“The balloon was just the kick start, I had to do the rest myself”: Adolescents living with severe obesity experiences of an intra-gastric balloon alongside a lifestyle support programme

Background Few treatments exist for adolescents living with severe obesity. This qualitative study explored the experiences of severely obese adolescents and their families who participated in the BOB study. Methods Twelve adolescents (5 males;7 females; mean age 15 years; BMI > 3.5 s.d; puberty stage 4 +) who were engaged with the research study BOB (a non-randomised, pilot novel obesity treatment programme that involved the insertion of an intra-gastric balloon coupled with a family lifestyle behavioural support programme). Adolescents attended weekly lifestyle sessions before, during and post balloon insertion. All participants were interviewed at 3 months, (halfway through intra-gastric balloon insertion) and at 12 months follow-up (6 months post intra-gastric balloon removal, 3 months post lifestyle intervention). Results All BOB participants had exhausted all treatment options deeming this study their final option. Many alluded to feelings of desperation and referred to a sense of hope that this intervention would be effective. Family involvement and attendance within the structured sessions differed significantly. Adolescents and parents perceived support from the research study ceased when the intra-gastric balloon was removed at 6-months despite attendance post balloon removal being poor. All participants emphasised a need for further support longer term with the integration of the family a critical factor. Conclusions Further research is needed to explore the specific role families play within treatment to optimise health and wellbeing outcomes. Adolescents perspectives should be integrated within treatment to inform and improve the effectiveness of future treatment programmes for severely obese adolescents and their families.

868 The management of acute lower gastrointestinal bleeding using a Sengstaken-Blakemore tube

Introduction Acute lower gastrointestinal haemorrhage can potentially be life-threatening. We present a case of a massive rectal bleed which was managed successfully with a balloon tamponade device designed for upper gastrointestinal haemorrhage. Presentation of case A 75-year-old gentleman, with a history of human immunodeficiency virus and cirrhosis with portal hypertension, presented with bright red rectal bleeding. Investigations showed a low haemoglobin level (74 g/L) and deranged clotting. Oesophago-gastro-duodenoscopy demonstrated no fresh or altered blood. Flexible sigmoidoscopy revealed active bleeding from a varix within the anterior rectal wall 4 cm from the anal verge. Efforts to stop the bleeding, including endoscopic clips, adrenaline injection and rectal packing, were unsuccessful and the patient became haemodynamically unstable. A Sengstaken-Blakemore tube was inserted per rectum and the gastric balloon was inflated to tamponade the lower rectum. The oesophageal balloon was then inflated to hold the gastric balloon firmly in place. A computed tomography angiogram demonstrated no evidence of haemorrhage with balloon tamponade. After 36 h, the balloon was removed with no further episodes of bleeding. Discussion The application of a balloon tamponade device should be considered in the management algorithm for acute lower gastrointestinal bleed. Advantages include its rapid insertion, immediate results and ability to measure further bleeding after the catheter has been placed. Conclusions Sengstaken-Blakemore tube per rectum may effectively control massive low rectal bleeding when alternative methods have been unsuccessful.

1129 UK Based Experience of The Elipsetm Intragastric Balloon; Short Term Safety and Effectiveness

Aim Intra Gastric Balloons (IGB) have been used over the last three decades as a minimally invasive, non-surgical weight-loss option. The ElipseTM gastric balloon (EIGB) is a ‘procedure-less’ gastric balloon which can be placed in an average of 20 minutes without the need of endoscopy or sedation. The aim of our study is to investigate the first cohort of patients in uk who underwent IGB capsule and short term follow up. Method Single centre retrospective study of the first consecutive 202 patients that had the Eclipse IGB inserted between May 2018 and November 2020. Patients swallow the ElipseTM capsule and pre-inflation x-ray is taken to confirm correct positioning after which the gastric balloon is inflated with 550mls of sterile water and a post-inflation x-ray is taken. The balloon is designed to be in-situ for 4 months and then automatically deflates. Results Out of 202 patients 24 were lost to follow-up, 146 patients followed up to an average of 15 weeks, while 26 patients followed up to 4 weeks. Average weight loss at 4 weeks was 6% Total Weight Loss (%TWL) while at last follow up 9.63% TWL. Majority of patients experienced post procedural reflux, abdominal pain, bloating and vomiting. 6 patients had early removal of the balloon due to severe symptoms (4), pancreatitis (1) and hyperinflation (1). 1 had early expulsion at 2 months. Conclusions Eclipse IGB is safe and effective in selective patients, however long-term follow is needed to compare it with the other balloons in terms of significant and sustained weight loss.

Gastric balloon: A rare cause of lumbar radiculopathy

Background: Factors that are known to cause lumbar epidural venous plexus (EVP) engorgement include inferior vena cava (IVC) obstruction, portal hypertension, vascular agenesis, morbid obesity, and/or hypercoagulable states. Here, we present a 32-year-old female admitted with the new onset of lumbar radiculopathy attributed to a gastric balloon causing compression of the IVC and engorgement of the EVP. Case Description: A 32-year-old female was admitted with a left L5 radiculopathy. She had a history of morbid obesity and had undergone intragastric balloon insertion 4 months ago. The abdominal/pelvic CT documented an intragastric balloon producing a voluminous gastric mass with resultant compression of the IVC. The lumbar MRI showed the resultant marked multilevel engorgement of the lumbar EVP. Here, following balloon removal, the patient was immediately symptom free and remained asymptomatic over the next postoperative year. Conclusion: An intragastric balloon can produce a voluminous gastric mass that can result in IVC occlusion and engorgement of the EVP, leading to lumbar radiculopathy. Removal of the balloon results in immediate and permanent resolution of the compressive symptoms.

“The Balloon was Just the Kick Start I Had to do the Rest Myself”: Adolescents Living with Severe Obesity Experiences of an Intra-Gastric Balloon Alongside a Lifestyle Support Programme

Background: Few treatments exist for adolescents living with severe obesity. This qualitative study explored the experiences of severely obese adolescents and their families who participated in the BOB study.Methods: Twelve adolescents (5 males;7 females; mean age 15 years; BMI > 3.5 s.d; puberty stage 4 +) who were engaged with the research study BOB (a non-randomised, pilot novel obesity treatment programme that involved the insertion of an intra-gastric balloon coupled with a family lifestyle behavioural support programme). Adolescents attended weekly lifestyle sessions before, during and post balloon insertion. All participants were interviewed at 3 months, (halfway through intra-gastric balloon insertion) and at 12 months follow-up (6 months post intra-gastric balloon removal, 3 months post lifestyle intervention).Results: All BOB participants had exhausted all treatment options deeming this study their final option. Many alluded to feelings of desperation and referred to a sense of hope that this intervention would be effective. Family involvement and attendance within the structured sessions differed significantly. Adolescents and parents perceived support from the research study ceased when the intra-gastric balloon was removed at 6-months despite attendance post balloon removal being poor. All participants emphasised a need for further support longer term with the integration of the family a critical factor.Conclusions: Further research is needed to explore the specific role families play within treatment to optimise health and wellbeing outcomes. Adolescents perspectives should be integrated within treatment to inform and improve the effectiveness of future treatment programmes for severely obese adolescents and their families.