Extrinsic compression of pancreatic duct by intragastric balloon treatment and its potential to cause acute pancreatitis: Two case reports and clinical discussion.

We describe two cases of increased pancreatic enzyme levels after intragastric balloon (IGB) placement possibly related to extrinsic pancreatic duct compression, followed by a short review of the literature. Case 1 is the first, to our knowledge, of a patient with asymptomatic increase of pancreatic enzymes due to pancreatic duct compression, with unknown clinical significance. We hypothesize that this finding maybe can be relatively common in IGB users and almost certainly an important risk factor for the development of acute pancreatitis (AP). On the other hand, case 2 reports an AP that occurred one day after IGB placement, presented with nausea and vomiting, making AP a differential diagnosis of initial IGB intolerance.

Axial Spondyloarthritis after bariatric surgery: a 7-year retrospective analysis.

BACKGROUND: In recent decades, obesity has become a public health problem in many countries. The objective of this study was to evaluate the main joint and extra-articular manifestations related to spondyloarthritis (SpA) after bariatric surgery (BS) in a retrospective cohort. METHODS: Demographic, clinical, laboratory and imaging data from nine patients whose SpA symptoms started after a BS have been described. Modified New York (mNY) criteria for ankylosing spondylitis (AS) and the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial (ax-SpA) and peripheral (p-SpA) spondyloarthritis were applied. RESULTS: The mean weight reduction after BS was 49.3 ± 21.9 kg. The BS techniques were Roux-en-Y gastric bypass (n = 8; 88.9%) and biliopancreatic diversion with duodenal switch (n = 1; 11.1%). Four (44.4%) patients had no axial or peripheral pain complaints before BS, while the other four (44.4%) had sporadic non-inflammatory back pain that had been attributed to obesity. One patient (11.1%) had persistent chronic back pain. In all nine cases, patients reported back pain onset or pattern (intensity or night pain) change after BS (mean time 14.7 ± 18 months). In addition, 8 of them (88.9%) were human leukocyte antigen (HLA)-B27 positive. All nine patients could be classified according to ASAS criteria as ax-SpA and five (55.6%) patients were classified as AS, according to the mNY criteria. CONCLUSION: Our data highlight a temporal link between SpA onset symptoms and the BS, suggesting a possible causal plausibility between the two events.

Axial Spondyloarthritis after bariatric surgery: a 7-year retrospective analysis

Abstract Background: In recent decades, obesity has become a public health problem in many countries. The objective of this study was to evaluate the main joint and extra-articular manifestations related to spondyloarthritis (SpA) after bariatric surgery (BS) in a retrospective cohort. Methods: Demographic, clinical, laboratory and imaging data from nine patients whose SpA symptoms started after a BS have been described. Modified New York (mNY) criteria for ankylosing spondylitis (AS) and the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial (ax-SpA) and peripheral (p-SpA) spondyloarthritis were applied. Results: The mean weight reduction after BS was 49.3 ±21.9 kg. The BS techniques were Roux-en-Y gastric bypass (n =8; 88.9%) and biliopancreatic diversion with duodenal switch (n = 1; 11.1%). Four (44.4%) patients had no axial or peripheral pain complaints before BS, while the other four (44.4%) had sporadic non-inflammatory back pain that had been attributed to obesity. One patient (11.1%) had persistent chronic back pain. In all nine cases, patients reported back pain onset or pattern (intensity or night pain) change after BS (mean time 14.7 ± 18 months). In addition, 8 of them (88.9%) were human leukocyte antigen (HLA)-B27 positive. All nine patients could be classified according to ASAS criteria as ax-SpA and five (55.6%) patients were classified as AS, according to the mNY criteria. Conclusion: Our data highlight a temporal link between SpA onset symptoms and the BS, suggesting a possible causal plausibility between the two events.

Derivação biliopancreática com gastrectomia longitudinal e preservação pilórica(Duodenal Switcha) / Biliopancreatic bypass with longitudinal gastrectomy and pilori preservation (Duodenal Switch)

A Derivação biliopancreática com gastrectomia longitudinal e preservaçãopilórica (Duodenal switch) é uma modificação da operaçãode Scopinaro que vem ganhando espaço na cirurgia bariátrica. Sua configuração visa diminuir os efeitos colaterais da derivação bilio-pancreática. Por laparotomia ou laparoscopia realiza-se gastrectomia vertical com manutenção do piloro e tubo gástrico da pequena curvatura. Secciona-se o duodeno no plateau pancreático. A boca distal é sepultada. O íleo é seccionado entre 200 e 300cm do ceco e a boca distal é anastomosada ao bulbo duodenal.A boca proximal é anastomosada ao íleo de 50 a 100cm do ceco. A perda do excesso de peso relatada é de 75. É mantida ao longo do tempo quando utilizadas medidas mais curtas de alças alimentar e comum. Alças comuns fixas em 100cm podem estar relacionadasa recuperação de peso a longo prazo. Doenças associada como diabetes e dislipidemias obtiveram altas taxas de resolução. Desnutrição protéica, perda de peso demasiada, anemia ferropriva e hiperparatireoidismo secundário foram as principais complicações a longo prazo. Mecanismos endócrinos estão associados aos efeitos benéficos da cirurgia para pacientes diabéticos.A gastrectomia com manutenção pilórica apresenta efeito sacietógeno. A má-absorção seletiva de lípides atua na melhora da hipercolesterolemia. A cirurgia produz ótimo resultado quantoà perda ponderal e controle das doenças associadas à obesidade. Minimiza os efeitos colaterais da cirurgia de Scopinaro. Pode levar a complicações metabólicas e nutricionais.

Bariatric surgery in a patient with possible psychiatric contraindications.

Grade III obesity (BMI > 39.9 kg/m2) is considered a chronic disease where clinical and diet therapy show poor results, with high rates of relapse. The most consistent results are those obtained through surgical procedures. Several authors discuss the contraindications for the performance of anti-obesity operations. Psychiatric disorders are often considered contraindications to these operations, especially affective disorders, psychotic disorders and personality disorders. The authors report the case of a 37-year-old patient, with obesity history since the age of 12, and anorexiant abuse (amphetamine-derived substances) during 20 years, binge-eating episodes, purgative compensatory behaviors and recurrent depressive symptoms. She was submitted to anti-obesity surgery in August 2000 (BMI 40.2). The outcome is reported and a discussion of the possible psychiatric contraindications for the anti-obesity surgeries is proposed.