A Highly Effective Anti-voming Regimen Post Intragastric Balloon Implantation

S. Brooks* 1, 1, E. Tsvang2, M. Ganon2, et al

Introduction: Approximately 250,000 intragastric balloons (IGB) have been utilized for weight loss since the 1980’s, with well over 5,000 patients reported in the literature. Nausea and vomiting has been a consistent complaint in almost all patients during the first 3-4 days post balloon implantation.  The anti-emetic regimen of ondansetron or other serotonin 5-HTreceptor antagonists in combination with prokinetic agents such as metachlopramide or domperidone have little if any effect. At the suggestion of an oncology nurse, we report our experience with an anti-emetic regimen (used for chemotherapy induced nausea and vomiting) for the immediate post IGB implantation period.

Aims & Methods: Our study assessed the efficacy of aprepitant, an NK1 receptor antagonist, in combination with ondansetron in alleviating the immediate post IGB implantation nausea and vomiting. Between February 2015 and November 2015, 161 patients (76% females) ; mean age 45 (19-70); mean wt 98.3 kg (70-144.6); mean BMI 35.4(29.3-75.3); were implanted with the Spatz3 Adjustable balloon (Spatz FGIA Inc., NY, USA) with a mean balloon volume of 483 ml (400-600). All patients were prescribed aprepitant (125 mg PO day 1, and 80 mg days 2 and 3) plus ondansetron (8mg PO Q6H) for 3 days. Patients were asked to record the presence of nausea and the number of vomiting and retching episodes. The dietician was in direct contact daily with patients for at least 3 days or until the symptoms abated. 151 out of 161 were able to give accurate reports of their symptoms.

Results: 27/151 patients (17.9%) reported episodes of nausea and vomiting over 1-4 days with a mean 6.8 vomits/patient (range 1-25). 10 patients had 1 day of vomiting. 6 patients had 2 days of vomiting. 4 patients had 3 days of vomiting. 7 patients had 4 days of vomiting.  2 patients with > 15 vomits over 4 days had moderate non-erosive gastritis.
110/151(72.8%) reported nausea without vomiting for a mean 2.3 days.
14/151(9.3%) reported no nausea or vomiting. No untoward drug reactions were noted.

Conclusion: In our experience, the combination of aprepitant and ondansetron effectively prevented vomiting in 82% of patients in the early post implantation period. However, it was not effective in preventing nausea, as it was present in 91%. The combination was not effective in the presence of moderate non-erosive gastritis. This study demonstrates the safety and efficacy of this drug combination in preventing the immediate post IGB implantation vomiting.