Short Term Outcomes of Using Fecal Immunochemical Test for a Pilot Colorectal Cancer Screening Program. A Single Center Study on 3024 Consecutive Patients.

Background: In Romania, colorectal cancer does not benefit yet from a national screening program. In order to decrease the harm and burden of colorectal cancer (CRC), opportunistic programs relying on endoscopy has been adopted by each centre according to its capacity. A colorectal cancer (CRC) screening programme based on faecal immunochemical test (FIT) was launched at Ponderas Academic Hospital (PAH) in 2019. Aim: The present study analyses the outcomes after the first 1500 tests in the PAH-FIT-CRC Screening Program. We have also aimed to compare the efficiency of the FIT testing program with the screening colonoscopies performed in our Center, withing the same time interval (2019). Methods: The test was recommended in asymptomatic patients over 45 years, and it was followed by a colonoscopy when the test results were positive. Furthermore, we performed a retrospective observational study gathering data from all the consecutive patients prospectively included in the respective databases of our hospital, comparing the efficacy of the two colorectal cancer screening methods (FIT versus colonoscopy). Results: Between 01.01.2019 and 01.01.2020, 1524 screening colonoscopies were performed, and the resulting data were compared with those obtained in the FIT group (1500 FIT tests freely distributed). In the screening colonoscopy group, the polyp detection rate was 38.98% and 22 (1.44%) adenocarcinomas were identified. In the FIT group, the FIT uptake rate was 71% with a positivity rate of 21.7%. The colonoscopy compliance rate for positive FIT patients was 29.4%, with only 2 adenocarcinomas detected. Conclusions: Following data analysis, the need for improvement of uptake rate and colonoscopy compliance rate was suggested, due to the lower acceptance of FIT tests and colonoscopies, especially among men. Moreover, special efforts should be made in order to improve quality indicators for screening colonoscopies (especially adenoma detection rate) with the purpose of decreasing interval CRC.

Intragastric Fluid Filled Balloon for Weight Reduction - A Single Bariatric Center Study.

Introduction: Obesity is a pandemic health problem which significantly reduces life expectancy because of its strong association with severe cardiologic, respiratory, dermatological, gastrointestinal, genito-urinary and psychiatric complications. Intragastric fluid filled balloon (IGB) is a minimally invasive option for weight reduction. Several studies have demonstrated its superiority to lifestyle changes in reducing the morbidity and mortality associated with obesity. Long-term data is very limited, while the balloons are not anticipated to maintain weight beyond 1 year unless an efficient nutritional program is maintained. Aim: This study evaluated the safety and efficacy of intragastric fluid filled balloon in the weight reduction process for patients referred for weight cutback in a center of excellence in bariatric surgery. Methods: This is a retrospective, single institution study which included all the consecutive patients opting for gastric balloon therapy at Ponderas Academic Hospital, Bucharest between October 2017 and October 2019. Two surgeons certified in endoscopy performed the procedures of implantation and extraction. Results: Forty-four patients were included in this study, with a mean age of 36 years. There were 34 (77%) females and 10 (23%) males. The mean index BMI was 32.56 kg/m2 and the mean BMI after 6 months (post extraction of the balloon) was 28.83 kg/m2. Length of stay was 24 hours for 40 (91%) of patients and 48 hours for 4 (9%) patients. Minor complications were registered in 8 (18%) cases and these were not followed by balloon extraction. Overall total weight loss (TWL) mean was 11.76%. Conclusions: Our data demonstrated a clear benefit of intragastric fluid-filled balloon on weight loss, after six month placement of the balloon. At the end of treatment, body weight, excess body weight and BMI were significantly lowered as compared with initial measurements. Successful weight loss was defined as 10% weight loss after 6 months with intragastric balloon in situ. Further research is needed in order to better define the long-term results after balloon extraction.

Re-sleeve Gastrectomy - An Efficient Revisional Bariatric Procedure - 3 Years Results.

Background: Laparoscopic gastric sleeve is a well-known bariatric procedure with good results on weight loss and remission of comorbidities. For patients with weight regain and a large sleeved stomach, the laparoscopic re-sleeve (re-LSG) can be considered a revisional option. AIM: The objective of this study is to evaluate the results of laparoscopic re-sleeve as revisional procedure in patients with weight regain after gastric sleeve, in a Center of Excellence in Bariatric Surgery (BS-CoE). METHOD: A retrospective evaluation of a prospectively maintained database identified 27 patients who underwent laparoscopic gastric re-sleeve after gastric sleeve from January 2013 - December 2016 in our BS-CoE. Patients were monitored in conformity with our standard bariatric program and the efficiency of re-sleeve in terms of weight loss and comorbidities outcome was evaluated at 6 months, 1 year and 3 years postoperative. Results: Re-sleeve gastrectomy was performed by laparoscopic approach in all cases and 24 (89%) patients had concurrent surgical procedures, all of them hiatal hernia repair. No intra or postoperative complications were found except one case of gastric tube stenosis. Mean BMI before resleeve was 35.69 kg/m2 (range 28,58-52) and follow-up results at 6 months after re-sleeve revealed mean BMI was 28.39 +- 5.32 kg/m2 with EWL 83.88%, at 1 year mean BMI 27.23 +- 5.23 kg/m2 with EWL 94.45% and at 3 years BMI 27.65 +- 5.13 kg/m2 with EWL 85.41%. There are statistically significant differences (p 0.01), between BMI before re-sleeve and BMI for all other moments of measurement 6 months, 1 year and 3 years after re-sleeve. All the 6 patients (22%) with comorbidities before re-sleeve had remission of their diseases at ne year postoperative, but 1 patient had recurrence of hypertension at 3 years postoperative. CONCLUSION: Laparoscopic redo sleeve is an efficient revisional surgery option for weight regain after primary gastric sleeve with effective weight loss and improvement of comorbidities in a medium term follow-up.