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Bazarbashi AN, McCarty TR, Al-Obaid LN, Skinner MJ, Thompson CC. Efficacy and Safety of Novel, Disposable Endoscopic Scissors in Patients with Roux-en-Y Gastric Bypass: a Single-Center Feasibility Study. Obes Surg 2020; 29:3749-3753. [PMID: 31428973 DOI: 10.1007/s11695-019-04125-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Retained suture material from primary Roux-en-Y gastric bypass or revisions may result in local inflammation, ulcer formation, and abdominal pain. The primary aim of this study was to evaluate the feasibility, efficacy, and safety of novel, disposable endoscopic scissors for suture removal. METHODS This was a single-center, retrospective analysis of prospectively collected data from December 2016 to January 2019. Patients with history of Roux-en-Y gastric bypass and upper endoscopy utilizing this novel, disposable endoscopic scissors device were reviewed. Measured outcomes included endoscopy indication, technical success (as determined by ability to achieve adequate cut and suture removal), improvement in abdominal pain if present prior to procedure, and adverse events. RESULTS Sixty-two patients were included in this analysis. Mean age was 54.69 ± 9.40 years. Eighty-eight percent of patients were female. Roux-en-Y gastric bypass occurred on average 142.43 ± 62.33 months prior to suture removal. Primary indications for endoscopy were evaluation of gastric pouch and gastrojejunal anastomosis for weight regain (37.10%) and abdominal pain (30.65%). Overall, technical success of these novel endoscopic scissors was 100% with a mean procedure duration of 23.00 ± 9.50 min. Symptom improvement post-suture removal occurred in approximately half of the patients (48.65%). Post-procedure bleeding was self-limited and occurred in 2 patients (3.23%). Two patients developed transient post-procedure abdominal pain. CONCLUSIONS Novel, disposable endoscopic scissors appear to be highly effective and safe for removal of suture material with high technical success and minimal adverse events.
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Kakiuchi T, Nakayama A, Nojiri J, Yamanouchi T, Matsuo M. Jejuno-jejunal intussusception caused by a percutaneous endoscopic gastrojejunostomy tube in a pediatric patient: A case report. Medicine (Baltimore) 2020; 99:e19888. [PMID: 32312016 PMCID: PMC7220696 DOI: 10.1097/md.0000000000019888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Although percutaneous endoscopic gastrojejunostomy (PEG-J) tubes are believed to reduce the side effect of aspiration, cautious catheter management is required. Intussusception is a serious complication of these tubes. PATIENT CONCERNS A 7-year-old boy bedridden with hypoxic encephalopathy owing to drowning at the age of 1 year was admitted our hospital with urinary retention for 1 month. At the age of 4 years, a PEG-J tube was inserted. Concomitant with hyperaldosteronemia, an intestinal intussusception from the duodenum to the jejunum was observed via computed tomography (CT). The patient's condition worsened dramatically; gastrointestinal perforation was suspected, and laparotomy was performed. DIAGNOSIS Jejuno-jejunal intussusception. INTERVENTIONS Open surgery was performed to release the intussusception. By assessing the reduced intestinal tract, the intussusception starting from a 50 cm portion from the Treitz ligament had been extended to 100 cm from the Treitz ligament. The oral side jejunum was dilated. No evidence of intestinal perforation or strangulated ileus was observed, and the intussusception was manually remediable. OUTCOMES Preoperative CT examination showed intussusception from the duodenum to the jejunum. Laparotomy showed intussusception on the anal side of the Treitz ligament. With regard to the CT findings associated with the progression of intussusception to the duodenal site, as a result of the telescope phenomenon extending to the duodenum due to the relaxation of the Treitz ligament through repeated intussusception, it was considered that CT examination revealed intussusception extending from the jejunum to the duodenum of oral side. After 3 postoperative weeks, the patient was finally able to return home. LESSONS If the ileus is observed during the insertion of a PEG-J, clinicians should consider the possibility of intussusception even in the duodenum.
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Ruban A, Prechtl CG, Glaysher MA, Chhina N, Al-Najim W, Miras AD, Smith C, P Goldstone A, Patel M, Moore M, Ashrafian H, Byrne JP, Teare JP. Effectiveness of different recruitment strategies in an RCT of a surgical device: experience from the Endobarrier trial. BMJ Open 2019; 9:e032439. [PMID: 31727662 PMCID: PMC6886935 DOI: 10.1136/bmjopen-2019-032439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Recruiting participants into clinical trials is notoriously difficult and poses the greatest challenge when planning any investigative study. Poor recruitment may not only have financial ramifications owing to increased time and resources being spent but could adversely influence the clinical impact of a study if it becomes underpowered. Herein, we present our own experience of recruiting into a nationally funded, multicentre, randomised controlled trial (RCT) of the Endobarrier versus standard medical therapy in obese patients with type 2diabetes. Despite these both being highly prevalent conditions, there were considerable barriers to the effectiveness of different recruitment strategies across each study site. Although recruitment from primary care proved extremely successful at one study site, this largely failed at another site prompting the implementation of multimodal recruitment strategies including a successful media campaign to ensure sufficient participants were enrolled and the study was adequately powered. From this experience, we propose where appropriate the early engagement and investment in media campaigns to enhance recruitment into clinical trials. Trial Registration: ISRCTN30845205.
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Krutsri C, Kida M, Yamauchi H, Iwai T, Imaizumi H, Koizumi W. Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. World J Gastroenterol 2019; 25:3313-3333. [PMID: 31341358 PMCID: PMC6639547 DOI: 10.3748/wjg.v25.i26.3313] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy must be performed by a highly experienced endoscopist. The challenges are accessing the afferent limb in different types of reconstruction, cannulating a papilla with a reverse orientation, and performing therapeutic interventions with uncommon endoscopic accessories. The development of endoscopic techniques has led to higher success rates in this group of patients. Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction; however, these success rate is lower in long-limb reconstruction. ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length; however, it must be performed by a highly experienced and skilled endoscopist. Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography, but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy. Laparoscopic-assisted ERCP has an almost 100% success rate in long-limb reconstruction because of the use of a conventional side-view duodenoscope, which is compatible with standard accessories. This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy. This review focuses on the advantages, disadvantages, and outcomes of various procedures that are suitable in different situations and reconstruction types. Emerging new techniques and their outcomes are also discussed.
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Ebrahimi R, Kermansaravi M, Eghbali F, Pazouki A. Gastric remnant perforation due to trocar site herniation after laparoscopic Roux-en-Y gastric bypass. Ann R Coll Surg Engl 2019; 101:e88-e90. [PMID: 30602308 PMCID: PMC6400925 DOI: 10.1308/rcsann.2018.0216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2018] [Indexed: 11/22/2022] Open
Abstract
A 39-year-old woman was admitted with colicky left upper-quadrant pain, dyspnoea, low-grade fever, tachycardia and a subtle left upper-quadrant tenderness without leucocytosis. Computed tomography revealed a distended gastric remnant due to small-bowel loop herniation at the trocar site. The patient underwent a diagnostic laparoscopy as her general condition worsened. Perforation across the staple line was seen and repaired. The postoperative period was uneventful. As a rare complication of laparoscopic Roux-en-Y gastric bypass, small-bowel obstruction is of great importance because it can lead to gastric remnant perforation if not managed correctly. There have been rare reports of trocar site herniation as a cause of small-bowel obstruction following laparoscopic Roux-en-Y gastric bypass. Prompt diagnostic laparoscopy should be considered. This is the first case reported in which the excluded stomach was perforated due to trocar site herniation of the small-bowel loop. It should be noted that the tissue around the perforation is fragile and proper tension should be employed when it is repaired. Generally, an omental patch is not encouraged.
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Khayat M, Hussain JS, Chick JFB, Hage AN, Srinivasa RN. Percutaneous transgastrostomic interventional radiology-operated endoscopy facilitates foreign body removal using rigid endobronchial forceps. Diagn Interv Radiol 2018; 24:42-45. [PMID: 29225197 PMCID: PMC5765928 DOI: 10.5152/dir.2017.17431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 10/31/2017] [Indexed: 11/22/2022]
Abstract
Retained foreign bodies within the stomach and proximal small bowel may be problematic in patients with prior cerebrovascular injury or head, neck and esophageal malignancy, given the increased vulnerability of this patient population to complications from aspiration and increased difficulty of esophagogastroduodenoscopy in cases of tumoral obstruction. This article presents an alternative method for foreign body retrieval through an existing gastrostomy tract, which offers the benefits of fast procedure times, reduction in radiation dose and fluoroscopy time, and allows for safer retrieval of foreign bodies by using direct visualization. This technique may be performed entirely by interventional radiologists.
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Glaysher MA, Mohanaruban A, Prechtl CG, Goldstone AP, Miras AD, Lord J, Chhina N, Falaschetti E, Johnson NA, Al-Najim W, Smith C, Li JV, Patel M, Ahmed AR, Moore M, Poulter N, Bloom S, Darzi A, Le Roux C, Byrne JP, Teare JP. A randomised controlled trial of a duodenal-jejunal bypass sleeve device (EndoBarrier) compared with standard medical therapy for the management of obese subjects with type 2 diabetes mellitus. BMJ Open 2017; 7:e018598. [PMID: 29146657 PMCID: PMC5695522 DOI: 10.1136/bmjopen-2017-018598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The prevalence of obesity and obesity-related diseases, including type 2 diabetes mellitus (T2DM), is increasing. Exclusion of the foregut, as occurs in Roux-en-Y gastric bypass, has a key role in the metabolic improvements that occur following bariatric surgery, which are independent of weight loss. Endoscopically placed duodenal-jejunal bypass sleeve devices, such as the EndoBarrier (GI Dynamics, Lexington, Massachusetts, USA), have been designed to create an impermeable barrier between chyme exiting the stomach and the mucosa of the duodenum and proximal jejunum. The non-surgical and reversible nature of these devices represents an attractive therapeutic option for patients with obesity and T2DM by potentially improving glycaemic control and reducing their weight. METHODS AND ANALYSIS In this multicentre, randomised, controlled, non-blinded trial, male and female patients aged 18-65 years with a body mass index 30-50 kg/m2 and inadequately controlled T2DM on oral antihyperglycaemic medications (glycosylated haemoglobin (HbA1c) 58-97 mmol/mol) will be randomised in a 1:1 ratio to receive either the EndoBarrier device (n=80) for 12 months or conventional medical therapy, diet and exercise (n=80). The primary outcome measure will be a reduction in HbA1c by 20% at 12 months. Secondary outcome measures will include percentage weight loss, change in cardiovascular risk factors and medications, quality of life, cost, quality-adjusted life years accrued and adverse events. Three additional subgroups will investigate the mechanisms behind the effect of the EndoBarrier device, looking at changes in gut hormones, metabolites, bile acids, microbiome, food hedonics and preferences, taste, brain reward system responses to food, eating and addictive behaviours, body fat content, insulin sensitivity, and intestinal tissue gene expression. TRIAL REGISTRATION NUMBER ISRCTN30845205, ClinicalTrials.gov Identifier NCT02459561.
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Mouradides C, Taha A, Borbath I, Deprez PH, Moreels TG. How to treat intestinal obstruction due to malignant recurrence after Whipple’s resection for pancreatic head cancer: Description of 2 new endoscopic techniques. World J Gastroenterol 2017; 23:6181-6186. [PMID: 28970734 PMCID: PMC5597510 DOI: 10.3748/wjg.v23.i33.6181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 05/23/2017] [Accepted: 06/12/2017] [Indexed: 02/06/2023] Open
Abstract
The prognosis of pancreatic cancer remains poor, even after initial surgical therapy. Local recurrence after Whipple’s pancreatico-duodenectomy may lead to intestinal obstruction at the level of the afferent limb or the alimentary limb. Endoscopic insertion of a self-expandable metal stent (SEMS) into the intestinal malignant stricture is the preferred method of choice for palliation. We describe two new endoscopic techniques to treat a malignant intestinal obstruction with the insertion of a SEMS into the afferent limb and the alimentary limb. A case of malignant gastric outlet obstruction after a Whipple’s resection was treated by the creation of an endoscopic gastrojejunostomy by the insertion of a lumen apposing HotAxios stent in between the stomach and the alimentary limb under fluoroscopic and endoscopic ultrasound control. Biliary obstruction and jaundice caused by a malignant stricture of the afferent limb after a Roux-en-Y Whipple’s resection was treated by the insertion of a SEMS by means of the single-balloon overtube-assisted technique under fluoroscopic control. Feasibility and advantages of both techniques are discussed.
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MESH Headings
- Aged
- Anastomosis, Roux-en-Y/adverse effects
- Anastomosis, Roux-en-Y/methods
- Constriction, Pathologic/etiology
- Constriction, Pathologic/surgery
- Endoscopy, Digestive System/instrumentation
- Endoscopy, Digestive System/methods
- Endosonography/methods
- Feasibility Studies
- Female
- Fluoroscopy/methods
- Gastric Bypass/instrumentation
- Gastric Bypass/methods
- Gastric Outlet Obstruction/etiology
- Gastric Outlet Obstruction/surgery
- Humans
- Intestinal Obstruction/etiology
- Intestinal Obstruction/surgery
- Neoplasm Recurrence, Local/complications
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Palliative Care/methods
- Pancreatic Neoplasms/complications
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Pancreaticoduodenectomy/instrumentation
- Pancreaticoduodenectomy/methods
- Self Expandable Metallic Stents
- Ultrasonography, Interventional/methods
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Ichter ZA, Voeller L, Rivas H, Khoury H, Azagury D, Morton JM. Buttressing of the EEA stapler during gastrojejunal anastomosis decreases rate of bleeding-related complications for laparoscopic gastric bypass. Surg Obes Relat Dis 2017; 13:802-806. [PMID: 28325504 DOI: 10.1016/j.soard.2017.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/15/2016] [Accepted: 01/01/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery is a well-tolerated and effective treatment for severe obesity. Newer surgical techniques and equipment have improved safety standards surrounding bariatric surgery. In particular, buttressing of the staple line in sleeve gastrectomy has decreased rates of clinically significant postoperative bleeding. The present study investigates the effectiveness of buttressing the circular stapled anastomosis during laparoscopic Roux-en-Y gastric bypass (LRYGB). SETTING Academic, accredited hospital. METHODS A total of 253 patients undergoing LRYGB at a single academic institution were included in this retrospective study between 2014 and 2015. Buttressing material was used in 125 of these cases. Demographic information was collected from both groups preoperatively. Surgical characteristics were also obtained analyzed using unpaired t or χ2 tests. RESULTS Patients in both buttressing and nonbuttressing groups were on average 46 years old and predominantly female (79.2% versus 74.2% female, respectively), with a body mass index of approximately 48 kg/m2. Postoperative weight loss did not significantly differ between groups at any time point (buttressing versus nonbuttressing percentage of excess weight loss: 39.5% versus 41.5% at 3 mo, P = .3860; 56.4% versus 56.7% at 6 mo, P = .9341). There were no significant differences for operating time, length of stay, readmissions, or reoperations. Complications due to strictures were found to be lower for the buttressing group (0% buttressing versus 2.3% nonbuttressing, P = .0851). Specific rates of bleeding-related complications were significantly lower for the group in which buttressing was used (0% buttressing versus 3.1% nonbuttressing, P = .0463). CONCLUSION Buttressing of the gastrojejunal anastomosis during LRYGB significantly reduces bleeding-related complications and increases tolerability of the procedure.
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Teoh AY, Ng EK, Chan SM, Lai M, Moran S, Binmoeller KF, Moon JH, Ho KY. Ex vivo comparison of the lumen-apposing properties of EUS-specific stents (with video). Gastrointest Endosc 2016; 84:62-8. [PMID: 26684601 DOI: 10.1016/j.gie.2015.11.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/25/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Several EUS-specific stents have become available. It has been claimed that some of these stents have lumen-apposing properties, but objective data measuring such properties are not available. The aim of this study is to measure the lumen-apposing force (LAF) of these stents. METHODS The LAF of 3 EUS-specific metallic stents (stents A, N, and S) were compared in an ex vivo setting. Four types of anastomoses were performed with the stents including cholecysto-duodenal, cholecysto-gastric, gastro-gastric, and gastro-jejunal and compared with a hand-sewn (HS) equivalent of the anastomosis. The outcome parameter was the LAF created by each type of stent. RESULTS Sixty-four anastomoses were created. The overall mean (standard deviation) LAFs were significantly higher for stents A and S (P < .001). This difference persisted regardless of the type of anastomosis: gastro-gastric (P = .002), gastro-jejunal (P = .005), cholecysto-gastric (P = .002), and cholecysto-jejunal (P = .003). The differences in LAF created by each type of stent across different types of anastomoses were also compared. A trend to significance was observed in the anastomoses created by stent N (P = .064) and stent A (P =.052); a significant difference in LAF was observed among different anastomoses created by stent S (P = .015). The LAF created by HS anastomosis was significantly higher than that for all stents across all anastomoses. CONCLUSIONS Stents A and S had a higher LAF. The use of these stents should be considered when performing EUS-guided transmural luminal anastomoses in non-adherent organs. Further studies are required to confirm the clinical efficacies of these EUS-specific stents.
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de Moura EGH, Orso IRB, Martins BC, Lopes GS. Endoscopic Therapeutic Option for Weight Loss and Control of Type 2 Diabetes: the Duodenal-Jejunal Bypass Liner. Surg Technol Int 2015; 26:115-119. [PMID: 26054998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
For a long time, obesity has been known as a risk factor for cardiovascular disease, which is one of the main causes of death in developed countries. This risk is due to the coexistence of other factors associated with obesity, such as hypertension, dyslipidemia, nonalcoholic fatty liver disease, and abnormalities in glycemic metabolism. Obesity is also a major risk factor for type 2 diabetes, and it is not surprising that the global prevalence of this disease continues to increase. Surgical intervention is now the most effective modality to treat severe obesity and its comorbidities. However, endoluminal interventions performed entirely through the gastrointestinal tract by using endoscopic devices offer the potential for an outpatient weight loss procedure that may be safer, less invasive, and more cost-effective, compared with current surgical approaches. Given the emerging role of endoscopic procedures in the treatment of obesity and rapid changes in endoscopic technologies and techniques, this review considers the current state of endoscopic management of obesity and type 2 diabetes. Endoscopic techniques attempt to mimic some of the anatomic features of bariatric surgery and rely on gastric restriction and duodenal exclusion. The endoscopic placement of the duodenal-jejunal bypass liner in morbidly obese patients induces significant weight loss. Additionally, early studies reported significant improvements in several parameters of glucose homeostasis in morbidly obese patients with type 2 diabetes. In this article we will review the available results obtained with the duodenal-jejunal bypass liner.
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Mazer-Amirshahi M, Bleecker ML, Barrueto F. Intraperitoneal elemental mercury exposure from a mercury-weighted bougie. J Med Toxicol 2014; 9:270-3. [PMID: 23619712 DOI: 10.1007/s13181-013-0303-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Significant exposure to elemental mercury can occur if a mercury-weighted medical device is damaged during use. We report a case of an elemental mercury spill into the peritoneum of a patient undergoing laparoscopic gastric bypass surgery. CASE REPORT A 64-year-old man with multiple comorbidities underwent an elective Roux-en-Y gastric bypass procedure for the treatment of morbid obesity. A mercury-weighted esophageal bougie was inadvertently used during construction of the anastomosis. A suture placed through the distal tip of the device caused elemental mercury to leak into the peritoneum. Two days later, the patient underwent another surgical procedure for removal of the mercury. Intermittent air measurements taken from the laparoscope exhaust showed a peak intraperitoneal mercury concentration of 98,169 ng/m³. Blood mercury levels peaked at 146 μg/L on day 22 after the exposure, and urine mercury concentrations peaked on day 43 at 227 μg/L. The patient had no evidence of acute toxicity, but he was found to have proteinuria on follow-up evaluation. DISCUSSION Patients can be exposed inadvertently to toxic amounts of elemental mercury when the integrity of medical devices is compromised. We encourage hospitals to discontinue the use of devices that contain mercury. Effective alternatives that do not pose exposure risks to patients or health care workers are readily available.
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Neff KJ, Miras AD, le Roux C. Duodenal-jejunal bypass liners: outcomes in glycaemic control and weight loss. Curr Opin Endocrinol Diabetes Obes 2013; 20:420-8. [PMID: 23974770 DOI: 10.1097/01.med.0000433057.84323.2e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Duodenal-jejunal bypass liners (DJBLs) are a novel therapy with potential treating a range of metabolic diseases. This review discusses the weight loss and glycaemic improvements observed following the use of the DJBL. RECENT FINDINGS We summarize the evidence for the clinical application of DJBL to date. Within this, we outline the evidence available on the mechanisms of the observed effects. SUMMARY Based on the most recent trials, we cannot fully mimic the clinical or physiological effects of bariatric surgery with this device, but we are getting closer.
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Song TJ, Seo DW, Kim SH, Park DH, Lee SS, Lee SK, Kim MH. Endoscopic gastrojejunostomy with a natural orifice transluminal endoscopic surgery technique. World J Gastroenterol 2013; 19:3447-3452. [PMID: 23801837 PMCID: PMC3683683 DOI: 10.3748/wjg.v19.i22.3447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/27/2013] [Accepted: 04/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the technical feasibility and safety of an endoscopic gastrojejunostomy with a pure natural orifice transluminal endoscopic surgery (NOTES) technique using a T-anchoring device in a porcine survival model.
METHODS: An endoscopic gastrojejunostomy with a pure NOTES technique using a T-anchoring device was performed on 10 healthy female minipigs weighing approximately 40 kg each under general anesthesia. All procedures were performed with a transgastric approach using a 2-channel therapeutic endoscope.
RESULTS: The transgastric gastrojejunostomy was technically successful in all cases. A total of four to six stitched pairs of a T-anchoring device were used to secure the anastomosis. The median time required to enter the peritoneal cavity and pull the small bowel into the stomach was 34 min (range: 19-41 min); the median time required to suture the anastomosis was 67 min (range: 44-78 min). An obstruction of the efferent limb occurred in one case, and a rupture of the anastomosis site occurred in another case. As a result, the functional success rate was 80% (8/10). Small bowel adhesion to the stomach and liver occurred in one case, but the anastomosis was intact without leakage or obstruction.
CONCLUSION: A transgastric gastrojejunostomy with a T-anchoring device may be safe and technically feasible. A T-anchoring device may provide a simple and effective endoscopic suturing method.
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Dakin GF, Eid G, Mikami D, Pryor A, Chand B. Endoluminal revision of gastric bypass for weight regain--a systematic review. Surg Obes Relat Dis 2013; 9:335-42. [PMID: 23561960 DOI: 10.1016/j.soard.2013.03.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 01/29/2013] [Accepted: 03/01/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND Weight recidivism after Roux-en-Y gastric bypass (RYGB) is a challenging problem for patients and bariatric surgeons alike. Traditional operative strategies to combat weight regain are technically challenging and associated with a high morbidity rate. Endoluminal interventions are thus an attractive alternative that may offer a good combination of results coupled with lower periprocedure risk that might one day provide a solution to this increasingly prevalent problem. The purpose of this article is to systematically review the available literature on endoluminal procedures used to address weight regain after RYGB, with specific attention to the safety profile, efficacy, cost, and current availability. This review focuses only on endoluminal procedures that are performed for weight regain after RYGB, as opposed to primary endoluminal obesity procedures. METHODS This study was a retrospective review. RESULTS Several methods of endoluminal intervention for weight regain are reviewed, ranging from injection of inert substances to suturing and clipping devices. The literature review shows the procedures on the whole to be well tolerated with limited efficacy. The majority of the literature is limited to small case series. Most of the reviewed devices are no longer commercially available. CONCLUSIONS Endoluminal therapy represents an intriguing strategy for weight regain after RYGB. However, the current and future technologies must be rigorously studied and improved such that they offer durable, repeatable, cost-effective solutions.
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Copăescu C. [Laparoscopic Roux-en Y gastric bypass]. Chirurgia (Bucur) 2012; 107:379-388. [PMID: 22844838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Jaskolka D, Brown N, Cohen E, Mounstephen W, Connolly B. Evaluating the implementation of a quality improvement initiative: weekend gastrojejunostomy tube maintenance service in a tertiary pediatric center. Can Assoc Radiol J 2012; 64:229-35. [PMID: 22503326 DOI: 10.1016/j.carj.2011.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/15/2011] [Accepted: 09/01/2011] [Indexed: 11/17/2022] Open
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Perzanowski C. Ventricular fibrillation resulting from diaphragmatic stimulation during gastric bypass surgery. Obes Facts 2012; 5:648-50. [PMID: 23108166 DOI: 10.1159/000343600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 11/30/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Gastric bypass operations are common and severely obese patients are prone to arrhythmias, particularly atrial fibrillation. Intraoperative ventricular arrhythmias during bariatric surgery have not been reported previously. CASE REPORT A 35-year-old, severely obese, diabetic woman with no other prior medical history underwent thorough preoperative cardiovascular evaluation before having laparoscopic Roux-en-Y gastric bypass. Intraoperatively she developed sudden onset ventricular fibrillation during the use of unipolar electrocautery near the Angle of His. The procedure was aborted, and the patient underwent repeat cardiovascular assessment including coronary angiography and serial electrophysiology studies before being unremarkably re-operated 6 months later, at which time a harmonic scalpel was used for dissection. 12 months post operation, the patient remains asymptomatic. CONCLUSION Owing to the proximity of the right ventricle overlying the diaphragm, far-field stimulation was likely responsible for inducing VF.
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Sandler BJ, Rumbaut R, Swain CP, Torres G, Morales L, Gonzales L, Schultz S, Talamini M, Horgan S. Human experience with an endoluminal, endoscopic, gastrojejunal bypass sleeve. Surg Endosc 2011; 25:3028-33. [PMID: 21487876 DOI: 10.1007/s00464-011-1665-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 03/11/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND This report describes the authors' experience with a unique endoluminal, endoscopically delivered and retrieved gastroduodenojejunal bypass sleeve, including short-term weight loss and changes in comorbidities. METHODS A prospective, single-center trial was designed. The patients were morbidly obese individuals who met the National Institutes of Health criteria for bariatric surgery. The device used was a unique gastroduodenojejunal bypass sleeve secured at the esophagogastric junction with endoscopic and laparoscopic techniques and designed to create an endoluminal gastroduodenojejunal bypass. At completion of the trial, the device was explanted with endoscopic retrieval. The primary end points were safety and incidence of adverse events. The secondary outcomes included the percentage of excess weight loss and changes in comorbidities, specifically glucose control, use of antihyperglycemic medications, and changes in hemoglobin A1c levels. RESULTS From July 2008 to February 2010, 24 patients were enrolled in the trial. The gastroduodenojejunal bypass sleeve was implanted, left in situ, and then retrieved. The 7 men and 17 women in the study had a mean preoperative body mass index of 42 kg/m(2). The device was successfully delivered in 22 of the 24 patients (92%) and retrieved endoscopically from all 22 patients in whom it was implanted (100%). Two patients were excluded from the study preprocedurally. The one patient was excluded preoperatively due to noncompliance with the preoperative liquid diet. For the other excluded patient, the device was not attempted endoscopically due to significant inflammation at the gastroesophageal junction at the time of laparoscopic evaluation. Of the 22 patients who had the device implanted, 17 maintained it (77%) and completed the full 12-week trial. These patients had 39.7% excess weight loss at completion of the study. The primary reason for early explantation of the device was early postoperative dysphagia. The seven patients with preoperative diabetes mellitus all had normal blood glucose levels throughout the trial, and none required antihyperglycemic medications. All four patients with elevated hemoglobin A1c levels preoperatively showed improvement by the end of the trial. CONCLUSIONS This trial demonstrated that the endoluminal gastroduodenojejunal sleeve can achieve excellent weight loss at 12 weeks. No patient safety issues were encountered. Adverse effects were minimal and resolved at endoscopic device removal. Effective glycemic control was demonstrated through use of the device during the trial. Long-term results are needed.
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Kalina M, Giberson F. A novel use of a gastrojejunostomy tube for duodenal diversion after traumatic duodenal injury. Am Surg 2011; 77:361-362. [PMID: 21375854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Sundbom M, Wanhainen A, Hedberg J, Ljungman C, Haglund U. [Aortic injury--uncommon but severe complication of gastric bypass. Bariatric surgery can cause life-threatening hemorrhage, shown by three case reports]. LAKARTIDNINGEN 2011; 108:146-149. [PMID: 21365819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Copăescu C. [Laparoscopic gastric plication at the greater curvature (for treatment of morbid obesity)]. Chirurgia (Bucur) 2011; 106:91-97. [PMID: 21523962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Snyder BE, Wilson T, Leong BY, Klein C, Wilson EB. Robotic-assisted Roux-en-Y Gastric bypass: minimizing morbidity and mortality. Obes Surg 2009; 20:265-70. [PMID: 19885708 DOI: 10.1007/s11695-009-0012-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 10/07/2009] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the rapid acceptance of laparoscopic Roux-en-Y gastric bypass (RYGB) by the community and increase in the number of these procedures being done, there is still significant morbidity and mortality. METHODS At the University of Texas Medical School at Houston, we have performed 320 RYGB with robotic assistance (RARYGB). Surgical times, length of stay, morbidity, and mortality have been recorded since the beginning of our robotic experience and represent the world's largest single institution series of RARYGB. Outcome data were examined in a postoperative cohort. RESULTS The average starting BMI was 49.1 kg/m(2), and it declined by 66% to 32.5 kg/m(2) by the end of 1 year. The average operative time was 192 min, and the average length of stay was 2.7 days. Within the first year, there were a total of 77 (24.1%) complications. The foremost complications noted in the literature to be 3% to 11% were all <1% in our series, and we have no mortalities. Compared to our 356 laparoscopic RYGB, there was a significantly lower gastrointestinal leak rate in the robotic arm. A cohort of 79 postoperative patients was analyzed with respect to weight loss, resolution of co-morbidity, and quality of life. While there was no variation in quality of life over time, weight loss, resolution of co-morbidities, and overall outcome score were significantly improved. CONCLUSIONS We effectively perform robotic-assisted RYGB that lowers the morbidity and mortality of this procedure compared to today's standard while maintaining thriving outcomes.
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Salgado Júnior W, Macedo Neto MM, dos Santos JS, Sakarankutty AK, Ceneviva R, de Castro e Silva Jr O. Study of the patency of different peritoneal drains used prophylactically in bariatric surgery. World J Gastroenterol 2009; 15:2340-4. [PMID: 19452575 PMCID: PMC2684599 DOI: 10.3748/wjg.15.2340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 04/13/2009] [Accepted: 04/20/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the performance of different types of abdominal drains used in bariatric surgery. METHODS A vertical banded Roux-en-Y gastric bypass was performed in 33 morbidly obese patients. Drainage of the peritoneal cavity was performed in each case using three different types of drain selected in a randomized manner: a latex tubular drain, a Watterman tubulolaminar drain, and a silicone channeled drain. Drain permeability, contamination of the drained fluid, ease of handling, and patient discomfort were evaluated postoperatively over a period of 7 d. RESULTS The patients with the silicone channeled drain had larger volumes of drainage compared to patients with tubular and tubulolaminar drains between the third and seventh postoperative days. In addition, a lower incidence of discomfort and of contamination with bacteria of a more pathogenic profile was observed in the patients with the silicone channeled drain. CONCLUSION The silicone channeled drain was more comfortable and had less chance of occlusion, which is important in the detection of delayed dehiscence.
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