title: Intragastric balloon as a novel modality for weight loss in patients with cirrhosis and morbid obesity awaiting liver transplantation.
abstract: BACKGROUND
  In extreme obesity, bariatric surgery or weight loss by lifestyle modification is often not possible because of presence of decompensated cirrhosis. Endoscopic intragastric balloon placement may be used as minimal invasive technique to promote weight loss and make them better candidates for liver transplantation surgery; however, there is no literature in this regard.
  
  
  METHODS
  Patients with body mass index (BMI) >40 kg/m(2) or BMI between 35 and 40 (with a low graft to recipient weight ratio) were considered for weight reduction modalities including dietary counseling and intragastric balloon placement when feasible.
  
  
  RESULTS
  Intragastric balloon placement was done in six males and two females, age 46 ± 5 years, BMI 43.5 ± 6.9 kg/m(2). All patients (except one with hepatocellular carcinoma) had decompensated liver disease, mean Child score was 8.5 ± 1.6. Five of them had successful liver transplantation (three deceased and two living donor liver transplantation) after weight loss, while three are waiting. All these five patients had uneventful post-transplant course. All patients had transient vomiting except one, in whom volume of balloon was decreased due to persistent vomiting. All patients except one had weight loss. None of patients had any serious complications. Three of five patients maintained weight loss post-transplant also.
  
  
  CONCLUSIONS
  Intragastric balloon placement is a useful modality for promoting short-term weight loss and thereby making morbidly obese recipients fit for liver transplantation surgery.
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Narendra Singh
authors.initials: NS
authors.lastname: Choudhary
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Puri
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India. neerajsaraf@hotmail.com.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Saraf
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Saigal
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Rai
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Goja
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Bhangui
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Sumana K
authors.initials: SK
authors.lastname: Ramchandra
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Raut
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Randhir
authors.initials: R
authors.lastname: Sud
authors.affiliation: Medanta Institute of Liver Transplantation, Medanta The Medicity, Gurgaon, 122 001, India.
authors.forename: Arvinder
authors.initials: A
authors.lastname: Soin
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D015905:Gastric Balloon; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome; D014850:Waiting Lists; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000379:methods*
keywords: Liver transplantation; Living donor liver transplantation; Obesity; Surgery