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第85日本消化器内視鏡学会(高度肥満患者に対する内視鏡的胃内バルーン留置術)
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第85日本消化器内視鏡学会(高度肥満患者に対する内視鏡的胃内バルーン留置術)
1.
高度肥満患者に対する内視鏡的 胃内バルーン留置術 前川 智 1 , 野村亮介
1 , 村瀬貴之 1 , 安 泰善 1 , 麻植ホルム正之 1 , 笠井英裕 2 1. 独立行政法人労働者健康福祉機構 新潟労災病院 消化器内科 , 2. 独立行政法人労働者健康福祉機構 新潟労災病院 循環器内科
2.
当科では 2010 年
7 月より現在までに「ダイ エット入院」という 1 週間の教育入院を含む 低炭水化物食を中心とした内科的治療を 220 例に行い、 6 か月間で 11 ~ 12 %程度の体重 減少効果を認めている。ただ、高度肥満者は 食事療法のみではある程度で頭打ちとなり、 理想体重に達しない症例もあり、内科的治療 と外科的治療(手術)の中間に位置する内視 鏡的胃内バルーン留置術を 2012 年 10 月より 導入した。 背景・目的背景・目的
3.
[ 適応 ] 6
ヵ月以上の十分な内科的治療に対し抵抗性 を示す BMI27 以上の 20 ~ 79 歳の患者で、 減量により高度肥満に伴う糖尿病や高血圧な どの合併症の改善が期待できる症例を対象と した。 [ 方法 ] 経鼻内視鏡で観察しながら、 BIB® (OrberaTM ) System(Allergan 社, Santa Brbara, CA, USA) を胃内に留置した。 適応・方法適応・方法
4.
期間: 2012 年
10 月~ 2013 年 4 月 症例: 6 例(男性 1 例、女性 5 例) 合併症(重複あり):糖尿病 2 例、高血圧 3 例、高脂血症 3 例、脂肪肝 4 例、変形性 膝関節症 1 例 平均年齢: 47.2±20.2 歳 平均体重: 97.4±32.2 Kg 平均 BMI ( Kg/m2) : 36.3±7.0 対象対象
5.
胃内バルーン留置胃内バルーン留置
6.
項目 平均施行時間(秒) 646.2±106.8 平均バルーン量( ml
) 583.3±75.3 胃内バルーン留置時間・注入量胃内バルーン留置時間・注入量
7.
副作用 人数 % 腹痛
3/6 50% 膨満感 5/6 83% 胸焼け 5/6 83% 口渇感 5/6 83% 吐気 6/6 100% 嘔吐 5/6 83% 副作用副作用
8.
胃内バルーン抜去胃内バルーン抜去
9.
体重・%体重・% EWLEWL (超過体重減少(超過体重減少 率)の推移率)の推移
10.
BMIBMI の推移の推移
11.
臨床データの推移臨床データの推移
12.
・約半年間で 6 例の胃内バルーン留置術を施行 した。バルーン留置の平均施行時間は約
11 分 で、術後 3 日間にほぼ全例で嘔気・嘔吐を認め たが、 1 週間程度で消失した。 ・バルーン留置後、全例で順調に体重 , BMI の 減少を認めた。 ・ HbA1c が上昇している症例に関しては、バ ルーン留置により低下傾向を示した。 ・空腹時血糖 , 収縮期血圧 , HDL-C, LDL-C, TG に関しては、バルーン留置後も著変がなかった 。 まとめまとめ
13.
胃内バルーン留置術により体重減少効果、耐 糖能異常の改善を認めた。 今後症例を集積し、胃内バルーン留置術の有 用性を検証していきたい。 結語結語
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