente mais considerada \u00e9 que o ambiente b\u00e1sico devido ao uso de IBPs possa ser a causa da presen\u00e7a dessa ocorr\u00eancia. Observamos na pr\u00e1tica di\u00e1ria, em concord\u00e2ncia com a literatura a grande preval\u00eancia de candida albicans<\/em><\/strong> nos casos de fungos em BIG. (Kotzampassi, K., et al. 2013).<\/p>\n

\"Coloniza\u00e7\u00e3o<\/a>

Coloniza\u00e7\u00e3o por fungos<\/p><\/div>\n

Vazamento do bal\u00e3o:<\/strong> nos EUA o bal\u00e3o intrag\u00e1strico habitualmente n\u00e3o \u00e9 preenchido com o marcador azul de metileno para identifica\u00e7\u00e3o de eventual vazamento, j\u00e1 em nosso pa\u00eds a utiliza\u00e7\u00e3o desse marcador \u00e9 amplamente difundida. Dessa forma a ocorr\u00eancia da complicac\u00e3o \u00e9 amplamente documentada em terras brasileiras, e a incid\u00eancia gira em torno de 0,35 a 1,5%, valores correspondentes com a literatura internacional.(Genco, Bruni et al. 2005). Quando do vazamento o medico responsavel deve estar atento pois casos de migra\u00e7\u00e3o para o intestino causando obstru\u00e7\u00e3o aguda s\u00e3o relatados na literatura (Di Saverio, Bianchini Massoni et al. 2014, Daghfous, Baraket et al. 2015).<\/p>\n

\u00a0<\/strong><\/p>\n

Pancreatite aguda:<\/strong> Nas condi\u00e7\u00f5es de represamento de conte\u00fado e distens\u00e3o da c\u00e2mara g\u00e1strica como as referidas anteriormente, mas n\u00e3o s\u00f3 nelas, existem chances de uma intercorr\u00eancia relativamente comum, a pancreatite leve. Trata-se de um quadro de dor abdominal seguida de eleva\u00e7\u00e3o das enzimas pancre\u00e1ticas e sinais tomogr\u00e1ficos de pancreatite leve , principalmente caudal. Em alguns casos causando a retirada do BIG. Existem raros relatos de pancreatite aguda grave na literatura (Vongsuvanh, Pleass et al. 2012).<\/p>\n

\u00dalceras: <\/strong> s\u00e3o eventos de ocorr\u00eancia pouco frequente, entretanto podem ocasionar cen\u00e1rios catastr\u00f3ficos com HDA, exigindo retirada do BIG e terap\u00eautica endosc\u00f3pica imediata.<\/p>\n

\"\u00dalcera<\/a>

\u00dalcera p\u00f3s-BIG<\/p><\/div>\n

Perfura\u00e7\u00f5es<\/strong> g\u00e1stricas:<\/strong> a causa ainda \u00e9 desconhecida, sendo a principal hip\u00f3tese a isquemia da parede do \u00f3rg\u00e3o por compress\u00e3o do acess\u00f3rio, ou por abras\u00e3o, formando \u00falcera e evoluindo para perfura\u00e7\u00e3o. A incid\u00eancia relatada de perfura\u00e7\u00f5es g\u00e1stricas em pacientes usando bal\u00e3o intrag\u00e1strico na literatura \u00e9 de 0,2% (Genco, Bruni et al. 2005).<\/p>\n

Complica\u00e7\u00f5es relacionadas ao procedimento:<\/strong> as complica\u00e7\u00f5es oriundas do implante e da retirada do acess\u00f3rio incluem eventos durante a seda\u00e7\u00e3o e\/ou anestesia, al\u00e9m de les\u00f5es agudas do TGI. A necessidade de realizar o procedimento em ambiente controlado, com suporte avan\u00e7ado de vida, todo o arsenal de acess\u00f3rios, como pin\u00e7a, tesoura endosc\u00f3pica, al\u00e7a grande, cateter de perfura\u00e7\u00e3o, overtube, etc\u2026 \u00e9 mandat\u00f3rio para fazer de um procedimento simples tamb\u00e9m um procedimento seguro.<\/p>\n

Conclus\u00e3o:<\/strong> A efici\u00eancia comprovada da abordagem (Moura, Oliveira et al. 2016) e a aparente simplicidade do m\u00e9todo, despertou o interesse dos endoscopistas. O manejo do bal\u00e3o intrag\u00e1strico enquanto n\u00e3o h\u00e1 complica\u00e7\u00f5es \u00e9 bastante pr\u00e1tico e tranquilo, entretanto a variedade de eventos e a gravidade dos mesmos, fazem com que os profissionais que trabalham com esse acess\u00f3rio, devam estar treinados e preparados para enfrentar as poss\u00edveis complica\u00e7\u00f5es .<\/p>\n

Clique aqui e confira nossa galeria de imagens de complica\u00e7\u00f5es de bal\u00e3o intrag\u00e1strico<\/strong><\/a><\/p>\n

Refer\u00eancias:<\/strong><\/h2>\n

Daghfous, A., et al. (2015). “[Intestinal obstruction caused by migration of intragastric balloon. A case report].” Tunis Med<\/u> 93(4): 272-274.<\/p>\n

De Castro, M. L., et al. (2010). “Efficacy, safety, and tolerance of two types of intragastric balloons placed in obese subjects: a double-blind comparative study.” Obes Surg<\/u> 20(12): 1642-1646.<\/p>\n

Di Saverio, S., et al. (2014). “Complete small-bowel obstruction from a migrated intra-gastric balloon: emergency laparoscopy for retrieval via enterotomy and intra-corporeal repair.” Obes Surg<\/u> 24(10): 1830-1832.<\/p>\n

Genco, A., et al. (2005). “BioEnterics Intragastric Balloon: The Italian Experience with 2,515 Patients.” Obes Surg<\/u> 15(8): 1161-1164.<\/p>\n

Kotzampassi, K., et al. (2013) “Candida albicans colonization on an intragastric balloon.” Asian J Endosc Surg<\/u> 6(3): 214-216.<\/p>\n

Milone, M., et al. (2014). “An early onset of acute renal failure in a young woman with obesity and infertility who underwent gastric balloon positioning. A case report.” G Chir<\/u> 35(3-4): 73-74.<\/p>\n

Moura, D., et al. (2016). “Effectiveness of intragastric balloon for obesity: A systematic review and meta-analysis based on randomized control trials.” Surg Obes Relat Dis<\/u> 12(2): 420-429.<\/p>\n

Vongsuvanh, R., et al. (2012). “Acute necrotizing pancreatitis, gastric ischemia, and portal venous gas complicating intragastric balloon placement.” Endoscopy<\/u> 44 Suppl 2 UCTN: E383-384.<\/p>\n

Zheng, Y., et al. (2015). “Short-term effects of intragastric balloon in association with conservative therapy on weight loss: a meta-analysis.” J Transl Med<\/u> 13: 246.<\/p>\n

Autor<\/strong><\/h2>\n

Dr. Sergio Barrichello<\/p>\n","protected":false},"excerpt":{"rendered":"

Desde o inicio de sua utiliza\u00e7\u00e3o na d\u00e9cada de 80, ainda numa forma bastante…<\/p>\n","protected":false},"author":536,"featured_media":4373,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[281],"tipo":[158],"volume":[147],"class_list":["post-4375","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-281","tipo-endoscopia-bariatrica","volume-volume-ii"],"yoast_head":"\nComplica\u00e7\u00f5es do Bal\u00e3o Intrag\u00e1strico • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/complicacoes-de-balao-intragastricos\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Complica\u00e7\u00f5es do Bal\u00e3o Intrag\u00e1strico\" \/>\n<meta property=\"og:description\" content=\"Desde o inicio de sua utiliza\u00e7\u00e3o na d\u00e9cada de 80, ainda numa forma bastante rudimentar, o bal\u00e3o intrag\u00e1strico proporciona bons resultados. Entretanto, no\" \/>\n<meta property=\"og:url\" content=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/complicacoes-de-balao-intragastricos\/\" \/>\n<meta property=\"og:site_name\" content=\"Endoscopia Terapeutica\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/endoscopiaterapeutica\" \/>\n<meta property=\"article:published_time\" content=\"2016-08-15T09:30:31+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-05-14T23:42:25+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/2016-03-18-PHOTO-00007785.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1105\" \/>\n\t<meta property=\"og:image:height\" content=\"848\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Sergio Barrichello\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" 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