ENDOSCOPIC ABLATION COMBINED WITH FUNDOPLICATION PLUS ACID SUPPRESSION-DUODENAL DIVERSION PROCEDURE FOR LONG SEGMENT BARRETT´S ESOPHAGUS: EARLY AND LONG-TERM OUTCOME

ABSTRACT BACKGROUND: The addition of endoscopic ablative therapy plus proton pump inhibitors or fundoplication is postulated for the treatment of patients with long-segment Barrett´s esophagus (LSBE); however, it does not avoid acid and bile reflux in these patients. Fundoplication with distal gastrectomy and Roux-en-Y gastrojejunostomy is proposed as an acid suppression-duodenal diversion procedure demonstrating excellent results at long-term follow-up. There are no reports on therapeutic strategy with this combination. AIMS: To determine the early and long-term results observed in LSBE patients with or without low-grade dysplasia who underwent the acid suppression-duodenal diversion procedure combined with endoscopic therapy. METHODS: Prospective study including patients with endoscopic LSBE using the Prague classification for circumferential and maximal lengths and confirmed by histological study. Patients were submitted to argon plasma coagulation (21) or radiofrequency ablation (31). After receiving treatment, they were monitored at early and late follow-up (5–12 years) with endoscopic and histologic evaluation. RESULTS: Few complications (ulcers or strictures) were observed after the procedure. Re-treatment was required in both groups of patients. The reduction in length of metaplastic epithelium was significantly better after radiofrequency ablation compared to argon plasma coagulation (10.95 vs 21.15 mms for circumferential length; and 30.96 vs 44.41 mms for maximal length). Intestinal metaplasia disappeared in a high percentage of patients, and histological long-term results were quite similar in both groups. CONCLUSIONS: Endoscopic procedures combined with fundoplication plus acid suppression with duodenal diversion technique to eliminate metaplastic epithelium of distal esophagus could be considered a good alternative option for LSBE treatment

Fundamentos fisiopatológicos de la cirugía en diabetes mellitus tipo 2

Bariatric surgery is the only effective treatment for morbid obesity. Also, bariatric procedures have shown excellent results in controlling disorders of the glucose metabolism, improving glycemic control in diabetic patients and achieving remission in 48 to 98% of them. These results are better after surgeries with a malabsorptive effect, such as gastric bypass rather than purely restrictive procedures. In these patients, this improvement in glucose metabolism is observed after a short period of time after surgery, before a substantial weight lost is achieved. This phenomenon suggest that this effect is independent of weight lost and decreased food intake and there are other mechanisms that explain it. This article explains briefly some theories to understand these mechanisms

Plasma ghrelin levels in the late postoperative period of vertical sleeve gastrectomy Efecto de la gastrectomía tubular vertical en los niveles de ghrelina plasmática en pacientes obesos

© 2015, Sociedad Medica de Santiago. All rights reserved.Background: Plasma ghrelin levels may decrease after vertical sleeve gastrectomy, probably due to the excision of a large portion of the gastric fundus. It is worth exploring the long term effects of this surgical procedure on ghrelin levels and their associations with changes in body weight. Aim: To assess ghrelin levels and changes in body weight, one and five years after a vertical sleeve gastrectomy. Material and Methods: Plasma ghrelin was measured prior to gastric sleeve gastrectomy, immediately after surgery and BMI was controlled at one and five years of the postoperative period in 16 and 10 obese patients, respectively. Mean baseline body mass index was 40.4 ± 6 kg/m<sup>2</sup>. Results: Ghrelin decreased in 10 patients and increased in six during the long term postoperative period. At one year, mean body mass index decreased to 25.1 ± 1.6 kg/m<sup>2</sup>. Changes in weight and ghrelin levels had no relationship whats

Plasma ghrelin levels in the late postoperative period of vertical sleeve gastrectomy

Artículo de publicación ISIBackground: Plasma ghrelin levels may decrease after vertical sleeve gastrectomy, probably due to the excision of a large portion of the gastric fundus. It is worth exploring the long term effects of this surgical procedure on ghrelin levels and their associations with changes in body weight. Aim: To assess ghrelin levels and changes in body weight, one and five years after a vertical sleeve gastrectomy. Material and Methods: Plasma ghrelin was measured prior to gastric sleeve gastrectomy, immediately after surgery and BMI was controlled at one and five years of the postoperative period in 16 and 10 obese patients, respectively. Mean baseline body mass index was 40.4 ± 6 kg/m2. Results: Ghrelin decreased in 10 patients and increased in six during the long term postoperative period. At one year, mean body mass index decreased to 25.1 ± 1.6 kg/m2. Changes in weight and ghrelin levels had no relationship whatsoever. At five years of follow up, body mass index had increased to 29.9 ± 2.5 kg/m2, again without any association with ghrelin levels. Conclusions: Ghrelin levels may decrease or increase after vertical sleeve gastrectomy and have no association with changes in body weigh

Resultados del bypass gástrico en diabéticos tipo 2 con índice de masa corporal menor a 35 Kg/m

Currently type 2 diabetes and obesity behave as epidemic diseases. Medical treatment achieved adequate metabolic control in a insufficient number of patients and is not exempt of complications. Mean while the group of diabetics with severe and morbid obesity that have been submitted to bariatric surgery have evolved mostly with remission of their diabetes in medium and long term, so that surgery has become the first choice of treatment. There mision that ensue early in the postoperatory, is not only explained by weight loss, other mechanisms ligated to anatomic and functional changes mediated by surgery are under research. There is a great interest to explore new treatment options for type 2 diabetes including surgery, for patients with mild to severe obesity, with very good initial results

Pharyngo-ileo-colo-anastomosis with microvascular blood supply augmentation for esophago-gastric replacement due to esophago-gastric necrosis after caustic ingestion

Background: Complete esophago-gastric necrosis after caustic ingestion is a challenging surgical scenario for reconstruction of the upper digestive transit. Aim: To present a surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy due to esophageal and gastric necrosis Method: The transit was re-established by means of a pharyngo-ileo-colic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Colo-duodeno-anastomosis and ileo-transverse colic anastomosis were performed for complete digestive transit reconstruction. Result: This procedure was applied in a case of 41 years male attempted suicide by ingesting alkali caustic liquid (concentrated sodium hydroxide). Total necrosis of the esophagus and stomach occurred, which required initially total esophago-gastrectomy, closure at the level of the crico-pharyngeal sphincter and jejunostomy for enteral feeding with a highly deteriorated quality of life. The procedure was performed later and there were no major early and late postoperative complications and normal nutritional conditions were re-stablished. Conclusion: The procedure is feasible and must be managed by multidisciplinary team in order to re-establish a normal quality of life

Evolution of type 2 diabetes mellitus in non morbid obese gastrectomized patients with Roux en-Y reconstruction: Retrospective study

Objective Bariatric surgery in morbidly obese patients with type 2 diabetes results systematically in adequate glycemic control, normalization of insulinemia, and a decrease in glycosylated hemoglobin, effects that appear early after surgery in nearly 80 to 90% of them. Possible reasons that have been discussed are a decrease in caloric consumption, weight loss, and hormonal changes at the gastrointestinal level, which could have a positive effect on glucose metabolism. Various authors have proposed the possibility of passing on this indication to diabetic patients who are overweight or are mildly obese. The purpose of this retrospective investigation was to determine the effect of total or subtotal gastrectomy with Roux-en-Y reconstruction on the metabolic control of patients with type 2 diabetes with a body mass index (BMI)<35, operated on for reasons other than obesity. Methods From January 1999 to December 2007, a total of 23 diabetic patients who underwent total or subtotal gastr

National Trend in Laparoscopic Gastrectomy for Gastric Cancer: Analysis of the National Register in Chile

© 2018 S. Karger AG, Basel.Introduction: The laparoscopic approach for the treatment of gastric cancer has many advantages. However, outside Asia there are few large case series. Aim: To evaluate postoperative morbidity, long-term survival, changes in indication, and the results of laparoscopic gastrectomy. Methods: We included all patients treated with a laparoscopic gastrectomy from 2005 to 2014. We compared results across 2 time periods: 2005-2011 and 2012-2014. Median follow-up was 39 months. Results: Two hundred and eleven patients underwent a laparoscopic gastrectomy (median age 64 years, 55% male patients). In 135 (64%) patients, a total gastrectomy was performed. Postoperative morbidity occurred in 29%. A significant increase in the indication of laparoscopic surgery for stages II-III (32 vs. 45%; p = 0.04) and higher lymph node count (27 vs. 33; p = 0.002) were observed between the 2 periods. The 5-year overall survival was 72%. According to the stage, the 5-year overall surv

Is laparoscopic sleeve gastrectomy an acceptable primary bariatric procedure in obese patients? Early and 5-year postoperative results

In this paper, we analyze and discuss the possibility of Laparoscopic sleeve gastrectomy being accepted as a primary and definitive procedure for obese patients with comorbidities. This is based on our postoperative and 5 years of follow-up result and comparing them with the data reported in the international literature. For comparison of the results, a narrative revision of the literature was performed, using the Medline, Pubmed, and data base publications (Medline, Lilacs, and Cochrane Library), looking for the term "Sleeve gastrectomy," "Obesity," "Bariatric surgery," "Laparoscopic surgery" including "Review" articles and also other 42 selected papers. The current results demonstrate very low morbidity (<10%), nil mortality (<1%), mean % weight loss after 5 years of follow-up of 57%, very satisfactory results regarding comorbidities or improvement. However, gastroesophageal reflux manifestation after the operation (20% to 31%) and the possibility of regaining weight after 5 years (