Search

Banded Roux-en-Y gastric bypass (RYGB) was a common bariatric procedure in the 2000s, and the ring slippage is one of its late adverse events. Both plastic and metallic stents have been reported as adjunct methods to induce erosion and facilitate endoscopic removal of the ring. To compare the safety and effectiveness of self-expanding metallic stents (SEMS) and plastic stents (SEPS) to treat ring slippage. We conducted a retrospective longitudinal study analyzing consecutive patients with ring dysfunction treated with stents plus endoscopic removal. Ninety patients were enrolled (36 SEMS vs. 54 SEPS). The mean age was 48.56 ± 13.07 and 45.6 ± 12.1 in the SEMS and SEPS groups, respectively. All patients had band slippage, but 24 from SEMS group and 23 from SEPS group had further complications. There were more complications in metallic stent concerning mean absolute number of therapy-related adverse events (1.33 ± 0.48 vs. 1.72 ± 0.5, p > 0.05) and time until erosion (14.9 ± 1.6 vs. 13.8 ± 1.4 days, p > 0.05). Female sex and age > 41 years old correlated with longer time to band erosion and higher incidence of adverse events in SEMS patients. In SEPS group, only female sex was a risk factor for adverse events. Both procedures were efficient at inducing band erosion with similar safety profiles. Older and female patients are at a higher risk of treatment-related adverse events, especially those receiving SEMS.

Roux-en-Y gastric bypass is one of the most widely performed bariatric surgeries. However, the relapse of obesity occurs in approximately 20% of patients and enlargement of the anastomosis is one of the factors associated with this relapse. Endoscopic treatment of the anastomosis has been proposed to assist in renewed weight loss. One endoscopic technique is the narrowing of the anastomosis argon plasma coagulation (APC). Objective: Evaluate the effectiveness and safety of the endoscopic treatment of an enlarged anastomosis with APC. A randomized controlled study was conducted comparing APC to exclusive multidisciplinary management after weight regain. Forty-two patients were divided into two groups: APC (n = 22) and control (n = 20). After 14 months of follow-up with a crossover at 6 months, significant improvement in satiety and greater weight loss were found in the APC group and after crossover. APC was associated with significant weight loss [9.73 (7.46, 12) vs. + 1.38 (− 1.39, 2.15)], a reduction in the anastomosis diameter [p

Background Hematopoietic stem cell transplantation (HSCT) can be used in the treatment of patients with refractory Crohn's disease (CD) when no alternative treatment is available. However, HSCT increases the risk of infections, in particular during the aplasia of mobilization and conditioning. Moreover, intestinal stomas in CD augment the risk of morbidity in immunocompromised patients and under aplastic conditions. The objective of this report was to describe the results of the first year after HSCT in a CD patient with an intestinal stoma. Methods The patient was assessed in respect to disease symptoms and endoscopic findings before the procedure and 30, 90, 180, and 365 days after HSCT. Results No complications were observed during mobilization and conditioning with sufficient CD34+ cells being harvested in just one apheresis session. Toxicity was restricted to the hematological series. Scores of all the CD indexes and the quality of life of the patient improved. However, two of three endoscopic scores remained unchanged even though improvements were found in the appearance of the lesions. Conclusion HSCT may be an alternative treatment for refractory CD in patients with an intestinal stoma, and a priori, carefully selected patients with stomas should not be excluded as candidates for this procedure.

An ectopic spleen occurs with less than 600 cases reported and has a large series of splenectomies less than 0.3%. Its highest prevalence occurs between 20 and 40 years of age, being more frequent in female patients. To present an original case report on the occurrence of ectopic spleen, mimicking hepatocellular carcinoma (HCC) after bariatric surgery. Occurrence of migratory spleen after late bariatric surgery, mimicking an HCC discovered in a routine evaluation. JCA patient, male, 66 years old, previously with sleep apnea, hypertensive and diabetic patients on medication regularly, who weighed 112.8 kg, with a BMI of 43.4 kg / m2. After 2 years of by-pass, a routine evaluation identified hepatobiliary surface on hepatic ultrasound performing MRI imaging suggestive of HCC. The team opted for a new laparoscopy with the possibility of cavity inventory beyond the biopsy of the tumor lesion already identified, to track intra-abdominal metastases and to review anatomy. The operation revealed that the suggestive lesion was subcapsular implanted only in the falciform and hepatic surface in segment amenable to total resection. The anatomopathological results of the lesions were described as congenital splenic cells compatible with ectopic spleen. The emergence of the ectopic spleen after laparoscopic bypass has not been reported so far because it is a non-traumatic surgery. The lesion in question had a benign behavior, with hepatic subcapsular implantation restricted to the falciform ligament, capable of total resection. Patient evolved well following follow up with gastroenterologist.

Made available in DSpace on 2018-12-11T16:45:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-01-03 Background and aims: Between 10 and 20% of all patients undergoing bariatric surgery procedures regain weight secondary to a gastrojejunostomy enlargement. The aim of this study was to validate the interobserver agreement while measuring gastric outlet diameters using a new standard guidewire. Methods: We selected thirty-five videos of consecutive endoscopic procedures on patients undergoing esophagogastroduodenoscopy after a Roux-en-Y gastric bypass procedure. All videos were evaluated by four raters: two expert endoscopists and two trainees. We excluded videos having a slipped Fobi ring or a strictured gastric outlet. Anastomosis diameter was measured using a novel device with standardized markings on a guidewire (Hydra jagwire, Boston Scientific, Natick. MA) as well as the current gold standard defined as a calibrated endoscopic measuring instrument (Olympus America, Center Valley, PA). Results: We obtained 272 measurements of the gastric outlet. Overall agreement measured through intra-class correlation coefficients for the gold standard was 0.84 (p < 0.01) and 0.83 (p < 0.01) for the new guidewire. Agreement among experts was 0.699 (p < 0.01), while among trainees it was 0.822 (p < 0.01). Conclusion: The new guidewire demonstrated a high degree of observer reliability, also presenting similar results between expert endoscopists and trainees. Department of Endoscopy and Bariatric Surgery Kaiser Clinic Day Hospital Department of Digestive Surgery School of Medicine of ABC Brazilian Bariatric Endoscopy International Group Gastro Obeso Center Department of Surgery Federal University of Pernambuco (UFPE) State University of Sao Paulo-Unesp-Ibilce, Rua Cristovão Colombo 2265 State University of Sao Paulo-Unesp-Ibilce, Rua Cristovão Colombo 2265

Background A multitude of endoscopic findings post-gastric bypass procedures have been previously reported in the literature, but to our knowledge, no present rules exist that could guide clinicians regarding which findings should be actively sought, once an initial finding is identified. Objective To identify co-occurrence patterns among endoscopic findings of patients having undergone past gastric bypass procedure. Methods Our registry involves all consecutive patients undergoing an upper endoscopic evaluation after a gastric bypass procedure. We collected information on the presence of the endoscopic findings in post-gastric bypass surgery patients. Co-occurrence evaluation involved the use of intersection, cluster and item factor analyses. Results A total of 396 endoscopic evaluations were made on 339 patients. Most patients were female (81.1%), with an average BMI of 31.88±6.7 at the time of endoscopy. Esophagitis was the most common isolated finding (35.3%). Endoscopic findings clustered around two groups, (1) the ring-related complications involving ring displacement, ring slips and gastric pouch, while (2) stenosis-related findings involved dilation and stenosis (P

It is estimated that about 80 million Americans are affected by digestive diseases, and about 30 million endoscopic procedures are performed annually in the US. In Brazil, it was estimated that the national average of endoscopies number was 600 tests / 100,000 inhabitants per year. Despite the common nature of the procedures, there is no standard methodology for the training of endoscopists or when a trainee met important technical competence. In addition, there is no tool that determines the qualification of front trainees to familiarize themselves with the endoscope and endoscopic equipment for clinicalprocedures.

About 40% of the population is overweight. It is estimated that there are about 80,000 deaths per year in Brazil for reasons arising from obesity. Bariatric surgery has been the most effective method for the treatment and prevention of complications caused by morbid obesity. The gastric bypass has shown good short term results in significant reduction of body weight. However, in the long run about 10 to 20% of patients tend to weight regained. This number seems to be relatively low; the reality is significantly higher when surgery is not accompanied by a long-term change in lifestyle. Thus, it was hypothesized that by applying argon plasma on the anastomosis, the weight regained is avoided. The aim of this work was to study the effect of argon plasma fulguration in the weight regained in patients undergoing gastric bypass. Of the 37 patients who underwent gastric bypass 24(75%) were female and 8(25%) were male. Considering the gastric bypass, the mean preoperative weight was 117.61 Kg. After the average weight surgery was 79.94 Kg. The mean difference of pre and post-operative weight was 37.66 kg, the difference being significant (p

Background: Cystic pancreatic lesions (LCP) include inflammatory pseudocysts or mesenchymal and epithelial cystic neoplasms in 80-90% and 10-15% of cases, respectively. Other pancreatic cystic lesions include cysts alone, pancreatic policistose (von Hippel-Lindau syndrome), cystic hydatid cyst and metastasis. The prevalence of LCP is about 3.5%. Objective: Was to investigate the clinical application of Biopsy guided by endoscopic ultrasound in patients with pancreatic cystic lesion, considering demographic, endoscopic and cytological data. Methods: We retrospectively studied 24 patients with pancreatic cystic lesion, regardless of sex and race, from the region of Sao Jose do Rio Preto, SP, underwent biopsy puncture guided by endoscopic ultrasound. The ecoguide of the punctures were performed using only 22G needle, and the collection and processing of medical liability endoscopist material.