Abu Dayyeh, Barham K

ObjectiveThe effects of intragastric balloon (IGB) therapy on gastric emptying (GE) and weight loss remain to be fully understood. The effects of IGB on GE were investigated in this study.MethodsThis was a single‐center, randomized, controlled study in which subjects with obesity either underwent IGB placement or were matched controls. IGB was removed at 6 months. GE was measured at baseline and at weeks 0, 8, 16, 27, and 39. Percent total body weight loss (%TBWL) was measured at 6 and 12 months.ResultsTwenty‐nine subjects with obesity were enrolled; 15 were randomized to IGB placement and 14 to control. Two subjects had the IGB removed early. At baseline, 1‐ and 2‐h gastric retention values were comparable between the groups but increased in the IGB group at weeks 8 and 16 (during IGB treatment) and then returned to baseline levels at 27 and 39 weeks. A greater increase in gastric retention from baseline to 8 weeks was associated with higher %TBWL.ConclusionsGE in subjects with IGB is delayed but returns to normal after IGB removal. Greater changes in increased gastric retention were associated with greater %TBWL. Altering gastric motility is a significant mechanism of action by which the IGB results in weight loss.

Objective Idiopathic duct-centric chronic pancreatitis (IDCP), also known as type 2 autoimmune pancreatitis (AIP), is an uncommon subtype of AIP. International Consensus Diagnostic Criteria for IDCP propose that the diagnosis requires pancreatic histology and/or concurrent IBD. We examined our experience with IDCP (type 2 AIP) to assess the appropriateness of these criteria, and identify unique characteristics in patients presenting with acute pancreatitis. Design We reviewed the Mayo Clinic AIP database through May 2014 to identify subjects with either definitive (n=31) or probable (n=12) IDCP. We compared demographic and clinical factors based on strength of diagnostic confidence (definitive versus probable), presence of IBD, and acute pancreatitis as the presenting manifestation. Relapse-free survival was determined using the Kaplan-Meier method. Results The clinical profiles were similar irrespective of the diagnostic criteria fulfilled. Common clinical presentations included acute pancreatitis (n=25, 58.1%, 12 of whom (27.9%) had recurrent pancreatitis) and pancreatic mass/obstructive jaundice (n=15, 34.9%). The cumulative relapse rate was 10.6% at 3 years (median follow-up 2.9 years). Relapse-free survival was similar for the different diagnostic categories, but was decreased in those initially presenting with acute pancreatitis (p=0.047) or treated with steroids (vs surgery, p=0.049). Conclusions The current diagnostic classification of probable IDCP and the inclusion of IBD as a supportive criterion appear valid, because patients have similar clinical profiles and disease-related outcomes to those with definitive IDCP. Concurrent IBD, especially in young patients, may suggest when IDCP is the underlying cause of recurrent acute pancreatitis, but additional studies are needed for validation.