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Allotey J, Caposole M, Attia A, Coonan E, Noguera V, Lewis E, Bloomenthal MS, Issa P, Omar M, Aboueisha M, Crisp B, Baker J, Levy S, Galvani C. GERD-screening before bariatric surgery: the predictive value of the GERD-HRQL questionnaire score compared with preoperative EGD findings. Surg Endosc 2023; 37:9572-9581. [PMID: 37730853 DOI: 10.1007/s00464-023-10388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/12/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND There is an ongoing debate on how to best identify patients with gastroesophageal reflux disease (GERD) before bariatric surgery. The value of routine preoperative esophagogastroduodenoscopy (EGD) is questioned, and patient reported symptoms are commonly used for screening. The goal of this study is to determine if patient reported symptoms using a validated questionnaire correlate with preoperative EGD findings. METHODOLOGY A prospective cohort study at a single institution was performed. Patients undergoing bariatric surgery between December 2020 and March 2023 were required to report symptoms of reflux by completing a preoperative GERD. Health-Related Quality of Life (GERD-HRQL) questionnaire and undergo a mandatory preoperative screening EGD. Patients were stratified into two cohorts: (group A) asymptomatic (score = 0) and (group B) symptomatic (score > 0). Statistical analysis was conducted using Pearson's chi-squared test and Wilcoxon rank-sum test in RStudio version 4.2.2. The predictive value of the GERD-HRQL score was analyzed using Areas Under the Curve (AUC; AUC = 0.5 not predictive, 0.5 < AUC ≥ 6 poor prediction & AUC > 0.9 excellent prediction) calculated from Receiver Operating Characteristic (ROC) curves. RESULTS 200 patients were included; median age was 42.0 years (IQR 36.0 to 49.2). There were 79 patients (39.5%) in Group A and 121 patients (60.5%) in Group B. There was no difference in the frequency esophagitis (27.8% vs 32.2%, p = 0.61) or hiatal hernias (49.4% vs 47.1%, p = 0. 867) between group A and group B, respectively. ROC analysis revealed that the total GERD HRQL scores, heartburn only scores and regurgitation only scores, were poor predictors of esophagitis found on EGD (AUC 0.52, 0.53, 0.52), respectively. In asymptomatic patients, higher BMI was significantly associated with esophagitis (OR 1.15, 95% CI 1.06-1.27, p = 0.002). CONCLUSION Symptoms, identified through the GERD-HRQL questionnaire, are a poor indicator of esophagitis or its severity in patients undergoing workup for bariatric surgery. Therefore, liberal screening upper endoscopy is recommended for pre-bariatric surgery patients to guide appropriate procedure selection.
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Affiliation(s)
- Jonathan Allotey
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Michael Caposole
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Abdallah Attia
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Erin Coonan
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Valeria Noguera
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Emma Lewis
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Molly S Bloomenthal
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Peter Issa
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Mahmoud Omar
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Mohamed Aboueisha
- Division of Otolaryngology- Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin Crisp
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - John Baker
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Shauna Levy
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Carlos Galvani
- Division of Bariatric and MIS, Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA.
- Division of Minimally Invasive Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
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2
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Doukas SG, Doukas PG, Vageli DP, Broder A. Gastric cancer after Bariatric Bypass Surgery. Do they relate? (A Systematic Review). Obes Surg 2023; 33:1876-1888. [PMID: 37041375 DOI: 10.1007/s11695-023-06567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
Bariatric bypass surgery has been an effective treatment for morbid obesity. However, there is an increasing number of reported cases of gastric cancer after bypass surgery. Our systematic review showed an increasing trend of gastric cancer cases after bariatric bypass surgery in the last decade, mostly located in the excluded stomach (77%) and diagnosed in an advanced stage. In addition to known risk factors such as tobacco smoking (17%), H. pylori infection (6%), and family history of gastric cancer (3%), bile reflux, a recently proposed cancer-promoting factor, was also estimated in 18% of the cases. Our data suggest that gastric cancer risk assessment should be considered before gastric bypass surgery, and further investigations are needed to determine the value of post-operative gastric cancer surveillance.
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Affiliation(s)
- Sotirios G Doukas
- Department of Medicine, Division of Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers-RWJ Medical School, 254 Easton Avenue, New Brunswick, NJ, 08901, USA.
| | - Panagiotis G Doukas
- Departmengt of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Dimitra P Vageli
- Departmengt of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Arkady Broder
- Department of Medicine, Division of Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers-RWJ Medical School, 254 Easton Avenue, New Brunswick, NJ, 08901, USA
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3
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De Simone B, Chouillard E, Ramos AC, Donatelli G, Pintar T, Gupta R, Renzi F, Mahawar K, Madhok B, Maccatrozzo S, Abu-Zidan FM, E Moore E, Weber DG, Coccolini F, Di Saverio S, Kirkpatrick A, Shelat VG, Amico F, Pikoulis E, Ceresoli M, Galante JM, Wani I, De' Angelis N, Hecker A, Sganga G, Tan E, Balogh ZJ, Bala M, Coimbra R, Damaskos D, Ansaloni L, Sartelli M, Pararas N, Kluger Y, Chahine E, Agnoletti V, Fraga G, Biffl WL, Catena F. Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines. World J Emerg Surg 2022; 17:51. [PMID: 36167572 PMCID: PMC9516804 DOI: 10.1186/s13017-022-00452-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. METHOD A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. CONCLUSIONS The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy-Ile de France, France.
| | - Elie Chouillard
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy-Ile de France, France
| | - Almino C Ramos
- GastroObesoCenter Institute for Metabolic Optimization, Sao Paulo, Brazil
| | - Gianfranco Donatelli
- Interventional Endoscopy and Endoscopic Surgery, Hôpital Privé Des Peupliers, Paris, France
| | - Tadeja Pintar
- Department of Abdominal Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Rahul Gupta
- Division of Minimally Invasive Surgery and Bariatrics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Federica Renzi
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milano, Milan, Italy
| | - Kamal Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Brijesh Madhok
- East Midlands Bariatric and Metabolic Institute, University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | - Stefano Maccatrozzo
- Department of Bariatric Surgery, Istituto Di Cura Beato Matteo, Vigevano, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Ernest E Moore
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna Del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Andrew Kirkpatrick
- Department of General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Francesco Amico
- Department of Surgery, John Hunter Hospital and The University of Newcastle, Newcastle, MSW, Australia
| | - Emmanouil Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Joseph M Galante
- University of California, Davis 2315 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | - Nicola De' Angelis
- Service de Chirurgie Digestive Et Hépato-Bilio-Pancréatique - DMU CARE, Hôpital Henri Mondor, Paris, France
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edward Tan
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Luca Ansaloni
- Department of Surgery, Pavia University Hospital, Pavia, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Nikolaos Pararas
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Elias Chahine
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy-Ile de France, France
| | - Vanni Agnoletti
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Gustavo Fraga
- School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Walter L Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
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Preoperative Assessment of Patients Undergoing Bariatric Sleeve Gastrectomy: A Cross-Sectional Study. Gastroenterol Res Pract 2022. [DOI: 10.1155/2022/3622119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction. Saudi Arabia (SA) is one of the top countries in the world when it comes to the number of bariatric procedures performed each year. There is still some debate on whether to do regular or selective upper endoscopy during the preoperative examination. The purpose of this study was to explore various endoscopic findings and Helicobacter pylori (HP) infection in symptomatic and asymptomatic patients having laparoscopic sleeve gastrectomy (LSG) prior to surgery. Methods. We investigated a cohort of 132 patients referred to the endoscopy unit from the bariatric surgery outpatient clinic for prebariatric esophagogastroduodenoscopy (EGD) as a part of preoperative LSG. Data extraction from medical records included clinical data such as body mass index (BMI), gastrointestinal symptoms (that include heartburn, regurgitation, epigastric pain, and nausea), medical comorbidities, and laboratory investigations. It included data about the endoscopic findings of EGD procedure as esophageal, gastric, and duodenal findings results as well as the results of biopsy specimens that were taken. Results. Out of 132 patients, 29 (22%) had a BMI of less than 40 kg/m2 whereas 103 (78%) had a BMI of 40 kg/m2 or above, with an average of
kg/m2. The average age of participants was
years. HP was detected in 36 patients (35.0%) with a slightly greater prevalence in patients with a higher BMI (33.7%) than in patients with lower BMI (35.0%). Collectively, 73 patients (55.7%) had positive endoscopic findings of various grades, sites, and combinations. Incompetent cardia (35.6%) was the most often seen esophageal finding, antral gastritis (34.1%) was the most frequently encountered gastric finding, and duodenitis 1st part was the commonest duodenal endoscopic finding (7.8%). Among asymptomatic patients, incompetent cardia was detected in 33.3%, antral gastritis was found in 30.1%, and around one-quarter of them were positive on HP testing (26.6%). Additionally, 16.1% of them had signs of reflux esophagitis, 17.2% had hiatal hernia, and 14.0% had nodular gastritis. Conclusion. The current study revealed a high prevalence of positive endoscopic findings as well as HP infection upon routine endoscopic examination among patients undergoing bariatric surgery even those who were asymptomatic from any gastrointestinal symptoms.
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Hajifathalian K, Mehta A, Ang B, Skaf D, Shah SL, Saumoy M, Dawod Q, Dawod E, Shukla A, Aronne L, Brown RS, Cohen DE, Dannenberg AJ, Fortune B, Kumar S, Sharaiha RZ. Improvement in insulin resistance and estimated hepatic steatosis and fibrosis after endoscopic sleeve gastroplasty. Gastrointest Endosc 2021; 93:1110-1118. [PMID: 32861753 DOI: 10.1016/j.gie.2020.08.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States and is closely associated with obesity and insulin resistance (IR). Weight loss is the best treatment for NAFLD. Endoscopic sleeve gastroplasty (ESG) is a promising endoscopic procedure for treatment of obesity. Our aim is to evaluate the change in IR and estimated hepatic steatosis and fibrosis after ESG. METHODS One hundred eighteen patients with obesity and NAFLD underwent ESG and were followed for 2 years. Weight loss was evaluated as % total body weight loss. IR was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). The previously validated hepatic steatosis index and NAFLD fibrosis score were used to estimate hepatic steatosis and risk of fibrosis. RESULTS Patients' mean body mass index was 40 ± 7 kg/m2 at baseline. Eighty-four percent of patients completed 2 years of follow-up. At 2 years, the mean total body weight loss was 15.5% (95% confidence interval, 13.3%-17.8%). Patients' HOMA-IR improved significantly from 6.7 ± 11 to 3.0 ± 1.6 after only 1 week from ESG (P = .019) with continued improvement up to 2 years (P = .03). Patients' hepatic steatosis index score improved significantly, decreasing by 4 points per year (P for trend, <.001). Patients' NAFLD fibrosis score improved significantly, decreasing by 0.3 point per year (P for trend, .034). Twenty-four patients (20%) improved their risk of hepatic fibrosis from F3-F4 or indeterminate to F0-F2, whereas only 1 patient (1%) experienced an increase in the estimated risk of fibrosis (P = .02). CONCLUSIONS Our results suggest a significant and sustained improvement in estimated hepatic steatosis and fibrosis after ESG in patients with NAFLD. Importantly, we showed an early and weight-independent improvement in insulin resistance, which lasted for 2 years after the procedure.
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Affiliation(s)
- Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Amit Mehta
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Bryan Ang
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Daniel Skaf
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Shawn L Shah
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Monica Saumoy
- Gastroenterology and Hepatology Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Qais Dawod
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Enad Dawod
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Alpana Shukla
- Division of Endocrinology Diabetes and Metabolism, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Louis Aronne
- Division of Endocrinology Diabetes and Metabolism, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - David E Cohen
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Andrew J Dannenberg
- Department of Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Brett Fortune
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Sonal Kumar
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
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Komaei I, Currò G, Mento F, Cassaro G, Lazzara C, Barbera A, Ammendola M, Alibrandi A, Navarra G. Gastric Histopathologic Findings in South Italian Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: Is Histopathologic Examination of All Resected Gastric Specimens Necessary? Obes Surg 2021; 30:1339-1346. [PMID: 31713151 DOI: 10.1007/s11695-019-04272-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The value of the routine histopathologic examination of resected gastric remnants following laparoscopic sleeve gastrectomy (LSG) remains to be controversial. This study aimed to determine whether the routine histopathologic examination of gastric specimens is necessary for all patients undergoing LSG if upper gastrointestinal endoscopy (UGIE) plus multiple biopsies are performed routinely during the preoperative work-up. MATERIALS AND METHODS Clinicopathologic data of 474 patients who underwent LSG were analysed. Types of histopathologic findings in LSG specimens and the prevalence of these and Helicobacter pylori (HP) infection were estimated. Comparisons were conducted to assess the association of risk factors with the most frequent abnormal and premalignant histopathologic findings. RESULTS Chronic gastritis was the most common gastric pathology (63.5%) and premalignant lesions were present in 7.8% of the specimens. The prevalence of HP infection was 36.9%. A statistically significant association was observed between HP infection and chronic gastritis (P = .000), and premalignant lesions (P = .000). Similarly, a statistically significant association was noted between age and premalignant gastric lesions (P = .000). CONCLUSION Histopathologic examination of LSG specimens may not be routinely needed and can be performed on selected patients. While we recommend routine preoperative UGIE in all LSG-treated patients, we suggest that histopathologic assessment of the LSG specimens should be mandatory when UGIE biopsies demonstrate HP infection and/or premalignant lesions, in all patients older than 42 years, and in cases of intraoperative detection of incidental tumours or suspicious lesions.
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Affiliation(s)
- Iman Komaei
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Giuseppe Currò
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy. .,Department of Health Sciences, General Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Federica Mento
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Gabriele Cassaro
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Claudio Lazzara
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Adalberto Barbera
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Michele Ammendola
- Department of Health Sciences, General Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Giuseppe Navarra
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
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7
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Nowak K, Di Palma A, Chieu K, Quereshy F, Jackson T, Okrainec A, Serra S, Chetty R. Histologic and Cost-Benefit Analysis of Laparoscopic Sleeve Gastrectomy Specimens Performed for Morbid Obesity. Arch Pathol Lab Med 2021; 145:365-370. [PMID: 32649836 DOI: 10.5858/arpa.2020-0084-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Laparoscopic sleeve gastrectomy (LSG) has quickly become the bariatric surgical procedure of choice for patients with obesity who have failed medical management. Laparoscopic sleeve gastrectomy results in a gastric remnant that is routinely subject to pathologic examination. OBJECTIVE.— To perform a histologic and cost-benefit analysis of gastric remnants post-LSG. DESIGN.— All LSG cases performed at University Health Network, Toronto, Ontario, Canada, between 2010 and 2019 were reviewed. Specimens that underwent routine histopathologic assessment and ancillary immunohistochemical analysis were analyzed. Baseline patient characteristics and surgical outcomes were obtained from our internal database. The total cost of specimen gross preparation, examination, sampling, and producing and reporting a hematoxylin-eosin slide was calculated. RESULTS.— A total of 572 patients underwent LSG during the study period and had their specimens examined histologically. A mean of 4.87 blocks generating 4 hematoxylin-eosin slides was produced. The most common histologic findings reported in LSG specimens ranged from no pathologic abnormalities identified together with proton pump inhibitor-related change. A minority of cases demonstrated clinically actionable histologic findings, of which Helicobacter pylori infection was the most common. The total cost for the complete pathologic analysis of these cases amounted to CaD $66 383.10 (US $47 080.21) with a mean of CaD $116.05 (US $82.40) per case. A total of CaD $62 622.75 (US $44 413.30) was spent on full examination of cases that had no further postoperative clinical impact. CONCLUSIONS.— There is a broad spectrum of pathologic findings in LSG specimens, ranging from clinically nonactionable to more clinically actionable. The vast majority of histologic findings had no clinical impact, with only a minority of cases being clinically significant. This study therefore recommends that LSG specimens be subject to gross pathologic examination in the vast majority of cases. However, sections should be submitted for microscopic analysis if grossly evident lesions are present and if there is a clinical/known history of clinically actionable findings.
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Affiliation(s)
- Klaudia Nowak
- From the Division of Anatomical Pathology, Laboratory Medicine Program (Nowak, Chieu, Serra, Chetty)
| | - Adam Di Palma
- and the Division of General Surgery (Di Palma, Quereshy, Jackson, Okrainec), Toronto, Ontario, Canada
| | - Kenny Chieu
- From the Division of Anatomical Pathology, Laboratory Medicine Program (Nowak, Chieu, Serra, Chetty)
| | - Fayez Quereshy
- and the Division of General Surgery (Di Palma, Quereshy, Jackson, Okrainec), Toronto, Ontario, Canada
| | - Timothy Jackson
- and the Division of General Surgery (Di Palma, Quereshy, Jackson, Okrainec), Toronto, Ontario, Canada
| | - Allan Okrainec
- and the Division of General Surgery (Di Palma, Quereshy, Jackson, Okrainec), Toronto, Ontario, Canada
| | - Stefano Serra
- From the Division of Anatomical Pathology, Laboratory Medicine Program (Nowak, Chieu, Serra, Chetty)
| | - Runjan Chetty
- From the Division of Anatomical Pathology, Laboratory Medicine Program (Nowak, Chieu, Serra, Chetty).,University Health Network and University of Toronto, Toronto, Ontario, Canada
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Donatelli G, Spota A, Cereatti F, Granieri S, Dagher I, Chiche R, Catheline JM, Pourcher G, Rebibo L, Calabrese D, Msika S, Dammaro C, Tranchart H, Lainas P, Tuszynski T, Pacini F, Arienzo R, Chevallier JM, Trelles N, Lazzati A, Paolino L, Papini F, Torcivia A, Genser L, Arapis K, Soprani A, Randone B, Chosidow D, Bouillot JL, Marmuse JP, Dumont JL. Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients. Surg Obes Relat Dis 2021; 17:1432-1439. [PMID: 33931322 DOI: 10.1016/j.soard.2021.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. OBJECTIVES To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. SETTING Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. METHODS EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)-guided deployment of DPS or lumen apposing metal stents. RESULTS A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). CONCLUSION Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France.
| | - Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milano, Italy
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Viale Concordia 1, Cremona, Italy
| | | | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Renaud Chiche
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Guillaume Pourcher
- Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Lionel Rebibo
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Daniela Calabrese
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Simon Msika
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Carmelisa Dammaro
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
| | - Filippo Pacini
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Roberto Arienzo
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Jean-Marc Chevallier
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Nelson Trelles
- Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France
| | - Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luca Paolino
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Federica Papini
- Service de Chirurgie Digestive, Group Hospitalier Nord-Essonne Site d'Orsay, Orsay, France
| | - Adriana Torcivia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Laurent Genser
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Kostas Arapis
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Antoine Soprani
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Bruto Randone
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Denis Chosidow
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Jean-Luc Bouillot
- Service de chirurgie digestive et obésité, hôpital Paris Saint-Joseph, Paris, France
| | | | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
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Temperley L, Sullivan A, Ruban A. Bariatric surgery and the endoscopist. Frontline Gastroenterol 2020; 12:683-689. [PMID: 34917327 PMCID: PMC8640407 DOI: 10.1136/flgastro-2020-101681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/04/2023] Open
Abstract
Bariatric surgery is an effective treatment for obesity and its metabolic related disorders. With the numbers of bariatric procedures being performed rising annually endoscopists are now more likely than ever to encounter this patient cohort on routine diagnostic lists. Endoscopy plays a vital role in both the pre and postoperative periods to diagnose and treat certain complications associated with bariatric surgery. Preoperative endoscopy may be useful in identifying pathologies that then influence the type of bariatric surgery being proposed. Postoperative endoscopy has an established role in identifying and managing complications such as anastomotic leaks and gastrointestinal bleeding. As endoscopic techniques develop, these complications may be managed without the need for surgical intervention or revision. Increased knowledge and awareness of the indications for endoscopy, together with the altered anatomy and common complications of bariatric surgery, is paramount in managing these patients effectively.
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Affiliation(s)
- Laura Temperley
- Clinical Fellow, Hepatology, King's College Hospital, London, UK
| | - Andrew Sullivan
- Clinical Fellow, Cardiology, Barts Health NHS Trust, London, UK
| | - Aruchuna Ruban
- Consultant Gastroenterologist, Imperial College Healthcare NHS Trust, London, UK
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Hiatal Hernia Evaluation Before Bariatric Surgery: Should It Be Routinely Done? Obes Surg 2020; 31:1013-1020. [PMID: 33130945 DOI: 10.1007/s11695-020-05092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The necessity of routine preoperative esophagogastroduodenoscopy (EGD) and upper gastrointestinal series (UGIS) in the evaluation of hiatal hernia (HH) among bariatric surgery candidates is controversial since most are detected during surgery, regardless of the preoperative work-up. The aim is to determine the accuracy of preoperative EGD and UGIS for HH diagnosis among bariatric surgery candidates. MATERIAL AND METHODS The records of bariatric surgery patients between 2011 and 2015 were reviewed. Patients underwent routine UGIS and/or EGD before the surgery. The positive and negative predictive values (PPV, NPV) for each study were calculated based on operative findings. RESULTS A total of 463 patients were included in the study. Mean age was 44.34 ± 12.99 years. Mean preoperative body mass index (BMI) was 42.7 ± 5.15 kg/m2. A total of 450 patients (97.2%) had a UGIS, 263 patients underwent EGD (56.8%), and 258 (55.7%) patients had both tests. HH was diagnosed in 26 (5.8%), 60 (13%), and 72 (27.8%) patients, respectively. HH was found intra-operatively in 53 patients (11.4%). It was associated with heartburn (P = 0.005) and previous bariatric surgery (P = 0.008). EGD had a greater sensitivity than UGIS (47.4% vs. 30.2%) and a lower specificity (81.4% vs. 97.5%). PPV and NPV for UGIS and EGD were 61.5% and 91.3% vs. 30% and 90.2%, respectively. The sensitivity of both tests when combined together reached 60.5%. CONCLUSIONS Both EGD and UGIS, whether solely performed or combined, have low sensitivity for diagnosis of HH and can probably be omitted from the preoperative evaluation, except for high-risk patients.
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11
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Xavier AT, Alvares AV, Iyer PG, Arantes VN. Unsedated Transnasal Endoscopy for Preoperative Examination of Bariatric Patients: a Prospective Study. Obes Surg 2020; 30:238-243. [PMID: 31377993 DOI: 10.1007/s11695-019-04120-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Esophagogastroduodenoscopy is a preoperative examination commonly required for candidates to bariatric surgery (BS). Overweight individuals have a greater risk of cardiorespiratory complications during endoscopy under sedation. This study aimed to investigate the feasibility, tolerance, and cardiovascular stress of transnasal endoscopy (TNE) without sedation in obese patients eligible for BS. METHODS This prospective study enrolled obese adult patients with indication for BS that consented to undergo unsedated preoperative TNE. All examinations were carried out in an outpatient center. The outcomes assessed were endoscopic findings, procedural success, patients' tolerance according to a visual analogic scale, cardiovascular stress estimated by double product (i.e., systolic blood pressure × heart rate) and adverse events. Statistical analyses were used to compare each patient's double product among different examination periods. RESULTS Ninety-four patients (77.6% female) completed the study, with an average body mass index (BMI) of 53 kg/m2 (range, 35-73.4 kg/m2). There were 63 super-obese individuals (67%), with BMI > 50 kg/m2. In 93 patients (98.9%), unsedated TNE was successfully completed up to the second part of the duodenum. TNE failed in one patient. Tolerance was rated as excellent or good in 95.7%. Minimal cardiovascular stress was noted in obese individuals, whereas the double product remained stable throughout the procedure in super-obese patients. Three patients (3.2%) had self-limited epistaxis. CONCLUSIONS Unsedated TNE for preoperative endoscopic evaluation of obese patients is feasible, safe, and well tolerated and should be preferentially considered when examining super-obese patients.
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Affiliation(s)
- Amaury Teixeira Xavier
- Endoscopy Unit, Alfa Institute of Gastroenterology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil. .,Instituto Alfa de Gatroenterologia, Universidade Federal de Minas Gerais - Medicine, Avenida Professor Alfredo Balena, 110, Santa Efigenia, Belo Horizonte, Minas Gerais, 30130-100, Brazil.
| | - Arthur V Alvares
- Endoscopy Unit, Military Hospital of Minas Gerais, Belo Horizonte, Brazil
| | - Prasad G Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
| | - Vitor N Arantes
- Endoscopy Unit, Alfa Institute of Gastroenterology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Mundi MS, Velapati S, Patel J, Kellogg TA, Abu Dayyeh BK, Hurt RT. Evolution of NAFLD and Its Management. Nutr Clin Pract 2019; 35:72-84. [PMID: 31840865 DOI: 10.1002/ncp.10449] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The global prevalence of nonalcoholic fatty liver disease (NAFLD) is estimated to be 25% and continues to rise worldwide in the setting of the obesity epidemic. This increase is especially concerning because NAFLD is often a progressive disease that can be associated with significant complications such as liver cirrhosis, hepatocellular carcinoma, and an increase in liver-related and overall mortality. Because of the devastating complications and comorbidities, NAFLD is a very costly disease for the healthcare system, with estimated annual direct medical costs exceeding $100 billion in the United States alone. Given this progressive course, it is imperative to make the diagnosis in patients with risk factors (metabolic syndrome, weight gain, and insulin resistance/diabetes). Once the diagnosis is made, the focus should shift to treatment and monitoring for the development of associated complications. Given that currently no pharmaceutical intervention is approved for the treatment of NAFLD, focus shifts instead to mitigation of risk factors through avoidance of foods that are rich in red meat, trans fats, refined carbohydrates, and high-fructose corn syrup; are low fiber; and have high energy density. The landmark of treatment, however, continues to be weight loss and improvement of insulin resistance, often through a multimodality approach. The current manuscript reviews the clinical phenotypes of NAFLD, its risk factors, and pathogenesis, as well as treatment options including lifestyle modifications and dietary interventions, medical therapies, endoscopic bariatric interventions, and bariatric surgery.
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Affiliation(s)
- Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Saketh Velapati
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Janki Patel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Todd A Kellogg
- Division of Breast, Endocrine, Metabolic, and GI surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.,Division of Breast, Endocrine, Metabolic, and GI surgery, Mayo Clinic, Rochester, Minnesota, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.,Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, Kentucky, USA
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13
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Granata A, Amata M, Ligresti D, Martino A, Tarantino I, Barresi L, Traina M. Endoscopic management of post-surgical GI wall defects with the overstitch endosuturing system: a single-center experience. Surg Endosc 2019; 34:3805-3817. [PMID: 31583467 DOI: 10.1007/s00464-019-07145-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Post-GI surgical wall defects are frequent and life-threatening complications, with limited literature regarding current treatment. This case series aims to assess the safety, feasibility, and outcomes of endoluminal therapy with the overstitch endoscopic suturing system (Apollo Endosurgery Inc, Austin). MATERIALS AND METHODS All patients who underwent endoscopic suturing for post-surgical wall defect management at IRCCS-ISMETT Palermo from October 2017 until January 2019 were retrospectively enrolled. Stratification therapy was applied according to the clinical scenario, time from surgery to endoscopic intervention, and structural condition of the wall defect layers (tissue status and suture feasibility). The therapeutic endoscopic strategy was divided into three groups (A: pure endoscopic direct suture; B: combined therapy with endoscopic direct suture + FC-SEMS placement + anchoring; C: FC-SEMS placement + anchoring). Success was considered the resolution of symptoms and the presence of a regular intestinal transit after a period of 4-6 weeks. RESULTS Twenty (20) patients (male/female 7/13; mean age 54 ± 13.43 years) were included in the study (group A: 9 patients, group B: 7 patients, group C: 4 patients). The types of operative procedures were bariatric (9/20), post-tracheostomy (3/20), post-operative GI surgery (8/20). The post-surgical defects were predominantly intermediate and chronic (24-72 h: 1/20; 3-30 days: 13/20; > 30 days: 6/20). The overall clinical success was 80% (17/20 patients), with a success of 94% (16/17 patients) when excluding the three cases of tracheo-esophageal fistula. No evidence of migration was detected. The only complication was short stenosis of the distal esophagus, present in 4 patients (19%) and successfully treated with a novel lumen-apposing metal stent. CONCLUSIONS In our experience, considering the absence of clear guidelines, the endoluminal approach with the overstich endoscopic suturing system is a valid alternative to conventional therapy, offering mini-invasiveness, and presenting promising opportunities in terms of technical feasibility and clinical efficacy.
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Affiliation(s)
- Antonino Granata
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Via Tricomi 5, 90127, Palermo, Italy
| | - Michele Amata
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Via Tricomi 5, 90127, Palermo, Italy.
| | - Dario Ligresti
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Via Tricomi 5, 90127, Palermo, Italy
| | - Alberto Martino
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Via Tricomi 5, 90127, Palermo, Italy
| | - Ilaria Tarantino
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Via Tricomi 5, 90127, Palermo, Italy
| | - Luca Barresi
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Via Tricomi 5, 90127, Palermo, Italy
| | - Mario Traina
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Via Tricomi 5, 90127, Palermo, Italy
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Arieira C, Boal Carvalho P, Dias de Castro F, Cotter J. Esophagogastroduodenoscopy Findings in Patients on the Waiting List for Bariatric Surgery. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:389-395. [PMID: 31832493 PMCID: PMC6876606 DOI: 10.1159/000495770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bariatric surgery (BS) is one of the most effective approaches to weight loss. Performing esophagogastroduodenoscopy (EGD) prior to BS is controversial but allows the detection and treatment of mucosal lesions that may affect surgical decision and type of surgery. AIM The aim of this study was to identify the frequency of gastric lesions and Helicobacter pylori (Hp) infection in a group of asymptomatic patients on the waiting list for BS. METHODS This is a retrospective descriptive study including patients undergoing EGD before BS. RESULTS A total of 360 patients were included with a mean age of 42.1 ± 10.8 years, 319 (88.6%) were females, with a mean body mass index of 42.8 ± 5.44 kg/m2. Regarding endoscopic findings, 25.6% presented no endoscopic lesions, 61.6% presented hyperemic gastropathy, 11.4% erosive gastropathy, 1.1% gastric polyp, and 0.3% gastric ulcer. Histologically, no changes were observed in 20.8% of the patients, 239 (66.4%) presented with superficial gastritis, 11.7% (n = 42) had chronic atrophic gastritis and intestinal metaplasia (n = 34 in the antrum, n = 1 in the body, and n = 7 in both the antrum and the body), and 1.7% (n = 6) had low-grade dysplasia. Hp was positive in 251 (69.7%) patients. We found that patients with metaplasia or dysplasia were more frequently submitted to surgical techniques that did not exclude the stomach (55.8 vs. 16.4%, p < 0.001). CONCLUSION EGD with histological analysis plays an important role in the pre-surgical evaluation in BS, with a high rate of pathological findings in asymptomatic patients. These findings may have an impact on the long-term management and outcomes of these patients.
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Affiliation(s)
- Cátia Arieira
- *Cátia Arieira, Hospital da Senhora da Oliveira, Rua dos Cutileiros, Creixomil, PT-4835-044 Guimarães (Portugal), E-Mail
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Gedeon M, Gomes S, Roy K, Duclos-Miller P, Rose JS. Use of noninvasive positive pressure ventilation in patients with severe obesity undergoing esophagogastroduodenoscopy: a randomized controlled trial. Surg Obes Relat Dis 2019; 15:1589-1594. [DOI: 10.1016/j.soard.2019.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/21/2019] [Indexed: 01/09/2023]
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Nasal positive pressure with the SuperNO 2VA™ device decreases sedation-related hypoxemia during pre-bariatric surgery EGD. Surg Endosc 2019; 33:3828-3832. [PMID: 30805788 DOI: 10.1007/s00464-019-06721-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/20/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Pre-operative esophagogastroduodenoscopy (EGD) is becoming routine practice in patients undergoing bariatric surgery. Many patients with morbid obesity have obstructive sleep apnea (OSA), which can worsen hypoxia during an EGD. In this study, we report our outcomes using the SuperNO2VA™ device, a sealed nasal positive airway pressure mask designed to deliver high-fraction inhaled oxygen and titratable positive pressure compared to conventional nasal cannula. METHODS Between June 2016 and August 2017, we conducted a prospective observational study that included 56 consecutive patients who presented for EGD prior to bariatric surgery. Airway management was done using either the SuperNO2VA™ (N = 26) device or conventional nasal cannula (N = 30). Patient demographics, procedure details, and outcomes were compared between the two groups. RESULTS The SuperNO2VA™ group had a lower median age compared to the control group (38.5 vs. 48.5 years, p = 0.04). These patients had a higher body mass index (BMI) (47.4 vs. 40.5, IQR, p < 0.0001), higher ASA class (p = 0.03), and were more likely to have OSA (53.9% vs. 26.7%, p = 0.04). Desaturation events were significantly lower in the SuperNO2VA™ group (11.5% vs. 46.7%, p = 0.004) and the median lowest oxygen saturation was higher in the SuperNO2VA™ group (100% vs. 90.5%, p < 0.0001). DISCUSSION This is the first study to report on the use of the SuperNO2VA™ device in bariatric patients undergoing pre-operative screening EGD. The use of the SuperNO2VA™ device offers a clinical advantage compared to the current standard of care. Our data demonstrate that patients with higher BMI, higher ASA classification, and OSA were more likely to have the SuperNO2VA™ device used; yet, paradoxically, these patients were less likely to have issues with desaturation events. Use of this device can optimize care in this challenging patient population by minimizing the risks of hypoventilation.
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AlEid A, Al Balkhi A, Hummedi A, Alshaya A, Abukhater M, Al Mtawa A, Al Khathlan A, Qutub A, Al Sayari K, Ahmad S, Azhar T, Al Otaibi N, Al Ghamdi A, Al Lehibi A. The utility of esophagogastroduodenoscopy and Helicobacter pylori screening in the preoperative assessment of patients undergoing bariatric surgery: A cross-sectional, single-center study in Saudi Arabia. Saudi J Gastroenterol 2019; 26:32-38. [PMID: 31898643 PMCID: PMC7045771 DOI: 10.4103/sjg.sjg_165_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIM Esophagogastroduodenoscopy (EGD) and Helicobacter pylori screening are routine parts of the preoperative assessment of patients undergoing bariatric surgery at many centers around the world. The reason for this step is to identify abnormalities that may change the surgical approach. In this study, we aim to evaluate the extent to which endoscopic findings and H. pylori testing affect the plan of care in bariatric patients. PATIENTS AND METHODS We retrospectively reviewed the investigational processes of 356 patients planned for bariatric surgery (2014-2016) at our center. Patients were categorized into two main groups (4 subgroups) from endoscopic findings. One group included patients with normal EGD and patients who had abnormal findings that did not change the surgical approach, whereas the other included patients who had findings that changed or canceled the surgical plan. A logistic regression analysis was used to evaluate how strongly can factors such as patient demographics, BMI, comorbidities, symptomatology, and H. pylori status predict the risk of having plan-changing endoscopic abnormalities. RESULTS The ages ranged between 15 and 66 years with a mean ± SD of 37 ± 11 years, and 56% were females. The majority of patients (75%; 95% CI: 73 - 82%) had either no findings (41%) or had abnormalities that did not change the surgical approach (34%). Only 25% (95% CI: 21-29%) were found to have pathologies that altered the surgical approach, and 0.6% of them had findings that were considered contraindications for surgery. In spite the relatively high prevalence of H. pylori in our cohort (41%; 95% CI 36-46%), the proportion of patients who had plan-changing abnormalities did not differ markedly from other studies. Gastroesophageal reflux disease (GERD) and obstructive sleep apnea symptoms were the only significant predictors of EGD findings (P = 0.009). CONCLUSIONS GERD and sleep apnea symptoms can be strong predictors of EGD abnormalities. However, this evidence is still not enough to safely recommend changing the current practice. Therefore, until a sensitive clinical prediction score is derived and validated according to the symptoms, we suggest that EGD should continue as the standard of care in all patients undergoing bariatric surgery.
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Affiliation(s)
- Ahmad AlEid
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia,Address for correspondence: Dr. Ahmad AlEid, Department of Gastroenterology and Hepatology, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia. E-mail:
| | - Areej Al Balkhi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Hummedi
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Anfal Alshaya
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Muhammad Abukhater
- Department of Surgical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Mtawa
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Khathlan
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Adel Qutub
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Al Sayari
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shameem Ahmad
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tauseef Azhar
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawaf Al Otaibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Al Ghamdi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abed Al Lehibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
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Pathologic findings of the removed stomach during sleeve gastrectomy. Surg Endosc 2019; 33:4003-4007. [PMID: 30771070 DOI: 10.1007/s00464-019-06689-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/25/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the preferred surgical intervention to treat morbid obesity. Despite the rising popularity of LSG, little is known on the histopathologic findings of the resected partial stomach specimens. Our study aims to identify prevalent pathologic findings of the removed stomach and explore the association between patient characteristics and abnormal findings. METHODS A retrospective analysis was conducted using a prospectively maintained database of 649 patients who underwent LSG between November 1, 2013 and December 31, 2015 at our institution. Patient characteristics included age, body mass index, gender, and preoperative comorbidities (diabetes, hyperlipidemia, depression, gastroesophageal reflux, hypertension, and sleep apnea). Statistical analysis was performed using descriptive analysis and logistic regression models. RESULTS Abnormal pathologic findings were identified in approximately one-fifth (n = 142, 21.9%) of the patients. The most common find is non-specific chronic gastritis (9.7%), followed by Helicobacter pylori gastritis (4.9%). Approximately 15% of patients had significant histopathological alterations that might require further investigation, treatment, or follow-up, including non-specific chronic gastritis, H. pylori gastritis, autoimmune atrophic gastritis, and gastrointestinal stromal tumor. The odds of abnormal findings in patients without hyperlipidemia was 0.09 times the corresponding odds in those with hyperlipidemia (95% CI 0.03-0.29), controlling for factors including age, body mass index, gender, and other preoperative comorbidities. CONCLUSION Patients with gastroesophageal reflux and hyperlipidemia might suggest higher incidence rate of gastric histopathologic abnormalities. Routine preoperative screening may not be beneficial for patients undergoing sleeve gastrectomy.
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Abstract
Compared with other periampullary tumors, cancers of the ampulla of Vater are rare. These tumors tend to present earlier than their pancreatic and distal bile duct brethren. In addition to the hypothesis that they are also less biologically aggressive, ampullary cancers tend to have better survival than other types of periampullary cancers. The mortality from this disease remains high, and much can still be learned about ampullary cancers.
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Hariri K, Dong M, Edwards ED, Kini SU, Inabnet WB, Herron DM, Fernandez-Ranvier G. Why Are Patients Readmitted? An Analysis of Adverse Events Leading to Readmission, Reintervention, or Reoperation After Bariatric Surgery. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2018.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kamyar Hariri
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Matthew Dong
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Eric D. Edwards
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Subhash U. Kini
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - William B. Inabnet
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Daniel M. Herron
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Gustavo Fernandez-Ranvier
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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Kırkıl C, Aygen E, Aktimur R, Korkmaz MF, Rzayev E. Laparoscopic Three-Port Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2018.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cüneyt Kırkıl
- Department of General Surgery, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Erhan Aygen
- Department of General Surgery, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Recep Aktimur
- Department of General Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Mehmet Fatih Korkmaz
- Department of General Surgery, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Elshad Rzayev
- Department of General Surgery, Faculty of Medicine, Firat University, Elazig, Turkey
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Kirkil C, Aygen E, Korkmaz MF, Bozan MB. QUALITY OF LIFE AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY USİNG BAROS SYSTEM. ACTA ACUST UNITED AC 2018; 31:e1385. [PMID: 30133677 PMCID: PMC6097161 DOI: 10.1590/0102-672020180001e1385] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/14/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric procedure in Turkey. The goal of weight reduction surgery is not only to decrease excess weight, but also to improve obesity related comorbidities and quality of life (QoL). AIM To evaluate the impact of LSG on patient quality of life, weight loss, and comorbidities associated with morbid obesity according to the updated BAROS criteria. METHODS Eleven hundred thirty-eight adult patients were undergone to LSG by our bariatric surgery team between January 2013 and January 2016. A questionnaire (The Bariatric Analysis and Reporting Outcome System - BAROS) was published on social media. The data on postoperative complications were collected from hospital database. RESULTS Number of respondants was 562 (49.4%). Six of 1138 patients(0.5%) had leakage. All patients who had leakage were respondants. The overall complication rate was 7.7%. After a mean period of 7.4±5.3 months(1-30), mean excess weight loss was 71.3±27.1% (10.2-155.4). The respondants reported 772 comorbidities. Of these, 162 (30%) were improved, and 420 (54.4%) were resolved. The mean scores for QoL were significantly increased after LSG (range, p<0.05 to <0.001). Of the 562 patients, 26 (4.6%) were classified as failures; 86 (15.3%) fair; 196 (34.9%) good; 144 (25.6%) very good, and 110 (19.6%) excellent results according to the updated BAROS scoring system. CONCLUSION LSG is a highly effective bariatric procedure in the manner of weight control, improvement in comorbidities and increasing of QoL in short- and mid-term.
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Affiliation(s)
- Cüneyt Kirkil
- Department of Surgery, Firat University Medical Faculty
| | - Erhan Aygen
- Department of Surgery, Firat University Medical Faculty
| | | | - Mehmet Buğra Bozan
- Department of Surgery, Turkish Ministry of Health Medical Sciences University, Elazig Training and Research Hospital, Elazig, Turkey
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Schlottmann F, Buxhoeveden R. Laparoscopic Roux-en-Y Gastric Bypass: Surgical Technique and Tips for Success. J Laparoendosc Adv Surg Tech A 2018; 28:938-943. [DOI: 10.1089/lap.2018.0393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Rudolf Buxhoeveden
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
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Schlottmann F, Nayyar A, Herbella FAM, Patti MG. Preoperative Evaluation in Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:925-929. [PMID: 30004270 DOI: 10.1089/lap.2018.0391] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
An adequate preoperative workup is critical for the success of bariatric surgery. A key component of the preoperative evaluation involves a comprehensive patient education about surgical outcomes and the postoperative behavioral regimen required. A complete medical evaluation should include the study of the cardiovascular, pulmonary, and gastrointestinal systems as well as a metabolic status assessment. The nutrition professional should be in charge of the nutritional assessment, preoperative weight loss efforts, and diet education regarding postoperative eating behaviors. A psychological evaluation is also needed because psychosocial factors have a significant impact on the long-term outcomes of bariatric surgery, including adherence to recommended postoperative lifestyle regimen, emotional adjustment, and weight loss outcomes. We recommend preoperative abdominal ultrasound to assess for biliary tract pathology, steatosis, fibrosis, and presence of nonalcoholic steatohepatitis. A routine preoperative esophagogastroduodenoscopy is also recommended to evaluate common gastrointestinal disorders associated with obesity. Preoperative weight loss should be strongly encouraged.
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Affiliation(s)
- Francisco Schlottmann
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,2 Department of Surgery, Hospital Alemán of Buenos Aires , Buenos Aires, Argentina
| | - Apoorve Nayyar
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Fernando A M Herbella
- 3 Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo , Sao Paulo, Brazil
| | - Marco G Patti
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,4 Department of Medicine, University of North Carolina , Chapel Hill, North Carolina
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Mangla A, Lu P, Mullane MR, Lad TE. Gastric Cancer in a Patient with Laparoscopic Adjustable Gastric Band: Case Report and Review of Literature. J Gastrointest Cancer 2018; 50:695-698. [PMID: 29797143 DOI: 10.1007/s12029-018-0120-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ankit Mangla
- Department of Medicine, Division of Hematology and Oncology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, Suite# 755, Chicago, Ill, 60612, USA.
| | - Pei Lu
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Ill, USA
| | - Michael R Mullane
- Department of Medicine, Division of Hematology and Oncology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, Suite# 755, Chicago, Ill, 60612, USA
| | - Thomas E Lad
- Department of Medicine, Division of Hematology and Oncology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, Suite# 755, Chicago, Ill, 60612, USA
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Weis JJ, Goldblatt M, Pryor A, Dunkin BJ, Brunt LM, Jones DB, Scott DJ. SAGES's advanced GI/MIS fellowship curriculum pilot project. Surg Endosc 2018; 32:2613-2619. [PMID: 29344791 DOI: 10.1007/s00464-018-6020-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/03/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The American health care system faces deficits in quality and quantity of surgeons. SAGES is a major stakeholder in surgical fellowship training and is responsible for defining the curriculum for the Advanced GI/MIS fellowship. SAGES leadership is actively adapting this curriculum. METHODS The process of reform began in 2014 through a series of iterative meetings and discussions. A working group within the Resident and Fellow Training Committee reviewed case log data from 2012 to 2015. These data were used to propose new criteria designed to provide adequate exposure to core content. The working group also proposed using video assessment of an MIS case to provide objective assessment of competency. RESULTS Case log data were available for 326 fellows with a total of 85,154 cases logged (median 227 per fellow). The working group proposed new criteria starting with minimum case volumes for five defined categories including foregut (20), bariatrics (25), inguinal hernia (10), ventral hernia (10), and solid organ/colon/thoracic (10). Fellows are expected to perform an additional 75 complex MIS cases of any category for a total of 150 required cases overall. The proposal also included a minimum volume of flexible endoscopy (50) and submission of an MIS foregut case for video assessment. The new criteria more clearly defined which surgeon roles count for major credit within individual categories. Fourteen fellowships volunteered to pilot these new criteria for the 2017-2018 academic year. CONCLUSIONS The new SAGES Advanced GI/MIS fellowship has been crafted to better define the core content that should be contained in these fellowships, while still allowing sufficient heterogeneity so that individual learners can tailor their training to specific areas of interest. The criteria also introduce innovative, evidence-based methods for assessing competency. Pending the results of the pilot program, SAGES will consider broad implementation of the new fellowship criteria.
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Affiliation(s)
- Joshua J Weis
- University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX, 75390-9092, USA
| | | | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | | | - L Michael Brunt
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Daniel J Scott
- University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX, 75390-9092, USA.
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Current Status of Preoperative Oesophago-Gastro-Duodenoscopy (OGD) in Bariatric NHS Units-a BOMSS Survey. Obes Surg 2017; 26:2257-2262. [PMID: 27424002 DOI: 10.1007/s11695-016-2304-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Preoperative oesophago-gastro-duodenoscopy (p-OGD) is often routinely employed in patients undergoing bariatric surgery. The value of p-OGD is still unclear; however, since all bariatric procedures modify stomach anatomy differently with exclusion of the remnant in a majority of cases, the question arises whether there is a rational for including it routinely in the preoperative pathway. MATERIAL AND METHODS To assess the current status of p-OGD in the UK, a survey was sent to the British Obesity & Metabolic Surgery Society members, regarding preoperative evaluation of patients, focusing on the role of p-OGD. Forty-nine UK bariatric units (in excess of 5000 patients estimated caseload/year) answered. RESULTS The survey has shown that 44 units (90 %) include OGD in their preoperative work up, routinely or selectively. According to results, 25 units (51 %) changed the operative plans after OGD because of peptic ulcer (46 %), hiatus hernia (43 %), Barrett's oesophagus (32 %) or gastrointestinal stromal tumour (25 %). Only 2 units (7 %) found incidental gastrointestinal cancer. When specifically asked, p-OGD was believed to be essential in patients with family history of gastrointestinal cancer (61 %), pernicious anaemia (57 %) and reflux symptoms (54 %). Five units (10 %) considered p-OGD completely unnecessary. Only 11 units (25 %) would not be able to accommodate routine p-OGD in all patients. CONCLUSIONS Most units value p-OGD, either selectively or routinely, in preparation for bariatric surgery. However, there seems to be a discrepancy on the specific risk factors involved in the selection process. National and international guidelines are advocated.
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Docimo S, Svestka M. Endoscopic Evaluation and Treatment of Postoperative Bariatric Surgery Complications. Surg Innov 2017; 24:616-624. [PMID: 29072533 DOI: 10.1177/1553350617736651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The number of patients undergoing bariatric surgery continues to increase. The American Society for Metabolic and Bariatric Surgery (ASMBS) estimates the number of bariatric surgical procedures performed increased from 158 000 in 2011 to 190 000 in 2015. Concurrently, the incidence of postoperative complications specific to bariatric patients will inevitably increase as well. Endoscopic evaluation of postoperative bariatric patients and endoscopic interventions are rapidly evolving. We present a review of the postoperative anatomy of bariatric patients, what complications to expect, and treatment options.
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29
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Gastric carcinoma after sleeve gastrectomy for obesity. Surg Obes Relat Dis 2017; 13:1459-1461. [DOI: 10.1016/j.soard.2017.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/08/2017] [Accepted: 04/12/2017] [Indexed: 12/16/2022]
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Histopathological examination of tissue resected during bariatric procedures - to be done or not to be done? Wideochir Inne Tech Maloinwazyjne 2017; 12:135-139. [PMID: 28694898 PMCID: PMC5502342 DOI: 10.5114/wiitm.2017.67807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/12/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Obesity is one of the major lifestyle diseases and provokes various comorbidities, such as hypertension, type 2 diabetes mellitus, obstructive sleep apnea, and even neoplasms. Bariatric surgery is the most effective treatment of obesity. Since cost-effectiveness has become a major concern, there is a tendency to avoid general histological evaluation of surgical specimens during routine procedures. AIM To evaluate the necessity of histopathological investigation of tissue excised during bariatric surgery and to verify whether the operation should be continued in the case of suspicious macroscopic findings. MATERIAL AND METHODS From January 2013 to December 2016, 1252 patients with obesity were qualified for bariatric procedures. The qualification was performed according to the current European recommendations. Every operation started with an inspection of the peritoneal cavity performed once the abdomen was insufflated. If a macroscopic pathology was found, the specimen was secured for histopathological investigation. RESULTS Out of 81 (6.47%) patients from whom histopathological samples were collected, 39% (n = 32) showed negative results, and 61% (n = 49) cases showed abnormalities. CONCLUSIONS As it is impossible to exclude the existence of gastric tumors only in preoperative gastroscopy and ultrasonography, especially as there is a higher risk in obese patients, routine histological examination of tissue excised during bariatric procedures should be considered. Since most of the neoplasms were found to be benign, there is no need to abandon the bariatric procedure if a pathology is found and resected. Bariatric surgeons should always focus on thorough examination of the abdominal and the pelvic cavity, especially in female patients.
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Sharaiha RZ, Kumta NA, Saumoy M, Desai AP, Sarkisian AM, Benevenuto A, Tyberg A, Kumar R, Igel L, Verna EC, Schwartz R, Frissora C, Shukla A, Aronne LJ, Kahaleh M. Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients. Clin Gastroenterol Hepatol 2017; 15:504-510. [PMID: 28017845 DOI: 10.1016/j.cgh.2016.12.012] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Endoscopic sleeve gastroplasty (ESG) is an incisionless, minimally invasive bariatric procedure that reduces the length and width of the gastric cavity to facilitate weight loss. We performed a prospective study to evaluate the effects of ESG on total body weight loss and obesity-related comorbidities. METHODS We collected data from 91 consecutive patients (mean age, 43.86 ± 11.26 years; 68% female) undergoing ESG from August 2013 through March 2016. All patients had a body mass index (BMI) greater than 30 kg/m2 and had failed noninvasive weight-loss measures or had a BMI greater than 40 kg/m2 and were not considered as surgical candidates or refused surgery. All procedures were performed with a cap-based flexible endoscopic suturing system to facilitate a triangular pattern of sutures to imbricate the greater curvature of the stomach. Patients were evaluated after 6 months (n = 73), 12 months (n = 53), and 24 months (n = 12) for anthropometric features (BMI, weight, waist circumference, blood pressure) and underwent serologic (hemoglobin A1c), lipid panel, serum triglycerides, and liver function tests. The primary outcomes were total body weight loss at 6, 12, and 24 months. Secondary outcomes were the effects of ESG on metabolic factors (blood pressure, diabetes, hyperlipidemia, steatohepatitis) and safety. RESULTS The patients' mean BMI before the procedure was 40.7 ± 7.0 kg/m2. Patients had lost 14.4% of their total body weight at 6 months (80% follow-up rate), 17.6% at 12 months (76% follow-up rate), and 20.9% at 24 months (66% follow-up rate) after ESG. At 12 months after ESG, patients had statistically significant reductions in levels of hemoglobin A1c (P = .01), systolic blood pressure (P = .02), waist circumference (P < .001), alanine aminotransferase (P < .001), and serum triglycerides (P = .02). However, there was no significant change in low-density lipoprotein after vs before ESG (P = .79). There was one serious adverse event (1.1%) (perigastric leak) that occurred that was managed non-operatively. CONCLUSIONS ESG is a minimally invasive and effective endoscopic weight loss intervention. In addition to sustained total body weight loss up to 24 months, ESG reduced markers of hypertension, diabetes, and hypertriglyceridemia.
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Affiliation(s)
- Reem Z Sharaiha
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
| | - Nikhil A Kumta
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Monica Saumoy
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Amit P Desai
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Alex M Sarkisian
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Andrea Benevenuto
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Amy Tyberg
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Rekha Kumar
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Leon Igel
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Elizabeth C Verna
- Department of Gastroenterology, Columbia University Medical Center, New York, New York
| | - Robert Schwartz
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Christina Frissora
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Alpana Shukla
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Louis J Aronne
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Michel Kahaleh
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
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Atef E, Zalata KR, Atef H, Abdel-Hamid AAM. Increased Proliferative Activity Accompanies the Local Inflammatory Response of Gastric Mucosa After Intragastric Balloon Insertion. Dig Dis Sci 2016; 61:3498-3505. [PMID: 27743165 DOI: 10.1007/s10620-016-4344-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/05/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM The use of BioEnterics intragastric balloon (BIB) is progressively increasing, owing to the fact that morbid obesity becomes a global epidemic together with risks of bariatric surgery. Yet, the possible local BIB effect on gastric mucosa is not clearly elucidated. The aim of the current study was to assess the histological changes occurring in the gastric mucosa post-BIB insertion. METHODS Gastric mucosa biopsy was obtained from 87 cases of morbid obesity both pre-BIB and 6 months post-BIB insertion to compare the local changes by histological and immunohistochemical analysis. RESULTS An inflammatory reaction was detected in the post-BIB mucosa which displayed a positive CD20, CD3 (p < 0.05), and the proliferation index (Ki67) increased significantly compared with that of the pre-BIB cases. The Ki67 index showed a significant positive correlation with CD20 and CD3 immunoexpression in the post-BIB gastric mucosae. CONCLUSION Our results demonstrated a possible increase in the gastric proliferative activity after BIB insertion accompanied with a remarkable local inflammatory reaction. Although these findings may be reactive and transient, endoscopic follow-up is recommended for early detection of further pathological changes.
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Affiliation(s)
- Ehab Atef
- Gastroenterology Surgical Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khaled Refaat Zalata
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hoda Atef
- Department of Histology and Cell Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed A M Abdel-Hamid
- Department of Histology and Cell Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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Ohanessian SE, Rogers AM, Karamchandani DM. Spectrum of Gastric Histopathologies in Severely Obese American Patients Undergoing Sleeve Gastrectomy. Obes Surg 2016. [PMID: 26210191 DOI: 10.1007/s11695-015-1801-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a commonly performed weight loss procedure, but the pathologic findings in sleeve specimens have not been investigated in a US population. METHODS We performed a retrospective review of histopathologic findings in LSG specimens from 310 consecutive bariatric patients at the Hershey Medical Center between June 2008 and August 2014. RESULTS Patients were 19 to 75 years old (mean 45 years) with a female-to-male ratio of 3:1. The histopathologic findings included the following: no pathological alteration in 214 patients (69.0 %), chronic inactive gastritis in 41 (13.2 %), fundic gland polyp in 17 (5.5 %), proton pump inhibitor therapy effect in 12 (3.9 %), Helicobacter pylori (H. pylori)-associated chronic active gastritis in 10 (3.2 %), chronic active gastritis (H. pylori negative) in 5 (1.6 %), chronic gastritis with intestinal metaplasia in 4 (1.0 %), gastrointestinal stromal tumor (GIST) in 3 (1.0 %), and hyperplastic polyp, granulomatous inflammation, xanthogranulomatous inflammation, and mucosal ulceration in 1 patient each (0.3 %). Prior endoscopy was performed in 8 patients (2.6 %) for unrelated causes, and the results did not change the surgical management. Nine patients (2.9 %) had a concurrent liver biopsy for visual evidence of significant hepatic fibrosis. CONCLUSION Although most cases showed no pathologic alteration, a minority had significant findings, with the incidence of GISTs higher than that reported in other series. Despite negative preoperative H. pylori testing, 3.2 % were still histologically positive, raising questions about the accuracy of preoperative methods used for H. pylori testing and treatment. Preoperative endoscopy may not be needed in sleeve patients.
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Affiliation(s)
- Sara E Ohanessian
- Department of Pathology, Division of Anatomic Pathology, College of Medicine, The Pennsylvania State University, 500 University Drive, H179, Hershey, PA, 17033-0850, USA
| | - Ann M Rogers
- Department of Surgery, Division of Minimally Invasive Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Dipti M Karamchandani
- Department of Pathology, Division of Anatomic Pathology, College of Medicine, The Pennsylvania State University, 500 University Drive, H179, Hershey, PA, 17033-0850, USA.
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Mihmanli M, Yazici P, Isil G, Tanik C. Should We Perform Preoperative Endoscopy Routinely in Obese Patients Undergoing Bariatric Surgery? Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mehmet Mihmanli
- General Surgery Clinic, Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Istanbul, Turkey
| | - Pinar Yazici
- General Surgery Clinic, Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Istanbul, Turkey
| | - Gurhan Isil
- General Surgery Clinic, Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Istanbul, Turkey
| | - Canan Tanik
- Pathology Clinic, Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Istanbul, Turkey
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Hernández J, Boza C. Novel treatments for complications after bariatric surgery. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2016; 10:3. [PMID: 26981148 PMCID: PMC4791794 DOI: 10.1186/s13022-015-0021-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/04/2015] [Indexed: 01/21/2023]
Abstract
Bariatric
surgery has been considered one of best treatments for obesity. As every surgical procedure—and any medical intervention, it is not exempt of complications, among which leaks, strictures, acute hemorrhages and fistulae highlight. Leaks are more common in the gastro-jejunal anastomosis (GJA) in the case of Roux-en-y Gastric Bypass (RYGB), while in Sleeve Gastrectomy (LSG) they locate in the stapler line. Stenosis can be seen in the gastro-jejunostomy in the RYGB and in the gastric tube in case of the LSG. For each of these complications, many innovative solutions have been developed, including new surgical devices. In spite of promising good results, evidence regarding utility and safeness of these technologies is still scarce. Self-expandable endoscopic stents have been used to treat leaks, with an overall success rate of 80–90 % and a migration rate of 15–35 %. The bear trap-like over-the-scope (Ovesco) clips have been used to treat GI hemorrhages, leaks and even fistulae, with a 70–80 % success rate, although more endoscopic sessions may be needed. Overstitch, an endosurgical suture devices, have been used to treat leaks, fistulae and perforations. Overall, technical success achievement approaches to 90 %, while clinical success ranges from 80 to 90 %, except for leaks closure, where a lower success rate has been observed. Despite of all of these advances, early diagnosis and treatment remains the main strategy to achieve success. In summary, novel therapies for complication management can be very useful, though further studies with larger series are still needed in order to confirm their efficacy and safeness.
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Affiliation(s)
- Julián Hernández
- Department of Digestive Surgery, Pontificia Universidad Católica De Chile, Santiago, Chile
| | - Camilo Boza
- Bariatric Surgery Unit, Department of Digestive Surgery, Clínica Las Condes, Estoril 450, Las Condes, Santiago, Chile
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da Rocha L, Ayub Pérez O, Arantes V. Endoscopic management of bariatric surgery complications: what the gastroenterologist should know. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2016. [DOI: 10.1016/j.rgmxen.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Endoscopic management of bariatric surgery complications: what the gastroenterologist should know. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2015; 81:35-47. [PMID: 26552500 DOI: 10.1016/j.rgmx.2015.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/16/2015] [Accepted: 06/18/2015] [Indexed: 12/11/2022]
Abstract
Obesity is a serious disorder in almost the entire world. It is an important risk factor for a series of conditions that affect and threaten health. Currently, bariatric surgery is the most effective treatment for morbid obesity, and in addition to the resulting weight loss, it reduces morbidity in this population. There has been a significant increase in the number of obese patients operated on. Despite the success of bariatric surgery, an important group of patients still present with major postoperative complications. In order for endoscopy to effectively contribute to the diagnosis and treatment of complications deriving from obesity surgery, the gastroenterologist must be aware of the particularities involved in bariatric surgery. The present article is a review of the resulting anatomic aspects of the main surgical techniques employed, the most common postoperative symptoms, the potential complications, and the possibilities that endoscopic diagnosis and treatment offer. Endoscopy is a growing and continuously evolving method in the treatment of bariatric surgery complications. The aim of this review is to contribute to the preparation of gastroenterologists so they can offer adequate endoscopic diagnosis and treatment to this high-risk population.
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Miao TL, Kielar AZ, Patlas MN, Riordon M, Chong ST, Robins J, Menias CO. Cross-sectional imaging, with surgical correlation, of patients presenting with complications after remote bariatric surgery without bowel obstruction. ACTA ACUST UNITED AC 2015; 40:2945-65. [PMID: 26467447 DOI: 10.1007/s00261-015-0548-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Both restrictive and malabsorptive types of bariatric surgery may be associated with short- and long-term complications. The lack of small bowel obstruction is not necessarily indicative of a normal study, as a variety of non-obstructed complications exist. These include stenosis at the gastrojejunostomy, leaks, abscesses, hemorrhage, internal hernias, and gastric band erosions. Radiologists should be familiar with these complications for early diagnosis and intervention before symptoms become life threatening. An understanding of the intraoperative appearances of these complications may improve imaging descriptions and add value to radiological consults for surgeons. This review provides surgical correlations to the imaging features of post-bariatric complications without obstruction of the bowel.
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Abstract
PURPOSE OF REVIEW Bariatric surgery is recognized as the most effective treatment against obesity as it results in significant weight reduction and a high rate of remission of obesity-related comorbidities. However, bariatric surgery is not uncommonly associated with complications and an endoscopic approach to management is preferred over surgical reintervention. This review illustrates the latest developments in the endoscopic management of bariatric surgical complications. RECENT FINDINGS For successful management of complications, precipitating and perpetuating factors must be addressed in addition to directing therapy at the target pathology. Endoscopy is well tolerated even in the acute postoperative setting when performed carefully with CO2 insufflation. Chronic proximal staple-line leaks/fistulas frequently do not respond to primary closure with diversion therapy, and a new technique of stricturotomy has been reported to improve outcomes. Innovations in the field of transoral endoscopic instruments have led to the development of a single-session entirely internal endoscopic retrograde cholangiopancreatography by creating a gastrogastric anastomosis. SUMMARY Endoscopy allows for early diagnosis and prompt institution of therapy and should, therefore, be the first-line intervention in the management of complications of bariatric surgery in patients who do not need urgent surgical intervention. Computed tomography-guided drainage may be necessary in patients with drainable fluid collections. VIDEO ABSTRACT http://links.lww.com/COG/A11.
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Janczak D, Pawłowski W, Ziomek A, Dorobisz T, Janczak D, Janus W, Chabowski M. Endoscopic esophageal self-expanding stent implantation WallFlex™ (Boston Scientific) in the management of a gastrocutaneous fistula, as a complication of sleeve bariatric gastrectomy. POLISH JOURNAL OF SURGERY 2015; 87:320-3. [PMID: 26247505 DOI: 10.1515/pjs-2015-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 11/15/2022]
Abstract
The study presented a case of a gastrocutaneous fistula, as a result of bariatric sleeve gastrectomy. The discussion considered the main pathogenesis, etiology, diagnostics and endoscopic treatment using the implantation of covered esophageal stents. Special attention was placed upon the multifactorial origin of this life-threatening clinical condition, typical for bariatric surgery.
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Franklin AL, Koeck ES, Hamrick MC, Qureshi FG, Nadler EP. Prevalence of Chronic Gastritis or Helicobacter pylori Infection in Adolescent Sleeve Gastrectomy Patients Does Not Correlate with Symptoms or Surgical Outcomes. Surg Infect (Larchmt) 2015; 16:401-4. [PMID: 26075412 DOI: 10.1089/sur.2014.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In adults undergoing gastric bypass surgery, it is routine practice to perform pre-operative testing for Helicobacter pylori infection. Evidence suggests that infection impairs anastomotic healing and contributes to complications. There currently are no data for adolescents undergoing bariatric procedures. Despite few patients with pre-operative symptoms, we noted occasional patients with H. pylori detected after sleeve gastrectomy. We reviewed our experience with our adolescent sleeve gastrectomy cohort to determine the prevalence of H. pylori infection, its predictive factors, and association with outcomes. We hypothesized that H. pylori infection would be associated with pre-operative symptoms, but not surgical outcomes. METHODS All patients undergoing sleeve gastrectomy at our hospital were included. We conducted a chart review to determine pre- or post-operative symptoms of gastroesophageal reflux disease GERD or gastritis, operative complications, and long-term anti-reflux therapy after surgery. Pathology reports were reviewed for evidence of gastritis and H. pylori infection. RESULTS 78 adolescents had laparoscopic sleeve gastrectomy from January 2010 through July 2014. The prevalence of chronic gastritis was 44.9% (35/78) and 11.4% of those patients had H. pylori (4/35). Only one patient with H. pylori had pre-operative symptoms, and only 25.7% (9/35) of patients with pathology-proven gastritis had symptoms. One staple line leak occurred but this patient did not have H. pylori or gastritis. Mean patient follow-up was 10 (3-26) mos. CONCLUSIONS There is a moderate prevalence of gastritis among adolescents undergoing sleeve gastrectomy, but only a small number of these patients had H. pylori infection. Neither the presence of chronic gastritis nor H. pylori infection correlated with symptoms or outcomes. Thus, in the absence of predictive symptomology or adverse outcome in those who are infected, we advocate for continued routine pathologic evaluation without the required need for pre-operative determination unless or until H. pylori infection is associated with adverse surgical outcomes.
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Affiliation(s)
- Ashanti L Franklin
- Division of Pediatric Surgery, Children's National Medical Center , Washington, DC
| | - Emily S Koeck
- Division of Pediatric Surgery, Children's National Medical Center , Washington, DC
| | - Miller C Hamrick
- Division of Pediatric Surgery, Children's National Medical Center , Washington, DC
| | - Faisal G Qureshi
- Division of Pediatric Surgery, Children's National Medical Center , Washington, DC
| | - Evan P Nadler
- Division of Pediatric Surgery, Children's National Medical Center , Washington, DC
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[Upper endoscopy findings in obese morbid patients candidates for bariatric surgery]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 38:426-30. [PMID: 25709107 DOI: 10.1016/j.gastrohep.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/03/2015] [Accepted: 01/12/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Body mass index has been associated with the presence and severity of various gastrointestinal symptoms. The aim of the study was to analyze the endoscopic findings and gastric histology of morbidly obese candidates for bariatric surgery. METHODS We retrospectively included patients undergoing bariatric surgery at the Hospital de León from March 2005 to April 2013. The findings of upper gastrointestinal endoscopy and antral histology were collected. The relationship of body mass index (BMI) with gastroscopy findings and the presence of Helicobacter pylori were assessed. RESULTS A total of 194 patients were included. An abnormality on endoscopy or antral biopsy was found in 48.7% and 78.9% of the patients, respectively. Three patients had gastric peptic ulcer, and consequently the intervention was postponed until healing. H.pylori infection was found in 63.9% of the patients. The presence of H.pylori and endoscopic findings were not related to BMI. CONCLUSION Gastroesophageal disease is common in morbidly obese patients and approximately half of the patients had some kind of alteration on endoscopy. Gastroscopy and H.pylori testing prior to surgery is required to rule out disease that could delay or contraindicate surgery.
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