Prospective randomized controlled trial of the closure of gastrojejunal anastomosis in RYGB with absorbable and inabsorbable thread

Introduction: The Roux-en-Y gastric bypass (RYGB) is, currently, the most performed technique in Brazil. Suture threads are classified according to their degradation properties. Objective: To analyze the influence on the size of the gastrojejunal anastomosis performed in Roux-en-Y gastric bypass surgery, as well as the main complications with the use of absorbable or inabsorbable thread. Methods: This study followed a prospective and randomized clinical trial, initially with 40 participants, with only 37 participants being duly selected, 19 of whom underwent gastrojejunostomy closure with an absorbable (Abs) polydioxanone suture (PDS II®) and 18 with the inabsorbable (Inb) ETHIBOND®. Statistical analysis was performed using the ANOVA and logistic regression tools (p<0.05 significant). Results: General complications and Upper Digestive Endoscopy (UDE) were less frequent at the end of 12 months in both groups. At the end of twelve months, the number of complications of the Inb thread decreased considerably, while the number of complications of the Abs thread showed an increase in other complications, including marginal ulcer and intrusive thread. Despite this, there was no significant difference between groups in terms of total weight loss. There was no statistically significant difference between the final values of the anastomotic diameter. The percentage of weight loss over the 12 months was 33.77 ± 6.97% for the Inb group and 36.10 ± 4.89% for the Abs group (p<0.05). Conclusion: Both suture threads (Inb and Abs) presented similar complications and did not present significant differences between the values of weight, gastrojejunal anastomosis, and pouch

LONG-TERM POSTOPERATIVE ENDOSCOPIC FINDINGS AFTER GASTRIC BYPASS PROCEDURE: a co-occurrence analysis

ABSTRACT Background A multitude of endoscopic findings post-gastric bypass procedures have been previously reported in the literature, but to our knowledge, no present rules exist that could guide clinicians regarding which findings should be actively sought, once an initial finding is identified. Objective To identify co-occurrence patterns among endoscopic findings of patients having undergone past gastric bypass procedure. Methods Our registry involves all consecutive patients undergoing an upper endoscopic evaluation after a gastric bypass procedure. We collected information on the presence of the endoscopic findings in post-gastric bypass surgery patients. Co-occurrence evaluation involved the use of intersection, cluster and item factor analyses. Results A total of 396 endoscopic evaluations were made on 339 patients. Most patients were female (81.1%), with an average BMI of 31.88±6.7 at the time of endoscopy. Esophagitis was the most common isolated finding (35.3%). Endoscopic findings clustered around two groups, (1) the ring-related complications involving ring displacement, ring slips and gastric pouch, while (2) stenosis-related findings involved dilation and stenosis (P<0.01). Conclusion While most endoscopic findings after gastric bypass endoscopic procedures are isolated, ring and stenosis-related clusters should be used as a set of rules by clinicians, as it might enhance their probability of finding co-occurring conditions

HEMATOPOIETIC STEM CELL TRANSPLANTATION AND CROHN’S DISEASE: POSITION PAPER FROM THE TRANSPLANTATION COMMITTEE OF THE BRAZILIAN GROUP FOR THE STUDY OF INFLAMMATORY BOWEL DISEASES (GEDIIB)

ABSTRACT Crohn’s disease (CD) is a relapse-remitting inflammatory bowel disease that can affect any part of the digestive system. This heterogeneous disease has multiple factors that contribute to an abnormal immune response to intestinal microorganisms. Treatment is based on the use of anti-inflammatories, corticosteroids, immunosuppressants and biologic biologic agents either alone or in combination. Surgical treatment is usual and, ten years after diagnosis, more than 80% of patients report having undergone surgical procedures related to the disease. Unfortunately, none of the treatments described offer a cure, and many cases become refractory or without therapeutic options. In this scenario, hematopoietic stem cell transplantation has been suggested because clinical remission was obtained in patients who had CD associated with malignant hematological diseases and an alternative since the first reports in 2010. In this report, the Transplantation Committee of the Brazilian Group for the Study of Inflammatory Bowel Diseases reviews the history and results of the procedure in patients with CD, detailing and discussing the various relevant points that permeate hematopoietic stem cell transplantation and cell therapy in this disease