The Role of Routine Upper Gastrointestinal Endoscopy Before Bariatric Surgery.

BACKGROUND: Obesity remains a major health concern for which surgery has proven to be the most effective treatment in the long term. Routine upper gastrointestinal endoscopy (UGE) is recommended before surgery, but few studies have evaluated its impact on postoperative complications. METHODS: We studied a cohort of 613 patients submitted to UGE before being listed for bariatric surgery between May 2004 and May 2015. A logistic regression analysis was performed to evaluate potential predictors of postoperative complications. RESULTS: Three hundred forty-five patients (56.3 %) presented abnormal endoscopic findings. Helicobacter pylori (Hp) was the strongest predictor of an abnormal endoscopy (OR 10.343, 95 % CI [3.970-26.943], p < 0.001). Of the 342 patients who underwent surgery, 43 (12.6%) developed a postsurgical complication and 2 (0.6%) patients died. In regression analysis, endoscopic ulceration was the only predictor of postoperative complications (OR 11.10, 95 % CI [1.80-68.467], p = 0.01). All patients with gastroduodenal ulcers were infected with Hp. CONCLUSIONS: UGE before bariatric surgery can identify a wide range of abnormal findings. Gastric and duodenal ulcers appear to be the major findings associated with postoperative complications. Routine Hp eradication may potentially reduce the risk of postoperative complications and should be attempted in all patients before surgery.

Role of endoscopy after an acute episode of diverticulitis: analysis of a cohort of Portuguese patients from a tertiary referral center.

INTRODUCTION: Acute diverticulitis represents an inflammatory process originating in a colonic diverticulum. Although acute diverticulitis usually follows a benign course - uncomplicated diverticulitis (UCD), up to 25% may develop complicated diverticulitis (CD) including abscesses, fistulas, strictures, and perforation. Current guidelines recommend performing colonoscopy after an episode of acute diverticulitis to rule out colorectal cancer (CRC). However, the literature supporting this recommendation is still scarce. AIM AND METHODS: Our aim was to assess the relevance of endoscopy following an acute diverticulitis. Using a large cohort from a tertiary center, we retrospectively evaluated endoscopic and histologic findings in patients with acute diverticulitis confirmed by abdominal ultrasound or computed tomography. Findings were characterized as (a) normal endoscopy (highlighting only the presence of diverticula), (b) abnormal endoscopy with low-grade lesions, and (c) abnormal endoscopy with high-grade lesions. RESULTS: A total of 427 patients were evaluated, including 347 cases with UCD and 80 cases with CD. The prevalence of normal findings at endoscopy was 67.3%. An advanced adenoma or neoplasm was found in 23.7%. The estimated number of endoscopies required for diagnosing a CRC was 29 in UCD and 10 in CD. Increasing age and male sex were associated significantly with the presence of polyps at endoscopy. Increasing age was associated with CD and cancer. CONCLUSION: In our series, the prevalence of high-grade lesions and CRC was higher than that in other studies. In our opinion, the findings justify endoscopic evaluation, especially in older patients with CD.

Three decades of hepatitis B control with vaccination.

Hepatitis B virus (HBV) continues to represent a major health problem and can lead to acute liver failure, acute hepatitis, chronic carriership, chronic hepatitis of HBV, liver cirrhosis, liver cancer, liver transplantation and death. There is a marked difference in the geographic distribution of carriers. More than 240 million people worldwide are chronic HBV carriers. Mother-to-child transmission remains the most important mechanism of infection in countries with a high prevalence of HBV. Percutaneous/parenteral transmission and unsafe sexual practices are important mode of spread transmission of HBV in other countries. Vaccination against HBV is the gold measure for primary prevention and control of the disease. Currently, 179 countries have added HBV vaccination to their routine vaccination programs with great results. Neonatal immunization with HBV vaccine has been one of the most highly effective measures in public health and the first anti-cancer program to be launched. In this paper we review the achievements for the last three decades.

Myeloid sarcoma of gastrointestinal tract: a rare cause of obstruction

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