Dietary Fiber and Lysolecithin Supplementation in Growing Ducks: Effect on Performance, Immune Response, Intestinal Morphology and Lipid Metabolism-Regulating Genes.

The impact of different dietary fiber (DF) levels (with or without lysolecithin supplementation) on growth performance, immune response, expression of some lipid regulating genes and intestinal morphology was assessed in 408 Pekin ducks for 2 months. Soybean hulls were added to the diet to provide four different levels of DF: 2.4 (control diet), 3.8, 5.3, and 6.7% for the first four groups, respectively, while groups 5 to 8 fed the same four levels of DF with lysolecithin addition. Increasing dietary DF non-significantly reduced (p > 0.05) the ducks' body weight (BW). However, ducks fed on 3.8% DF showed higher BW and improved feed conversion ratio. Lysolecithin supplementation with different DF did not support growth performance. Increasing DF with or without lysolecithin had no effect on serum lipid profile (p > 0.05). However, serum high-density lipoproteins (HDL) concentration was significantly increased with increasing fiber level in diet (p ˂ 0.05). Increasing DF with or without lysolecithin addition increased serum antioxidant activities and improved the immune response in terms of phagocytic and lysozyme activities. The DF level reduced the duodenal villi length and mucosal layer thickness while increased the villi width (p ˂ 0.05). Lysolecithin supplementation to diets ameliorated adverse effects on intestinal morphology. Moreover, DF level in ducks' diet with or without lysolecithin significantly upregulated the expression of fatty acid synthase and lipoprotein lipase (p ˂ 0.05). Thus, it could be concluded that ducks fed on soybean hulls containing a diet at the level of 4.5% and providing 3.8% fiber level with or without lysolecithin showed the best performance.

Gastric Stenosis After Sleeve Gastrectomy: an Algorithm for Management.

BACKGROUND: Gastric stenosis (GS) is a well-recognized complication after sleeve gastrectomy (SG) with a negative impact on patients' nutritional status and quality of life. There is no consensus on a validated, comprehensive management algorithm for GS. This study evaluates treatment modalities and proposes a management algorithm for obstructive gastric symptoms (OGSs) after SG. METHODS: This is a retrospective cohort study of patients with GS after SG between January 2013 and January 2019. Patients with concomitant GS and staple-line leak were excluded. The primary outcome was the clinical response to treatment. RESULTS: Forty-nine patients presented with OGSs. One patient underwent urgent surgical treatment for acute migration of cardia. Of 42 patients who had evident GS, pneumatic balloon dilatation (PBD) achieved clinical success in 28 (66.7%) patients. Six patients were diagnosed with indolent GS, and four of them improved after empirical PBD. The mean interval from index surgery to PBD was 5.3 (± 4.2) months. Longer duration of PBD session was associated with better clinical outcomes (5.8 ± 3.7 vs. 3.2 ± 1.7 min) (P = 0.017). After failed PBD, endoscopic stenting (n = 2) and revisional surgery (n = 7) were performed with clinical success in all patients. CONCLUSION: PBD using achalasia balloon is the mainstay of treatment with good clinical outcomes. The utility of endoscopic stenting for GS should be different from its use for leakage in aspects of dwelling time and required endoscopic expertise. RYGB is the gold standard revisional procedure due to the high success rate and technical familiarity. Controversial aspects of management require future prospective comparative studies.