Body mass index reduction improves the baseline procoagulant imbalance of obese subjects.

Obesity is a risk factor for cardiovascular diseases. The latter being dependent (at least in part) on plasma procoagulant imbalance (i.e., hypercoagulability). Information on hypercoagulability associated with obesity is scanty and mainly based on global traditional coagulation tests or on the measurement of individual components of coagulation (i.e., pro- and anticoagulants). Plasma from 33 obese subjects was investigated soon before endoscopic balloon placement and after removal (6 months later) by thrombin-generation procedures that are thought to represent much better than any other in vitro test the coagulation process occurring in vivo. We found that obese subjects possess a state of hypercoagulability as demonstrated by the modification of the main parameters of thrombin-generation. In particular, the median value (min-max) of the endogenous thrombin potential (ETP) of obese subjects at baseline was higher than that of controls [1968 (1335-2533) vs. 1710 (1010-2119), p < 0.001]. Endoscopic balloon placement achieved a BMI reduction from 38.9 (31.7-62.3) to 31.6 (21.9-53.3), p < 0.001 and a parallel reduction of thrombin-generation as demonstrated by the following findings. The ETP measured soon after balloon removal was significantly smaller than that measured at baseline [1783 (1224-2642) vs. 1968 (1335-2533), p < 0.01]. The other parameters of thrombin-generation, including lag-time, peak-thrombin, time-to-reach the peak and velocity index showed a pattern consistent with the ETP, both at baseline and soon after balloon removal. Endoscopic balloon placement achieves concomitant reduction of BMI and thrombin-generation in subjects with obesity.

Treatment of band erosion: feasibility and safety of endoscopic band removal.

BACKGROUND: Band erosion is reported with a highly variable incidence (0.3-14%) after laparoscopic adjustable gastric banding. Removal of the band is mandatory because the patient regains weight and may become symptomatic, but no consensus exists about the best method, surgical or endoscopic, for this purpose. This study aimed to evaluate the feasibility and effectiveness of endoscopic management of band erosion. METHODS: In this study, 23 patients were treated for band erosion after gastric banding: 8 from the authors' series of 951 patients (incidence, 0.84%) and 15 referred to the authors' surgical department from other hospitals. The endoscopic method of band removal was used in 20 cases. Because of complications associated with erosion, three patients were submitted instead to laparoscopic removal. RESULTS: Endoscopic removal of the band was successful for 16 of 20 patients. Four cases required conversion of the procedure to surgery: in one case due to complications with the endoscopic cutting wire and in the three remaining cases due to dense perigastric adhesions blocking the band. The follow-up evaluation of the patients who had the endoscopic removal was uneventful, with quick discharge at resumption of oral feeding. The patients who underwent laparoscopic removal had a longer hospital stay, and one patient had a leak from the anterior gastrotomy. CONCLUSIONS: Despite a few complications, endoscopic removal seems to be the procedure of choice for the treatment of band erosion. It allows quick resumption of oral feeding and rapid discharge of patients and appears to be safer and more effective than laparoscopic removal. Conversion to surgery is unlikely but possible. Therefore, the authors always recommend that the procedure be performed in the operating room.

Band erosion following gastric banding: how to treat it.

BACKGROUND: Intragastric band migration is an unusual but major long-term complication of gastric banding: its frequency ranges from 0.5-3.8% and always requires removal of the band. Different laparoscopic, laparotomic or endoscopic methods are currently used for band removal. METHODS: 571 morbidly obese patients underwent adjustable gastric banding from February 1998 to July 2006. Band erosion occurred in 3 patients (0.52%). In addition, 6 such patients were referred to our Department from other hospitals. To remove the migrated band, in most patients we used an endoscopic approach with a device designed to cut the band: the Gastric Band Cutter (AMI, Agency for Medical Innovation). RESULTS: In 7 of the 9 patients, we used the gastric band cutter to remove the band endoscopically. It was able to cut the band successfully in all cases except one, where twisting of the cutting wire required conversion from endoscopy to laparoscopy. In another case, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In 2 patients, we had to remove the band surgically - in one case for port-site infection with subphrenic abscess, and in the other case for complete band migration into the jejunum associated with acute pancreatitis, cholelithiasis and choledocholithiasis. CONCLUSION: The Gastric Band Cutter, when used, was successful in dividing the band in all cases except one, although we could not always complete the procedure endoscopically. Endoscopic removal seems to be the procedure of choice for band erosion, because it allows earlier patient discharge and avoids a surgical operation. It is advisable to perform the endoscopic removal in the operating theater, because of possible complications of the procedure.

Prognostic significance of different biomarkers (DNA content, PCNA, karyotype) in colorectal adenomas.

Immunohistochemical detection of proliferating cell nuclear antigen (PCNA), densitometric analysis of nuclear DNA content and fluorescence in situ hybridization with centromere-specific DNA probes to chromosomes 11 and 17 were carried out on histological sections from 55 colorectal adenomas, in order to identify those adenomas that are more likely to progress to cancer. A considerable variability of PCNA positivity (range: 23-28.2%; mean value: 12.8%), a DNA indexfrom 1 to 2.3 and numerical alterations of chromosome 11 were observed. In particular, 14 out of 55 adenomas (25%), independent of histological type, degree of dysplasia, location and size, showed a DNA-aneuploid content, trisomies and tetrasomies of chromosome 11 and high PCNA index. It was concluded that the combination of some biomarkers (additional chromosomes 11, high PCNA and DNA indices) may allow identification of more aggressive colorectal adenomas with increased ability to undergo malignant transformation.