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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.

Introduction: The Roux-en-Y gastric bypass (RYGB) is, currently, the most performed technique in Brazil. Suture threads are classified according to their degradation properties. Objective: To analyze the influence on the size of the gastrojejunal anastomosis performed in Roux-en-Y gastric bypass surgery, as well as the main complications with the use of absorbable or inabsorbable thread. Methods: This study followed a prospective and randomized clinical trial, initially with 40 participants, with only 37 participants being duly selected, 19 of whom underwent gastrojejunostomy closure with an absorbable (Abs) polydioxanone suture (PDS II®) and 18 with the inabsorbable (Inb) ETHIBOND®. Statistical analysis was performed using the ANOVA and logistic regression tools (p

Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. The etiology of CD is unknown; however, genetic, epigenetic, environmental, and lifestyle factors could play an essential role in the onset and establishment of the disease. CD results from immune dysregulation due to loss of the healthy symbiotic relationship between host and intestinal flora and or its antigens. It affects both sexes equally with a male to female ratio of 1.0, and its onset can occur at any age, but the diagnosis is most commonly observed in the range of 20 to 40 years of age. CD diminishes quality of life, interferes with social activities, traumatizes due to the stigma of incontinence, fistulae, strictures, and colostomies, and in severe cases, affects survival when compared to the general population. Symptoms fluctuate between periods of remission and activity in which complications such as fistulas, strictures, and the need for bowel resection, surgery, and colostomy implantation make up the most severe aspects of the disease. CD can be progressive and the complications recurrent despite treatment with anti-inflammatory drugs, corticosteroids, immunosuppressants, and biological agents. However, over time many patients become refractory without treatment alternatives, and in this scenario, hematopoietic stem cell transplantation (HSCT) has emerged as a potential treatment option. The rationale for the use of HSCT for CD is anchored in animal studies and human clinical trials where HSCT could reset a patient's immune system by eliminating disease-causing effector cells and upon immune recovery increase regulatory and suppressive immune cells. Autologous HSCT using a non-myeloablative regimen of cyclophosphamide and anti-thymocyte globulin without CD34+ selection has been to date the most common transplant conditioning regimen adopted. In this review we will address the current situation regarding CD treatment with HSCT and emphasize the medical, ethical, and legal aspects that permeate the procedure in Brazil.

Made available in DSpace on 2022-04-29T08:30:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-21 BACKGROUND Crohn’s disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBDs) with a remission-relapsing presentation and symptomatic exacerbations that have detrimental impacts on patient quality of life and are associated with a high cost burden, especially in patients with moderate-to-severe disease. The Real-world Data of Moderate-to-Severe Inflammatory Bowel Disease in Brazil (RISE BR) study was a noninterventional study designed to evaluate disease control, treatment patterns, disease burden and health-related quality of life in patients with moderate-to-severe active IBD. We report findings from the prospective follow-up phase of the RISE BR study in patients with active UC or CD. AIM To describe the 12-mo disease evolution and treatment patterns among patients with active moderate-to-severe IBD in Brazil. METHODS This was a prospective, noninterventional study of adult patients with active Crohn’s disease (CD: Harvey-Bradshaw Index ≥ 8, CD Activity Index ≥ 220), inadequate CD control (i.e., calprotectin > 200 µg/g or colonoscopy previous results), or active ulcerative colitis (UC: Partial Mayo score ≥ 5). Enrollment occurred in 14 centers from October 2016 to February 2017. The proportion of active IBD patients after 9-12 mo of follow-up, Kaplan-Meier estimates of the time to mild or no activity and a summary of treatment initiation, discontinuation and dose changes were examined. RESULTS The study included 118 CD and 36 UC patients, with mean ± SD ages of 43.3 ± 12.6 and 44.9 ± 16.5 years, respectively. The most frequent drug classes at index were biologics for CD (62.7%) and 5-aminosalicylate derivates for UC patients (91.7%). During follow-up, 65.3% of CD and 86.1% of UC patients initiated a new treatment at least once. Discontinuations/dose changes occurred in 68.1% of CD patients [median 2.0 (IQR: 2-5)] and 94.3% of UC patients [median 4.0 (IQR: 3-7)]. On average, CD and UC patients had 4.4 ± 2.6 and 5.0 ± 3.3 outpatient visits, respectively. The median time to first mild or no activity was 319 (IQR: 239-358) d for CD and 320 (IQR: 288-358) d for UC patients. At 9-12 mo, 22.0% of CD and 20.0% of UC patients had active disease. CONCLUSION Although a marked proportion of active IBD patients achieved disease control within one year, the considerable time to achieve this outcome represents an unmet medical need of the current standard of care in a Brazilian real-world setting. Department of Internal Medicine Botucatu Medical School at Sao Paulo State University (UNESP) Botucatu Department of Gastroenterology Escola Paulista de Medicina Sao Paulo São Paulo Department of Proctology Kaiser Day Hospital, São Jose do Rio Preto Department of Gastroenterology Faculdade de Medicina do ABC Santo Andre Department of Gastroenterology Faculdade de Medicina, Goiania 74535-170 Department of Gastroenterology CMIP Centro Mineiro de Pesquisa Juiz de Fora Department of Internal Medicine Federal University of Rio de Janeiro Rio de Janeiro Department of Gastroenterology Escola Paulista de Medicina São Paulo Hospital de Clínicas de Porto Alegre Hospital de Clínicas de Porto Alegre Porto Alegre Hospital de Clinicas da Universidade Federal do Paraná Hospital de Clinicas da Universidade Federal do Paraná Gastroenterology Department Hospital Nossa Senhora das Graças Curitiba Department of General Medicine Universidade Federal do Piauí Teresina Gastroenterology Hospital Universitario da Universidade Federal do Piaui Teresina Department of Medicine University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Juiz de Fora Department of Clinical Medicine Universidade Federal de Minas Gerais, Belo Horizonte Hospital de Clinicas da Universidade Federal do Paraná Hospital de Clinicas da Universidade Federal do Paraná, Curitiba Department of Surgery and Anatomy Ribeirao Preto Medical School University of Sao Paulo, Ribeirão Preto Scientific Affairs Takeda Pharmaceuticals Brazil Clinical Research Takeda Pharmaceuticals São Paulo IBD Unit Federal University of Bahia, Salvador Department of Internal Medicine Botucatu Medical School at Sao Paulo State University (UNESP) Botucatu

Made available in DSpace on 2021-06-25T10:51:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-14 BACKGROUND Understanding the treatment landscape of inflammatory bowel diseases (IBD) is essential for improving disease management and patient outcomes. Brazil is the largest Latin American country, and it presents socioeconomic and health care differences across its geographical regions. This country has the highest increase in IBD incidence and prevalence in Latin America, but information about the clinical and treatment characteristics of IBD is scarce. AIM To describe the sociodemographic, clinical, and treatment characteristics of IBD outpatients in Brazil overall and in the Southeast, South and Northeast/Midwest regions. METHODS Multicenter, cross-sectional study with a 3-year retrospective chart review component. Patients with moderate-to-severe Crohn's disease (CD) or ulcerative colitis (UC) were consecutively enrolled between October 2016 and February 2017. Active CD at enrollment was defined as a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or a calprotectin level > 200 μg/g or an active result based on colonoscopy suggestive of inadequate control during the previous year; active UC was defined as a partial Mayo score ≥ 5. Descriptive statistics were used to analyze all variables. RESULTS In a total of 407 included patients, CD was more frequent than UC, both overall (264 CD/143 UC patients) and by region (CD:UC ratios of 2.1 in the Southeast, 1.6 in the South and 1.2 in the Northeast/Midwest). The majority of patients were female (54.2% of CD; 56.6% of UC), and the mean ages were 45.9 ± 13.8 years (CD) and 42.9 ± 13.0 years (UC). The median disease duration was 10.0 (range: 0.5-45) years for both IBD types. At enrollment, 44.7% [95% confidence interval (CI): 38.7-50.7] of CD patients and 25.2% (95%CI: 18.1-32.3) of UC patients presented with active disease. More than 95% of IBD patients were receiving treatment at enrollment; CD patients were commonly treated with biologics (71.6%) and immunosuppressors (67.4%), and UC patients were commonly treated with mesalazine [5-Aminosalicylic acid (5-ASA)] derivates (69.9%) and immunosuppressors (44.1%). More than 50% of the CD patients had ileocolonic disease, and 41.7% presented with stricturing disease. One-quarter of CD patients had undergone CD-related surgery in the past 3 years, and this proportion was lower in the Northeast/Midwest region (2.9%). CONCLUSION In Brazil, there are regional variations in IBD management. CD outweighs UC in both frequency and disease activity. However, one-quarter of UC patients have active disease, and most are receiving 5-ASA treatment. Department of Internal Medicine Federal University of Rio de Janeiro Department of Surgery and Anatomy Ribeirão Preto Medical School University of São Paulo Department of Internal Medicine São Paulo State University (UNESP) Medical School IBD Unit Federal University of Bahia Department of Clinical Medicine Medical School Universidade Federal de Minas Gerais Department of Gastroenterology Escola Paulista de Medicina Hospital de Clinicas Universidade Federal do Parana Department of Proctology Beneficencia Portuguesa Hospital Kaiser Day Hospital Department of Gastroenterology and Hepatology Sciences Hospital de Clínicas Universidade Federal do Rio Grande do Sul Department of Gastroenterology Faculdade de Medicina do ABC Department of General Medicine Gastroenterology Unit University Hospital Federal University of Piaui Department of Gastroenterology Faculdade de Medicina Universidade Federal de Goiás Department of Surgery Botucatu Medical School São Paulo State University (UNESP) Department of Gastroenterology UNIFESP IBD Unit Gastroenterology Department Hospital Nossa Senhora das Graças Department of Proctology Kaiser Hospital Dia Health Sciences Center Epidemiology Unit State University of Piaui Department of Gastroenterology CMIP Centro Mineiro de Pesquisa Scientific Affairs Takeda Pharmaceuticals Brazil Clinical Research Takeda Pharmaceuticals Brazil Department of Medicine University Hospital of Federal University of Juiz de Fora Department of Internal Medicine São Paulo State University (UNESP) Medical School Department of Surgery Botucatu Medical School São Paulo State University (UNESP)

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

Crohn's disease (CD) is an inflammatory bowel disease that can affect any site of the digestive system. It occurs due to an immunological imbalance and is responsible for intestinal mucosal lesions and complications such as fistulas and stenoses. Treatment aims to stabilize the disease, reducing the symptoms and healing intestinal lesions. Surgical procedures are common in patients. Cell therapy was initially used to treat this disease in patients who also suffered from lymphoma and leukemia and were considered to be good candidates for autologous and allogeneic transplantation. After transplantation, an improvement was also observed in their CD. In 2003, the procedure began to be used to treat the disease itself, and several case series and randomized studies have been published since then; this approach currently comprises a new option in the treatment of CD. However, considerable doubt along with significant gaps in our knowledge continue to exist in relation to cell therapy for CD. Cell therapy is currently restricted to the autologous modality of hematopoietic stem cell transplantation and, experimentally, to mesenchymal stromal cells to directly treat lesions of the anal mucosa. This article presents the supporting claims for transplantation as well as aspects related to the mobilization regime, conditioning and perspectives of cell therapy.

Background Colonoscopy procedures are commonly performed and have high success rates. However, poor or inadequate bowel preparation is one of the most common reasons for a repeated or failed colonoscopy. We therefore performed an observational study followed by propensity score modeling to evaluate and compare the quality of bowel preparation with the use of Aquanet bowel cleansing devices (BCDs) versus the use of oral sodium picosulfate solution. Methods We performed a prospective cross-sectional study to compare the quality of pre-endoscopic bowel preparation using a BCD with oral solution. Our major outcome of interest was the quality of bowel preparation as measured through the Boston bowel preparation (BBP) scale. Our main predictor was the method of bowel preparation. The bowel was prepared using either sodium picosulfate or the BCD. Results A total of 314 participants were part of this study. The average age of the participants was 54 years and most of the participants were females (81%). Sodium picosulfate was associated with better scores at each segment. After propensity scoring with a 1:1 match and further adjusting for the unbalanced variable (age), we found that despite the apparent superior cleansing performance of sodium picosulfate over the BCD, the difference was not statistically significant. Conclusion This study reinforces previous reports regarding the quality, safety and comfort of BCDs, indicating that this technique should be considered for colonoscopy preparation. In the future, randomized controlled trials should be performed to validate these preliminary findings.

Made available in DSpace on 2018-11-26T20:08:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-02-01 Kaiser Clinic of Sao Jose do Rio Preto SP Brazil The Cronkhite-Canada syndrome (CCS) was first reported in 1955, since then more than 500 cases have been reported, indicating an estimated incidence of one case per 1 million inhabitants. The syndrome occurs predominantly in male, with a ratio of three males to two females. Because of the rarity of the syndrome, there are no evidence-based therapies and the treatments described include a combination of therapies, but none is consistently effective. Surgery is usually reserved for the treatment of complications. Herein, we present a case of adolescent CCS. The patient was a 15-year-old boy who presented with watery diarrhea with 20 episodes a day, vomiting and abdominal pain for 4 weeks, with a weight loss of 8.0 kg (15.0% of initial weight). Endoscopic examination revealed polyposis in the stomach, duodenum, and colon. CCS was diagnosed and the patient was treated with a combined corticosteroid and metronidazole. Followed up at 8 month after the diagnosis, the patient was asymptomatic. Kaiser Clin & Hosp, Sao Jose Do Rio Preto, SP, Brazil Uniao Fac Grandes Lagos Unilago Med Sch, Sao Jose Do Rio Preto, SP, Brazil Sao Paulo State Univ Unesp, Inst Biosci Humanities & Exact Sci Ibilce, Campus Sao Jose do Rio Preto, Sao Jose Do Rio Preto, SP, Brazil Sao Paulo State Univ Unesp, Inst Biosci Humanities & Exact Sci Ibilce, Campus Sao Jose do Rio Preto, Sao Jose Do Rio Preto, SP, Brazil

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.

Made available in DSpace on 2020-12-12T01:42:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-10-14 AbbVie Ferring Pharmaceuticals Pfizer Background: Inflammatory bowel diseases (IBD) have been associated with a low quality of life (QoL) and a negative impact on work productivity compared to the general population. Information about disease control, patient-reported outcomes (PROs), treatment patterns and use of healthcare resources is relevant to optimizing IBD management. Aim: To describe QoL and work productivity and activity impairment (WPAI), treatment patterns and use of healthcare resources among IBD patients in Brazil. Methods: A multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn's disease (CD) or ulcerative colitis (UC). At enrolment, active CD and UC were defined as having a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or calprotectin > 200 μg/g or previous colonoscopy results suggestive of inadequate control (per investigator criteria) and a 9-point partial Mayo score ≥ 5, respectively. The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L, the Inflammatory Bowel Disease Questionnaire (IBDQ), and the WPAI questionnaire. Information about healthcare resources and treatment during the previous 3 years was collected from medical records. Chi-square, Fisher's exact and Student's t-/Mann-Whitney U tests were used to compare PROs, treatment patterns and the use of healthcare resources by disease activity (α = 0.05). Results: Of the 407 patients in this study (CD/UC: 64.9%/35.1%, mean age 42.9/45.9 years, 54.2%/56.6% female, 38.3%/37.1% employed), 44.7%/25.2% presented moderate-to-severe CD/UC activity, respectively, at baseline. Expressed in median values for CD/UC, respectively, the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2, the EQ-visual analog scale score was 80.0/70.0, and the IBDQ overall score was 164.0/165.0. Moderate to severe activity, female gender, being unemployed, a lower educational level and lower income were associated with lower QoL (P < 0.05). Median work productivity impairment was 20% and 5% for CD and UC patients, respectively, and activity impairment was 30%, the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity (75.0% vs 10.0%, P < 0.001). For CD/UC patients, respectively, 25.4%/2.8% had at least one surgery, 38.3%/19.6% were hospitalized, and 70.7%/77.6% changed IBD treatment at least once during the last 3 years. The most common treatments at baseline were biologics (75.3%) and immunosuppressants (70.9%) for CD patients and 5-ASA compounds (77.5%) for UC patients. Conclusion: Moderate to severe IBD activity, especially among CD patients, is associated with a substantial impact on QoL, work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil. Department of Surgery and Anatomy Ribeirao Preto Medical School University of Sao Paulo Inflammatory Bowel Disease Center Federal University of Juiz de Fora Hospital de Clinicas da Universidade Federal do Parana Hospital de Clinicas de Porto Alegre Universidade Federal do Piaui Hospital de Clínicas da Universidade Federal do Parana CTI Clinical Trial and Consulting Services CMIP Centro Mineiro de Pesquisa Hospital Nossa Senhora das Gracas Hospital Universitario da Universidade Federal do Piaui Universidade Federal do Rio de Janeiro Universidade do Estado da Bahia Department of Internal Medicine Botucatu Medical School at Sao Paulo State University (UNESP) Instituto Goiano de Gastroenterologia e Endoscopia Digestiva Ltda Kaiser Clinica Escola Paulista de Medicina UNIFESP Disciplina de Gastroenterologia Faculdade de Medicina do ABC Faculdade de Medicina UFMG Takeda Pharmaceuticals Brazil Department of Internal Medicine Botucatu Medical School at Sao Paulo State University (UNESP)

PURPOSE To report a case of a patient with ischemic retinopathy associated with Crohn's disease. CASE REPORT This report presents a case of a 28-year-old female patient with Crohn's disease and sudden decrease of visual acuity in the right eye. Fluorescein angiography, optical coherence tomography, and multifocal electroretinography confirmed the clinical features of ischemic retinopathy. After systemic corticosteroid treatment, the patient developed epiretinal membrane without significant improvement in visual acuity. DISCUSSION The patient presented with ischemic retinopathy associated with Crohn's disease with deficiency of central visual acuity. Periodic examination by a retina specialist is recommended for patients being treated for Crohn's disease.

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.

The etiology of CD is unknown, but several proven riskfactors exist such as family history, smoking, oral contra-ceptives, diet and ethnicity. The combination of risk factors,and aberrant autoimmune response in the intestinal mucosawith endothelial dysfunction lead to digestive tract malfunc-tioning. Disease manifestations are heterogeneous but mostpatients present with abdominal pain, diarrhea sometimeswith blood, weight loss, fever and perianal lesions. Up to 30%of