Banded RYGB Ring Slippage Endoscopic Removal with Self-expandable Stents: a Comparative Study Between Metallic and Plastic One.

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

NEW BOWEL PREPARATION TECHNIQUE FOR COLONOSCOPY: CLINICAL TRIAL COMPARING AQUANET AND MANNITOL.

BACKGROUND: Fifty-five percent of Americans aged 50-65 are submitted to colonoscopy. For over 65-year, this number increases to 64%. In Brazil, it is forecast that the population submitted to colonoscopy will grow, even though inadequate preparation is still a major problem. AIM: To analyze the quality of a new intestinal preparation technique, Aquanet EC-2000®, compared to oral Mannitol solution. METHODS: This prospective longitudinal study enrolled 200 patients with indication for colonoscopy. The sample was randomly allocated to two groups of 100; one group received Aquanet EC-2000® to prepare for colonoscopy and the other Mannitol solution. The Boston scale was used to analyze the results. RESULTS: As expected both preparations produced similar results with the bowel cleansing of the different regions of the colon being classified as Boston scale 3 (excellent) in most patients (p>0.05). CONCLUSION: The results of bowel preparation using Aquanet EC-2000® were similar to using Mannitol solution.

New bowel preparation technique for colonoscopy: clinical trial comparing aquanet and mannitol / Nova técnica de preparo intestinal para colonoscopia: estudo clínico comparativo entre aquanet e manitol

ABSTRACT Background: Fifty-five percent of Americans aged 50-65 are submitted to colonoscopy. For over 65-year, this number increases to 64%. In Brazil, it is forecast that the population submitted to colonoscopy will grow, even though inadequate preparation is still a major problem. Aim: To analyze the quality of a new intestinal preparation technique, Aquanet EC-2000®, compared to oral Mannitol solution. Methods: This prospective longitudinal study enrolled 200 patients with indication for colonoscopy. The sample was randomly allocated to two groups of 100; one group received Aquanet EC-2000® to prepare for colonoscopy and the other Mannitol solution. The Boston scale was used to analyze the results. Results: As expected both preparations produced similar results with the bowel cleansing of the different regions of the colon being classified as Boston scale 3 (excellent) in most patients (p>0.05). Conclusion: The results of bowel preparation using Aquanet EC-2000® were similar to using Mannitol solution.

RESUMO Racional: Cinquenta e cinco por cento dos norte-americanos entre 50-65 anos fazem colonoscopia. Acima de 65 anos o número foi de 64%. No Brasil, estima-se crescente aumento da população submetida à colonoscopia, apesar da preparação inadequada ainda ser um grande problema. Objetivo: Analisar e comparar a qualidade do novo método de preparo intestinal por meio do Aquanet EC-2000® frente ao uso de solução oral de Manitol. Método: Por randomização 200 pacientes foram divididos em dois grupos de 100. Um recebeu Aquanet EC-2000® e o outro Manitol. O presente estudo seguiu modelo prospectivo longitudinal por meio da seleção de 200 pacientes com indicação à colonoscopia, formando dois grupos de 100. Para analisar os resultados foi utilizada a escala de Boston. Resultados: Ambos os preparos foram estatisticamente significativos com p<0,05. A escala 3 de Boston foi a mais frequente para ambos os métodos.Além disso, na estatística aplicada às diferentes regiões do cólon para ambos os procedimentos as proporções observadas concordaram com o esperado (3-excelente). Conclusão: Os resultados do preparo intestinal utilizando Aquanet EC-2000® foram semelhantes aos do Manitol.

LAPAROENDOSCOPIC TRANSGASTRIC RESECTION OF SUBEPITHELIAL JUXTACARDIAC TUMORS.

BACKGROUND: With a prevalence of 0.4-3.5%, subepithelial lesions of the upper digestive tract are discovered during endoscopic procedures. Treatment depends on etiological and pathophysiological information, ability to diagnose and the different technical resources available. AIM: To demonstrate the effectiveness of a surgical technique that combines endoscopy and videolaparoscopy in the transgastric resection of subepithelial juxtacardic lesions. METHOD: The patients were assisted with a technical combination between endoscopy and laparoscopy. After diagnosis of subepithelial tumor, intraoperative endoscopy was performed after pneumoperitoneum and placement of laparoscopic tweezers. Through endoscopy, the following steps were performed: demarcation of surgical margins, visualization of the intragastric image for the laparoscopic procedure and removal of the surgical specimen. By laparoscopy the following steps were performed: intragastric intra-abdominal access, resection of the part and closure of the gaps. RESULTS: This technique was applied in two cases in order to evaluate its initial results. There were two videolaparoendoscopic resections of juxtacardiac gastric tumors of the posterior wall. Both had their endoscopic diagnosis confirmed. After laparoendoscopic and tomographic and/or ecoendoscopic diagnostic complementation and preoperative performance, the laparoendoscopic procedure was indicated. The patients had a good recovery, with a short hospitalization time and no complications. CONCLUSION: The combined use of videolaparoscopy and endoscopy is a safe and effective technique for transgastric resection of juxtacardiac subepithelial lesions. It may be important for definitive diagnosis of the tumor.

Laparoendoscopic transgastric resection of subepithelial juxtacardiac tumors / Laparoendoscopia e ressecção transgástrica de tumores subepiteliais justacárdicos

ABSTRACT Background: With a prevalence of 0.4-3.5%, subepithelial lesions of the upper digestive tract are discovered during endoscopic procedures. Treatment depends on etiological and pathophysiological information, ability to diagnose and the different technical resources available. Aim: To demonstrate the effectiveness of a surgical technique that combines endoscopy and videolaparoscopy in the transgastric resection of subepithelial juxtacardic lesions. Method: The patients were assisted with a technical combination between endoscopy and laparoscopy. After diagnosis of subepithelial tumor, intraoperative endoscopy was performed after pneumoperitoneum and placement of laparoscopic tweezers. Through endoscopy, the following steps were performed: demarcation of surgical margins, visualization of the intragastric image for the laparoscopic procedure and removal of the surgical specimen. By laparoscopy the following steps were performed: intragastric intra-abdominal access, resection of the part and closure of the gaps. Results: This technique was applied in two cases in order to evaluate its initial results. There were two videolaparoendoscopic resections of juxtacardiac gastric tumors of the posterior wall. Both had their endoscopic diagnosis confirmed. After laparoendoscopic and tomographic and/or ecoendoscopic diagnostic complementation and preoperative performance, the laparoendoscopic procedure was indicated. The patients had a good recovery, with a short hospitalization time and no complications. Conclusion: The combined use of videolaparoscopy and endoscopy is a safe and effective technique for transgastric resection of juxtacardiac subepithelial lesions. It may be important for definitive diagnosis of the tumor.

RESUMO Racional: Lesões subepiteliais do trato digestivo superior são descobertas durante procedimentos endoscópicos com prevalência de 0,40-3,5%. Seu tratamento parte de conhecimento etiológico, fisiopatológico, capacidade diagnóstica e recursos técnicos variados. Objetivo: Demonstrar a eficácia de técnica cirúrgica que combina videolaparoscopia e endoscopia para ressecção transgástrica de lesões subepiteliais justacárdicas e seus resultados preliminares. Método: Os pacientes foram assistidos com uma combinação técnica entre endoscopia e laparoscopia. Após o diagnóstico de tumor sub-epitelial justacárdico endoscopia intra-operatória foi realizada após confecção do pneumoperitônio e colocação das pinças laparoscópicas. Através da endoscopia realizou-se os seguintes passos: demarcação de margens cirúrgicas, visualização da imagem intragastrica para o procedimento laparoscópico e retirada de peça cirúrgica; pela laparoscopia realizou-se os seguintes passos: acesso intragástrico por via intra-abdominal, ressecção da peça e fechamento das brechas. Resultados: Esta técnica foi aplicada em dois casos afim de serem avaliados seus resultados inicias. Foram duas ressecções videolaparoendoscópica de tumores gástricos justacárdicos, de parede posterior. Ambos tiveram seu diagnóstico endoscópico de tumores subepiteliais justacárdicos. Após complementação diagnóstica tomográfica e/ou ecoendoscópica e realização de pré operatório foi indicado o procedimento laparoendoscópico. Os pacientes tiveram recuperação muito satisfatória, com pequeno tempo de internação e sem complicações. Conclusão: O uso combinado de videolaparoscopia e endoscopia constitui técnica segura e eficaz para a ressecção transgástrica de lesões subepiteliais justacárdicas. Pode ser importante para diagnóstico definitivo da tumoração.

Validation of a new method for the endoscopic measurement of post-bariatric gastric outlet using a standard guidewire: an observer agreement study.

BACKGROUND AND AIMS: Between 10 and 20% of all patients undergoing bariatric surgery procedures regain weight secondary to a gastrojejunostomy enlargement. The aim of this study was to validate the interobserver agreement while measuring gastric outlet diameters using a new standard guidewire. METHODS: We selected thirty-five videos of consecutive endoscopic procedures on patients undergoing esophagogastroduodenoscopy after a Roux-en-Y gastric bypass procedure. All videos were evaluated by four raters: two expert endoscopists and two trainees. We excluded videos having a slipped Fobi ring or a strictured gastric outlet. Anastomosis diameter was measured using a novel device with standardized markings on a guidewire (Hydra jagwire, Boston Scientific, Natick. MA) as well as the current gold standard defined as a calibrated endoscopic measuring instrument (Olympus America, Center Valley, PA). RESULTS: We obtained 272 measurements of the gastric outlet. Overall agreement measured through intra-class correlation coefficients for the gold standard was 0.84 (p < 0.01) and 0.83 (p < 0.01) for the new guidewire. Agreement among experts was 0.699 (p < 0.01), while among trainees it was 0.822 (p < 0.01). CONCLUSION: The new guidewire demonstrated a high degree of observer reliability, also presenting similar results between expert endoscopists and trainees.