New endoscopic capsule vs upper gastrointestinal endoscopy in preoperative work-up of obese candidate for bariatric surgery: Relevance of a pilot study in the COVID-19 era

: Background and study aims  Obesity represents a major health concern; bariatric surgery is the most effective treatment reducing and maintaining weight loss. The role of a routine esophagogastroduodenoscopy (EGD) prior bariatric surgery is still debated. Moreover, in this scenario of COVID-19 pandemic, EGD is even more questionable due to the procedural risk of viral transmission. A new model of video-endoscopic capsule (VEC) recently has been introduced as a good alternative to the EGD. The aim of this study was to determine if this new capsule is an adequate diagnostic alternative to EGD in the work-up of patients selected for bariatric surgery, particularly in the setting of COVID-19. Patients and methods  From January to November 2020, 27 patients selected for bariatric surgery were enrolled in this pilot study to assess for noninferiority of VEC compared to EGD in detection of upper gastrointestinal disease. Results  VEC had sensitivity, specificity, and positive and negative predictive values in identification of significant lesions of 91.3 %, 83.33 %, 98.01 %, and 51.57 %, respectively, compared with EGD as the standard criterion. The accuracy was 90.51 % (95 % CI, 73.75 %-98.18 %) and the chi-square statistic is 0.1153 ( P  = 0.73). Conclusions  Our report confirms the diagnostic noninferiority of VEC in preoperative work-up of patients selected for bariatric surgery, compared to EGD. This is very important, particularly during the COVID-19 pandemic, given the high risk of contamination with EGD. Larger multicenter studies are required to confirm our preliminary results

Evaluation of Crude Oil Fouling Formation in a Heat Exchanger with Twisted Tape Inserts

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Multiple nodular lesions by colonic metastatic malignant melanoma

A 52 years-old caucasian man was referred from another citizen hospital to our Surgery Department presenting very poor clinical conditions, severe anemia (RGC 3.02 × 106 μl−1 – normal value 4.2–5.6, Hb 6.7 g/dl – normal value 12–16), rectorrhagia. Colonoscopy identified multiple nodular lesions, small in size (0.3–0.8 cm), scattered in the rectum and the colon, with spherical shaped without depression or ulceration, dark brown–black pigmented with violaceous ring around the base. These lesions were isolated in the right colon and clustered in the left colon (1). One of the lesions was resected, by inject and cut mucosectomy: histologic (EE stain) and immunohistochemical (HMB 45) (2) examination showed nests of big size epithelioid cells atrophizing colonic mucosa. The EGD finding was negative. Standard chest X-ray examination showed multiple coin lesions of lungs, which were considered to be metastatic tumours. Bronchoscopy confirmed the presence of multiple nodular lesions that resembled those described in the colon. The patient died 2 days after hospitalization following a multiorgan neoplastic failure. Autopsy revealed multiple hepatic methastasis and a subungual lesion of left thumb that proved to be an acral lentiginous melanoma. Usually, colonic metastatic malignant melanoma (1–22%) presents itself with flat, black macular lesions or subpeduncolated lesions, with dark or reddish depression or ulceration [1], [2] and [3]. The endoscopic appearance of our case is unusual and can imitate a different kind of lesion (for example, a vascular lesion or a Kaposi)

Multiple primary malignancy: role of advanced endoscopy to identify synchronous and metachronous tumors of the digestive tract

The development of new endoscopy systems represents a significant advance in the diagnosis of tumors. The prognosis for patients is strictly dependent on the early detection of malignant lesions, because early lesions of the digestive tract can be removed endoscopically by several techniques (e.g., polypectomy, endoscopic mucosal resection, submucosal endoscopic dissection)