GASTRIC PLICATION ASSOCIATED WITH FUNDOPLICATION IN INDIVIDUALS WITH CLASS I OBESITY AND GASTROESOPHAGEAL REFLUX DISEASE: WEIGHT LOSS OUTCOMES, REFLUX-RELATED SYMPTOMS, ENDOSCOPIC AND pH MONITORING FINDINGS.

BACKGROUND: The association of gastric plication with fundoplication is a reliable option for the treatment of individuals with obesity associated with gastroesophageal reflux disease. AIMS: To describe weight loss, endoscopic, and gastroesophageal reflux disease-related outcomes of gastric plication with fundoplication in individuals with mild obesity. METHODS: A retrospective cohort study was carried out, enrolling individuals who underwent gastric plication with fundoplication at a tertiary private hospital from 2015-2019. Data regarding perioperative and weight loss outcomes, endoscopic and 24-hour pH monitoring findings, and gastroesophageal reflux disease-related symptoms were analyzed. RESULTS: Of 98 individuals, 90.2% were female. The median age was 40.4 years (IQR 32.1-47.8). The median body mass index decreased from 32 kg/m2 (IQR 30,5-34) to 29.5 kg/m2 (IQR 26.7-33.9) at 1-2 years (p<0.05); and to 27.4 kg/m2 (IQR 24.1-30.6) at 2-4 years (p=0.059). The median percentage of total weight loss at 1-2 years was 7.8% (IQR -4.1-14.7) and at 2-4 years, it was 16.4% (IQR 4.3-24.1). Both esophageal and extra-esophageal symptoms showed a significant reduction (p<0.05). A significant decrease in the occurrence of esophagitis was observed (p<0.01). The median DeMeester score decreased from 30 (IQR 15.1-48.4) to 1.9 (IQR 0.93-5.4) (p<0.0001). CONCLUSIONS: The gastric plication with fundoplication proved to be an effective and safe technique, leading to a significant and sustained weight loss in addition to endoscopic and clinical improvement of gastroesophageal reflux disease.

Application of Scores Assessing Histological Activity and Estimated Long-Term Risk Analysis of Hepatic Decompensation of Non-Alcoholic Fatty Liver Disease in Individuals Undergoing Bariatric Surgery.

BACKGROUND: Histological scores can estimate disease staging, allowing a standardization of the assessment of non-alcoholic fatty liver disease (NAFLD). The prediction of risk of NAFLD progression is relevant to allow the planning of interventions. OBJECTIVE: To analyze the application of the Iowa NAFLD decompensation risk score, the NAFLD activity score (NAS), and steatosis-activity-fibrosis score (SAF) and to assess correlations between these scores. METHODS: This is a retrospective cross-sectional study enrolling 76 individuals who underwent bariatric surgery at a tertiary university hospital. Liver biopsy was performed during procedures; histological scores were then assessed. The Iowa score was calculated using age, diabetes, and platelet count. RESULTS: 89.5% were female and mean age was 39.1 ± 9.6 years. Mean BMI was 38.2 ± 3.7 kg/m2. Steatosis (92.1%), hepatocellular ballooning (93.4%), lobular inflammation (93.4%), and fibrosis (97.4%) were the commonest histopathological findings. According to NAS, 22.4% had definite non-alcoholic steatohepatitis (NASH). According to SAF, 89.5% had moderate or severe NAFLD. The mean risks of NAFLD decompensation at 5, 10, and 12 years were 0.8%, 2.5%, and 2.9%, respectively. The group whose risk of decompensation was above 10% comprised 2.6% and 5.3% at 10 and 12 years, respectively. The severity assessed by SAF significantly associated with definite NASH diagnosis through NAS (p < 0.001). Iowa score did not correlate with both NAS/SAF scores. CONCLUSION: The Iowa score demonstrated that individuals with obesity present with a significant long-term risk of NAFLD-related events. There were high rates of moderate/severe forms of NAFLD assessed by NAS and SAF scores. There were no significant correlations between Iowa and NAS/SAF scores.

GASTRIC PLICATION ASSOCIATED WITH FUNDOPLICATION IN INDIVIDUALS WITH CLASS I OBESITY AND GASTROESOPHAGEAL REFLUX DISEASE: WEIGHT LOSS OUTCOMES, REFLUX-RELATED SYMPTOMS, ENDOSCOPIC AND pH MONITORING FINDINGS / PLICATURA GÁSTRICA ASSOCIADA A FUNDOPLICATURA EM INDIVÍDUOS COM OBESIDADE GRAU I E DOENÇA DO REFLUXO GASTROESOFÁGICO: ANÁLISE DE PERDA DE PESO, SINTOMAS DE REFLUXO, ACHADOS ENDOSCÓPICOS E DE pHMETRIA

ABSTRACT BACKGROUND: The association of gastric plication with fundoplication is a reliable option for the treatment of individuals with obesity associated with gastroesophageal reflux disease. AIMS: To describe weight loss, endoscopic, and gastroesophageal reflux disease-related outcomes of gastric plication with fundoplication in individuals with mild obesity. METHODS: A retrospective cohort study was carried out, enrolling individuals who underwent gastric plication with fundoplication at a tertiary private hospital from 2015-2019. Data regarding perioperative and weight loss outcomes, endoscopic and 24-hour pH monitoring findings, and gastroesophageal reflux disease-related symptoms were analyzed. RESULTS: Of 98 individuals, 90.2% were female. The median age was 40.4 years (IQR 32.1-47.8). The median body mass index decreased from 32 kg/m2 (IQR 30,5-34) to 29.5 kg/m2 (IQR 26.7-33.9) at 1-2 years (p<0.05); and to 27.4 kg/m2 (IQR 24.1-30.6) at 2-4 years (p=0.059). The median percentage of total weight loss at 1-2 years was 7.8% (IQR −4.1-14.7) and at 2-4 years, it was 16.4% (IQR 4.3-24.1). Both esophageal and extra-esophageal symptoms showed a significant reduction (p<0.05). A significant decrease in the occurrence of esophagitis was observed (p<0.01). The median DeMeester score decreased from 30 (IQR 15.1-48.4) to 1.9 (IQR 0.93-5.4) (p<0.0001). CONCLUSIONS: The gastric plication with fundoplication proved to be an effective and safe technique, leading to a significant and sustained weight loss in addition to endoscopic and clinical improvement of gastroesophageal reflux disease.

RESUMO RACIONAL: A associação de plicatura gástrica com fundoplicatura é uma opção atrativa para o tratamento de indivíduos com obesidade associada à doença do refluxo gastroesofágico. OBJETIVOS: Descrever a evolução ponderal, clínica, endoscópica e de pHmetria após a gástrica com fundoplicatura em indivíduos com obesidade grau I e doença do refluxo gastroesofágico. MÉTODOS: Um estudo de coorte histórica foi realizado, incluindo indivíduos que realizaram gástrica com fundoplicatura em um hospital privado terciário de 2015 a 2019. Os dados sobre os resultados perioperatórios e de perda de peso, achados endoscópicos e de pHmetria de 24 horas e sintomas relacionados à doença do refluxo gastroesofágico foram analisados. RESULTADOS: Dos 98 indivíduos, 90,2% eram do sexo feminino. A idade mediana foi de 40,4 (IQR 32,1-47,8) anos. A mediana do índice de massa corporal diminuiu de 32 (IQR 30,5-34) kg/m2 para 29,5 (IQR 26,7-33,9) kg/m2 em 1-2 anos (p<0,05); de 2 a 4 anos, foi de 27,4 (IQR 24,1-30,6) kg/m2 (p=0,059). A mediana da porcentagem da perda total de peso em 1-2 anos foi de 7,8% (IQR −4,1-14,7) e em 2-4 anos, foi de 16,4% (IQR 4,3-24,1). Tanto os sintomas esofágicos quanto os extras esofágicos apresentaram redução significativa (p<0,05). Observou-se diminuição significativa na ocorrência de esofagite (p<0,01). A pontuação mediana do escore de DeMeester diminuiu de 30 (IQR 15,1-48,4) para 1,9 (IQR 0,93-5,4) (p<0,0001). CONCLUSÕES: A associação entre plicatura gástrica e fundoplicatura laparoscópica mostrou-se uma técnica eficaz e segura, levando a perda de peso significativa, bem como melhora endoscópica e clínica da doença do refluxo gastroesofágico.

Incidence and Impact of COVID-19 Cases in Brazilian Liver Transplant Recipients: An Academic, Single-center Experience.

BACKGROUND: Current literature reports diverge on the impact of COVID-19 in liver transplant (LT) recipients. Literature findings often report conflicting results, relying on small sample sizes, limited ethnic variability, and nonstandardized methodologies. Notably, there are no studies on this topic regarding Latin American populations. This study seeks to report the impact of COVID-19, disease characteristics, and progression in LT recipients in a Latin American academic center environment. METHODS: The study design was a historic cohort, including adult LT recipient patients with suspected or confirmed COVID-19 who sought care between December 2019 to October 2021. The primary end point was defined as COVID-19-related death. Demographic, clinical, and laboratory data was also collected. RESULTS: Twenty-seven patients were included, representing a 3.5% incidence within 752 patients in the follow-up. The mean age and years from transplantation were 54 (SD ± 11) and 6.3 years (SD ± 5.4), respectively. Most patients were white (23 - 85.2%) and male (21 - 25.2%). The hospitalization rate was 55.6%, and 5 patients (18.5%), all of whom subsequently died, were admitted to the intensive care unit. Neither the presence of comorbidities nor advanced age were related to lethality. Patients with immunosuppression modifications (P = 0.039) or isolated tacrolimus suspension (P = 0.006) were associated with increased mortality. CONCLUSIONS: This study described COVID-19 infections in LT recipients in Latin American populations. This group was not affected by common factors associated with higher lethality, and displayed a tendency toward lower hospitalization rates. Our study concurred with previously reported evidence of a protective association of tacrolimus maintenance during treatment in LT recipients affected by COVID-19.

Análise de prevalência e preditores de deficiências nutricionais após gastrectomia vertical / Prevalence analysis and predictors of nutritional deficiencies after sleeve gastrectomy

Objetivo: Avaliar a prevalência de deficiências nutricionais no pós-operatório de gastrectomia vertical (GV) e a influência do uso de multivitamínicos e da perda peso. Materiais e métodos: análise retrospectiva de 190 pacientes submetidos a GV de 2013 a 2017. Foi avaliada uma dosagem sérica de micronutrientes e a relação com a perda de peso. Resultados: dos 190 pacientes, 28,97% apresentavam anemia, 11,22% apresentaram ferritina baixa, deficiências de albumina (2%), zinco (1%), vitamina B12 (4,35%) e a vitamina D (9,78%). Além disso, 34,4% precisou repor vitamina D, 27,2% vitamina B12 e 12,5% ferro. A deficiência de vitamina D foi diretamente relacionada com peso pré-operatório mais elevado(p=0,038). Não houve relação entre o uso de multivitamínicos ou perda de peso e a prevalência das deficiências nutricionais. Conclusões: o peso pré-operatório elevado foi um preditor de deficiência de vitamina D no pós operatório.

Objective: Assess the prevalence of nutritional deficiencies in the postoperative period of sleeve gastrectomy and the influence of multivitamins use and weight loss. Methods: A retrospective and cross-sectional analysis of 190 patients who underwent sleeve gastrectomy from 2013 to 2017. Micronutrients levels were analyzed and compared with weight loss. Results: Anemia was present in 28.97% of the patients, and 11.22% had low ferritin, albumin (2%)and zinc (1%) levels. Regarding vitamin deficiencies, vitamin B12 was low in 4.35% and vitamin D in 9.78%. Besides, 34.4% of the sample required vitamin D supplementation, 27.2% vitamin B12 supplementation, and 12.5% iron supplementation. Vitamin D deficiency was directly related to higher preoperative weight (p = 0.038). There was no link between the use of multivitamins or weight loss and the prevalence of nutritional deficiencies. Conclusions: High preoperative weight was a predictor of postoperative vitamin D deficiency.

Esôfago de Barrett: concordância diagnóstica entre os achados da endoscopia digestiva alta e a histologia / Barrett's Esophagus: diagnostic agreement between high digestive endoscopy findings and histology

Justificativa: A Doença do Refluxo Gastroesofágico (DRGE) apresenta alta prevalência na população mundial. Uma de suas complicações, é o esôfago de Barrett (EB), uma alteração histológica pré-maligna do epitélio esofágico. O seu diagnóstico se da através do exame endoscópico e posterior confirmação histopatológica. Objetivo: Estimar a concordância diagnóstica, nos casos suspeitos de EB, entre o exame endoscópico e a análise histológica. Métodos: Foram analisados 151 pacientes, retrospectivamente, com suspeita diagnóstica de EB na endoscopia. Os dados foram obtidos a partir de prontuários eletrônicos, entre Julho de 2013 e Julho de 2014. Os laudos anatomopatológicos foram obtidos através de registros do laboratório Byori. Resultados: Entre os 151 pacientes submetidos a biópsias com suspeita endoscópica de EB, 47 (31,1%) obtiveram confirmação diagnóstica através do exame anatomopatológico. Conclusão: A endoscopia digestiva alta é um bom exame para detecção de metaplasia colunar, entretanto, nos casos de esôfago de Barrett, essa eficácia não se reproduziu.

Background: Gastroesophageal Reflux Disease (GERD) has a high prevalence in the world population. One of its complications is Barrett's esophagus (EB), a premalignant histological alteration of the esophageal epithelium. Its diagnosis is given through endoscopic examination and subsequent histopathological confirmation. Objective: Estimate at diagnostic agreement, we have suspense cases of EB, between endoscopic examination and histological analysis. Method: A total of 151 patients were retrospectively with suspected diagnosis of EB at endoscopy. Data were obtained from electronic medical records between July 2013 and July 2014. Anatomopathological reports were obtained from Byori laboratory records. Results: Among the 151 patients who underwent biopsy with endoscopic suspicion of EB, 47 (31.1%) obtained diagnostic confirmation through pathological examination. Conclusion: Upper digestive endoscopy is a good exam to detect columnar metaplasia, however, in Barrett's esophagus cases, this efficacy has not been reproduced.

Intussuscepção jejuno-jejunal e hérnia de petersen concomitantes pós cirurgia bariátrica / Concurrent jejuno-jejunal intussusception and petersen's hernia after bariatric surgery

A intussuscepção intestinal e a hérnia de Petersen são duas possíveis complicações em pacientes submetidos a bypass gástrico em Y de Roux. Os sintomas podem ocorrer de meses a anos após a cirurgia, caracterizando-se principalmente por um quadro obstrutivo em que a dor é o principal sintoma. Este é o primeiro relato da associação de ambas as condições em uma paciente do sexo feminino, 25 anos, que procurou o serviço do hospital 4 anos após ter realizado bypass gástrico com quadro de dor abdominal, náusea e parada de eliminação de flatos. Durante o ato cirúrgico, foi realizada a redução da hérnia e enterectomia do segmento com intussuscepção. O presente relato de caso corrobora para demonstrar a importância da suspeita clínica no diagnóstico diferencial de dor abdominal em pacientes submetidos a bypass gástrico em Y de Roux

Intussusception and Petersen's hernias are two possible complications in patients who underwent Roux-en-Y gastric bypass (RYGB). The symptoms may occur several months to years after the surgery, characterized by an obstructive acute abdomen with pain as the main symptom. This is the first report with both conditions in a 25-year-old female patient that presented to the emergency department (ER) after 4 years of RYGB with abdominal pain, nausea and no flatus. During the surgical procedure, the Petersen's hernia was reduced and the retrograde intussusception was resected. The present report aims to show the importance of clinical suspicion in the differential diagnosis of abdominal pain after RYGB

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP): ANALYSIS OF THE EFFECTIVENESS AND SAFETY OF THE PROCEDURE IN THE PATIENT WITH ROUX-EN-Y GASTRIC BYPASS.

BACKGROUND: Obesity can be treated with bariatric surgery; but, excessive weight loss may lead to diseases of the bile duct such as cholelithiasis and choledocholithiasis. Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for these conditions, and may be hampered by the anatomical changes after surgery. AIM: Report the efficacy and the safety of videolaparoscopy-assisted endoscopic retrograde cholangiopancreatography technique in patients after bariatric surgery with Roux-en-Y gastric bypass. METHOD: Retrospective study performed between 2007 and 2017. Data collected were: age, gender, surgical indication, length of hospital stay, etiological diagnosis, rate of therapeutic success, intra and postoperative complications. RESULTS: Seven patients had choledocholithiasis confirmed by image exam, mainly in women. The interval between gastric bypass and endoscopic procedure ranged from 1 to 144 months. There were no intraoperative complications. The rate of duodenal papillary cannulation was 100%. Regarding complications, the majority of cases were related to gastrostomy, and rarely to endoscopic procedure. There were two postoperative complications, a case of chest-abdominal pain refractory to high doses of morphine on the same day of the procedure, and a laboratory diagnosis of acute pancreatitis after the procedure in an asymptomatic patient. The maximum hospital stay was four days. CONCLUSION: The experience with endoscopic retrograde cholangiopancreatography through laparoscopic gastrostomy is a safe and effective procedure, since most complications are related to the it and did not altered the sequence to perform the conventional cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ercp): analysis of the effectiveness and safety of the procedure in the patient with roux-en-y gastric bypass / Colangiopancreatografia retrógrada endoscópica (cpre): análise da eficácia e segurança do procedimento em paciente com bypass gástrico em y-de- roux

ABSTRACT Background: Obesity can be treated with bariatric surgery; but, excessive weight loss may lead to diseases of the bile duct such as cholelithiasis and choledocholithiasis. Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for these conditions, and may be hampered by the anatomical changes after surgery. Aim: Report the efficacy and the safety of videolaparoscopy-assisted endoscopic retrograde cholangiopancreatography technique in patients after bariatric surgery with Roux-en-Y gastric bypass. Method: Retrospective study performed between 2007 and 2017. Data collected were: age, gender, surgical indication, length of hospital stay, etiological diagnosis, rate of therapeutic success, intra and postoperative complications. Results: Seven patients had choledocholithiasis confirmed by image exam, mainly in women. The interval between gastric bypass and endoscopic procedure ranged from 1 to 144 months. There were no intraoperative complications. The rate of duodenal papillary cannulation was 100%. Regarding complications, the majority of cases were related to gastrostomy, and rarely to endoscopic procedure. There were two postoperative complications, a case of chest-abdominal pain refractory to high doses of morphine on the same day of the procedure, and a laboratory diagnosis of acute pancreatitis after the procedure in an asymptomatic patient. The maximum hospital stay was four days. Conclusion: The experience with endoscopic retrograde cholangiopancreatography through laparoscopic gastrostomy is a safe and effective procedure, since most complications are related to the it and did not altered the sequence to perform the conventional cholangiopancreatography.

RESUMO Racional: A obesidade pode ser tratada com a cirurgia bariátrica; porém, doenças da via biliar como colelitíase e coledocolitíase podem surgir, principalmente devido à grande perda de peso. A colangiopancreatografia retrógrada é procedimento diagnóstico e terapêutico dessas afecções, e pode ser dificultada pela alteração anatômica após a operação. Objetivos: Relatar a eficácia e a segurança da colangiopancreatografia endoscópica retrógrada assistida por videolaparoscopia nos pacientes pós-cirurgia bariátrica com derivação gástrica em Y-de-Roux. Método: Estudo retrospectivo entre 2007 e 2017. Foram coletados: idade, gênero, indicação cirúrgica, tempo de internamento, diagnóstico etiológico, taxa de sucesso terapêutico, intercorrências intra e pós-operatórias. Resultados: Sete pacientes tiveram coledocolitíase confirmada por exame de imagem, principalmente em mulheres. O intervalo entre a derivação gástrica e o procedimento endoscópico variou de 1 a 144 meses. Não houve intercorrências intraoperatórias. A canulação da papila duodenal foi obtida em 100% dos casos. A maioria dos casos de complicações foi relacionada à gastrostomia, e raramente ao procedimento endoscópico. Houve duas intercorrências pós-operatórias, um caso de dor toracoabdominal refratária às doses elevadas de morfina no mesmo dia do procedimento, além de um diagnóstico laboratorial de pancreatite aguda pós-procedimento em paciente assintomático. A permanência hospitalar máxima foi de quatro dias. Conclusão: A colangiopancreatografia retrógrada endoscópica pela gastrostomia laparoscópica é método eficaz, seguro, visto que a maioria das complicações foi relacionada à gastrostomia; ela não altera a sequência de realização da colangiopancreatografia convencional.