Esophageal adenocarcinoma after sleeve gastrectomy. Actual or potential threat? Italian series and literature review

Background:Sleeve gastrectomy (SG) leads to esophageal mucosal damage in an elevated percent-age of cases, configuring a clinical condition of Barrett’s esophagus (BE) in a proportion as high as15–18.8%. BE may rarely evolve into esophageal adenocarcinoma (EAC).Objectives:To raise awareness of BE as a precancerous lesion which may progress toward malig-nancy after this popular bariatric procedure.Setting:Bariatric referral centers, Italy.Methods:All patients referred to our bariatric center who developed an EAC after SG between 2012and 2019 were reviewed and consecutively included in this study. The available scientific literatureregarding this complication is additionally reviewed.Results:The 3 male patients comprised in this case series underwent laparoscopic SG between 2012and 2015 in different bariatric referral centers. Age and body mass index at baseline ranged from 21–54 years and 43.1–75.6 kg/m2, respectively. All patients were lost to follow-up early after surgery (3.761.4 months), and were diagnosed with EAC at a mean of 27.367.6 months after SG. The 4 re-ported cases in the scientific literature developed an EAC at a mean of 32.5623 months fromSG. Overall, a diagnosis of EAC was made approximately 30.3617.1 months postoperatively, whichseems relatively and worryingly early after surgery. Conclusion:Although the rate and probability of progression from BE to EAC is still not well defined,assuming that the rising popularity and execution of SG leads to a growth in the BE incidence, then thepreoperative identification and stratification of cancer risk factors in this subset of patients is stronglyencouraged. Clinical and endoscopic follow-ups are essential to allow for prevention and early diag-nosis and for epidemiologic data collection purposes

The Stromboli geophysical experiment. Preliminary report on wide angle refraction seismics and morphobathymetry of Stromboli island (Southern Tyrrhenian sea, Italy)based on integrated offshore-onshore data acquisition (cruise STRO-06 R/V Urania)

The Stromboli geophysical experiment, performed to acquire onshore and offshore seismic data through a combined on-land and marine network, was finalized to reconstruct the seismic tomography of the volcano and to investigate the deep structures and the location of magma chambers. A detailed swath bathymetry around the volcano has also been acquired by the R/V Urania Multibeam. In particular, high resolution bathymetry of the ’Sciara del Fuoco’ area allows to image the present-day seafloor setting of the area involved by the submarine slide of 2002-12-30. During the experiment wide angle refraction seismics was performed all around the Stromboli volcano by a 4 GI-GUN tuned array. The data were recorded by the permanent seismic network of the INGV and 20 temporary stations and 10 OBS deployed on the SE, SW and NE submerged flanks of the volcano after detailed morpho-bathymetric analysis

Intragastric balloon positioning and removal: sedation or general anesthesia?

Different anesthesiological techniques are currently used for intragastric balloon positioning and removal. The aim of this study is to compare different anesthesiological approaches for balloon positioning and removal in a large multicentric patient population. Retrospective multicenter study was conducted. From May 2000 to April 2008, 3,824 patients underwent BIB(A (R)) placement [1,022 male/2,802 female; mean age 39.5 +/- A 14.7 years, range 12-71 years; mean body mass index (BMI) 44.8 +/- A 9.7 kg/m(2), range 28.0-79.1 kg/m(2); excess weight (EW) 59.1 +/- A 29.8 kg, range 16-210 kg; %EW 89.3 +/- A 31.7, range 21.4-262]. Patients were allocated to three groups according to anesthesiological technique used: conscious sedation (group A), deep sedation (group B), and general anesthesia (group C). Intragastric balloon was placed after diagnostic endoscopy and removed after 6 months. Both positioning and removal were done under different protocols. Conscious sedation was obtained with topical lidocaine spray, adding diazepam (0.05-0.1 mg/kg iv) or midazolam (0.03-0.05 mg/kg iv). Deep sedation was obtained with propofol alone or adding other drugs such as midazolam, meperidine/fentanyl or meperidine/fentanyl + midazolam. General anesthesia was obtained with midazolam premedication (0.01-0.02 mg/kg iv) followed by induction with propofol (1-1.5 mg/kg iv) + Norcuron (80 mcg/kg iv) + fentanyl (0.5-1 mcg/kg iv), and maintenance with propofol (50-150 mu g/kg/min) or sevorane. Oxygen saturation, hemodynamic stability, major anesthesiological complications and related mortality, patient satisfaction, time to return to autonomous walking, duration of procedure, and hospital stay were considered. Sedation-related mortality was absent. A significant number of patients with bronchoinhalation during balloon removal was observed with general anesthesia (P < 0.001). BIB positioning and removal should be performed under conscious sedation for patient safety and comfort, and technical success

Intragastric balloon or diet alone? A retrospective evaluation

Background Very few studies have reported results of the BioEnterics Intragastnic Balloon (BIB (R)) at >= 12 months follow-up. The aim of this study is the retrospective evaluation of the results of BIB placement compared to diet regimen alone. Methods From January 2005 to June 2006, 130 outpatients, underwent a structured diet plan with simple behavioral modification at Our institutions. Controls (n=130) were selected from the charts of patients who, during the same period, underwent BIB treatment. Patients in the outpatient group were given a structured balanced diet with a caloric intake between 1,000 and 1,200. The approximate macronutrient distribution, according the "Mediterranean diet," was 25% protein (at least 60 g/day), 20-25% lipids, and 50-55%, carbohydrates. In the BIB group, patients received generic Counseling for eating behavior. In both groups, We considered weight loss parameters (kilograms, percentage of excess weight loss [%EWL], body mass index [BMI], percentage of excess BMI loss [%EBL]) at 6 and 24 months from baseline and comorbidities at baseline and after 24 months. Results are expressed as mean standard deviation. Statistical analysis was done by Student's t-test and chi(2)- test or Fisher's exact test. p <.05 was considered significant. Results At the time of BIB removal (6 months), significantly better results in terms of weight loss in kilograms (16.7 +/- 4.7 vs. 6.6 +/- 2.6; p < 0.01), BMI (35.4 +/- 11.2 vs. 38.9 +/- 12.1; p < 0.01), %EBL (38.5 +/- 16.1 Vs 18.6 +/- 14.3; p < 0.01), and %EWL (33.9 +/- 18 vs. 24.3 +/- 17.0; p < 0.01) were observed in patients treated by intragastric balloon as compared to diet-treated patients. At 24 months from baseline, patient dropout was 1/130 (0.7%) and 25/130 (19.2%) in the BIB and diet groups, respectively (p < 0.001). At this tirne, patients treated with intragastric balloon have tended to regain weight, whereas diet-treated patients have already regained most of lost weight. Conclusions Although the strength of this study may be limited by its retrospective design, the results indicate that, in the short-to-medium term, BIB is significantly superior to diet in terms of weight loss