Cambios morfofuncionales en un modelo animal experimental de enfermedad hepática por hígado graso no alcohólico tras tratamiento con cirugía bariátrica versus dieta hipocalórica

La enfermedad por hígado graso no alcohólico o NAFLD es la primera causa de enfermedad hepática crónica a nivel mundial. Es considerada la manifestación hepática del síndrome metabólico, y en su etiopatogenia participan diversos factores que aún no se conocen por completo (dietéticos, metabólicos, genéticos, medioambientales, inmunológicos e incluso microbiológicos, entre otros). Actualmente no existe tratamiento definitivo conocido, siendo la pérdida de peso mediante dieta y ejercicio lo que por el momento se recomienda para su tratamiento. En relación a esto, en los últimos años se propone la cirugía bariátrica como posible terapia debido a su éxito en la pérdida de peso a largo plazo. Existen datos que demuestran la mejoría del NAFLD tras cirugía bariátrica, los cuales se extraen a partir de estudios observacionales que analizan fundamentalmente los cambios analíticos e histológicos en los pacientes obesos sometidos a cirugía bariátrica y al mismo tiempo enfermos por NAFLD. Sin embargo, no existen aún ensayos clínicos randomizados ni evidencia suficiente que avale estos efectos en la enfermedad por hígado graso, y en opinión de las últimas guías, aún es pronto para considerar a la cirugía bariátrica como tratamiento establecido para el NAFLD. Este trabajo, a partir de un modelo animal de enfermedad por NAFLD creado en ratas alimentadas con una fórmula de dieta rica en grasas, pretende añadir información a la ya existente acerca de la enfermedad y su tratamiento. En él se han querido evaluar los cambios propios de la enfermedad a un nivel bioquímico, histológico, hormonal, molecular y de expresión génica, y analizar después cuáles son los efectos de la cirugía bariátrica en comparación al tratamiento estándar actual, la dieta hipocalórica, a todos estos niveles. De él se puede extraer que la cirugía bariátrica, concretamente la técnica de la gastrectomía vertical o “sleeve gastrectomy” (SG), es superior a la dieta hipocalórica para el tratamiento de fases iniciales de NAFLD. Su superioridad radica en una mayor pérdida de peso, reversión de signos histopatológicos de la enfermedad, mejoría del daño endotelial sinusoidal hepático, disminución de hiperleptinemia e insulinorresistencia, y también reducción del riesgo cardiovascular mediante la disminución del colesterol total, los triglicéridos en plasma y la mejoría global del NAFLD en sí.Non-alcoholic fatty liver disease or NAFLD is the leading cause of chronic liver disease worldwide. It is considered the hepatic manifestation of the metabolic syndrome, and its etiopathogenesis involves several factors that are not yet fully understood (dietary, metabolic, genetic, environmental, immunological and even microbiological factors, among others). Currently, there is no known definitive treatment, being the weight loss through diet and exercise the only strategy recommended. Relative to this, in recent years bariatric surgery is proposed as a possible therapy due to its long-term success in weight loss. There is data showing the improvement of NAFLD after bariatric surgery, which is extracted from observational studies that fundamentally analyze the analytical and histological changes in obese patients undergoing bariatric surgery (and which are patients with NAFLD at the same time). However, there are no randomized clinical trials or sufficient evidence to support these apparently good effects in fatty liver disease, and according to the latest guidelines, it is still early to consider bariatric surgery as an established treatment for NAFLD. This work aims to add information to the existing evidence about the disease and its treatment. It is based on an animal model of NAFLD created in rats fed a high-fat diet formula. We wanted to evaluate the changes of the disease to a biochemical, histological, hormonal, molecular level and of gene expression, and to analyze which are the effects of the bariatric surgery in comparison to the current standard treatment, the hypocaloric diet. It can be inferred from this that bariatric surgery, specifically the vertical gastrectomy technique (SG), is superior to the hypocaloric diet for the treatment of initial phases of NAFLD. Its superiority lies in greater weight loss, reversion of histopathological signs of the disease, improvement of hepatic sinusoidal endothelial damage, decrease in hyperleptinemia and insulin resistance, and also reduction of cardiovascular risk through the reduction of total cholesterol, triglycerides in plasma and global improvement of the NAFLD itself

Cambios morfofuncionales en un modelo animal experimental de enfermedad hepática por hígado graso no alcohólico tras tratamiento con cirugía bariátrica versus dieta hipocalórica

La enfermedad por hígado graso no alcohólico o NAFLD es la primera causa de enfermedad hepática crónica a nivel mundial. Es considerada la manifestación hepática del síndrome metabólico, y en su etiopatogenia participan diversos factores que aún no se conocen por completo (dietéticos, metabólicos, genéticos, medioambientales, inmunológicos e incluso microbiológicos, entre otros). Actualmente no existe tratamiento definitivo conocido, siendo la pérdida de peso mediante dieta y ejercicio lo que por el momento se recomienda para su tratamiento. En relación a esto, en los últimos años se propone la cirugía bariátrica como posible terapia debido a su éxito en la pérdida de peso a largo plazo. Existen datos que demuestran la mejoría del NAFLD tras cirugía bariátrica, los cuales se extraen a partir de estudios observacionales que analizan fundamentalmente los cambios analíticos e histológicos en los pacientes obesos sometidos a cirugía bariátrica y al mismo tiempo enfermos por NAFLD. Sin embargo, no existen aún ensayos clínicos randomizados ni evidencia suficiente que avale estos efectos en la enfermedad por hígado graso, y en opinión de las últimas guías, aún es pronto para considerar a la cirugía bariátrica como tratamiento establecido para el NAFLD. Este trabajo, a partir de un modelo animal de enfermedad por NAFLD creado en ratas alimentadas con una fórmula de dieta rica en grasas, pretende añadir información a la ya existente acerca de la enfermedad y su tratamiento. En él se han querido evaluar los cambios propios de la enfermedad a un nivel bioquímico, histológico, hormonal, molecular y de expresión génica, y analizar después cuáles son los efectos de la cirugía bariátrica en comparación al tratamiento estándar actual, la dieta hipocalórica, a todos estos niveles. De él se puede extraer que la cirugía bariátrica, concretamente la técnica de la gastrectomía vertical o “sleeve gastrectomy” (SG), es superior a la dieta hipocalórica para el tratamiento de fases iniciales de NAFLD. Su superioridad radica en una mayor pérdida de peso, reversión de signos histopatológicos de la enfermedad, mejoría del daño endotelial sinusoidal hepático, disminución de hiperleptinemia e insulinorresistencia, y también reducción del riesgo cardiovascular mediante la disminución del colesterol total, los triglicéridos en plasma y la mejoría global del NAFLD en sí.Non-alcoholic fatty liver disease or NAFLD is the leading cause of chronic liver disease worldwide. It is considered the hepatic manifestation of the metabolic syndrome, and its etiopathogenesis involves several factors that are not yet fully understood (dietary, metabolic, genetic, environmental, immunological and even microbiological factors, among others). Currently, there is no known definitive treatment, being the weight loss through diet and exercise the only strategy recommended. Relative to this, in recent years bariatric surgery is proposed as a possible therapy due to its long-term success in weight loss. There is data showing the improvement of NAFLD after bariatric surgery, which is extracted from observational studies that fundamentally analyze the analytical and histological changes in obese patients undergoing bariatric surgery (and which are patients with NAFLD at the same time). However, there are no randomized clinical trials or sufficient evidence to support these apparently good effects in fatty liver disease, and according to the latest guidelines, it is still early to consider bariatric surgery as an established treatment for NAFLD. This work aims to add information to the existing evidence about the disease and its treatment. It is based on an animal model of NAFLD created in rats fed a high-fat diet formula. We wanted to evaluate the changes of the disease to a biochemical, histological, hormonal, molecular level and of gene expression, and to analyze which are the effects of the bariatric surgery in comparison to the current standard treatment, the hypocaloric diet. It can be inferred from this that bariatric surgery, specifically the vertical gastrectomy technique (SG), is superior to the hypocaloric diet for the treatment of initial phases of NAFLD. Its superiority lies in greater weight loss, reversion of histopathological signs of the disease, improvement of hepatic sinusoidal endothelial damage, decrease in hyperleptinemia and insulin resistance, and also reduction of cardiovascular risk through the reduction of total cholesterol, triglycerides in plasma and global improvement of the NAFLD itself

Evolution of laparoscopic gastrectomy for cancer in the East and West

Laparoscopic gastrectomy has evolved differently in Eastern and Western countries. Feasibility, safety and oncological outcomes of laparoscopic gastrectomy were addressed step-by-step by several randomized controlled trials from the East. Few phase III studies were published from the West that largely did not show a difference between the laparoscopic and open approach. Despite this, laparoscopic gastrectomy is seen as the standard for the surgical treatment of early and advanced gastric cancer in many European countries. Here, we review and comment on some important studies on laparoscopic gastrectomy for gastric cancer from Eastern and Western countries and also comment on current and future challenges

Prevention and treatment of a positive proximal margin after gastrectomy for cardia cancer

A tumour-positive proximal margin (PPM) after extended gastrectomy for oesophagogastric junction (OGJ) adenocarcinoma is observed in approximately 2–20% of patients. Although a PPM is an unfavourable prognostic factor, the clinical relevance remains unclear as it may reflect poor tumour biology. This narrative review analyses the most relevant literature on PPM after gastrectomy for OGJ cancers. Awareness of the risk factors and possible measures that can be taken to reduce the risk of PPM are important. In patients with a PPM, surgical and non-surgical treatments are available but the effectiveness remains unclear

Cambios morfofuncionales en un modelo animal experimental de enfermedad hepática por hígado graso no alcohólico tras tratamiento con cirugía bariátrica versus dieta hipocalórica /

Premi Extraordinari de Doctorat concedit pels programes de doctorat de la UAB per curs acadèmic 2017-2018La enfermedad por hígado graso no alcohólico o NAFLD es la primera causa de enfermedad hepática crónica a nivel mundial. Es considerada la manifestación hepática del síndrome metabólico, y en su etiopatogenia participan diversos factores que aún no se conocen por completo (dietéticos, metabólicos, genéticos, medioambientales, inmunológicos e incluso microbiológicos, entre otros). Actualmente no existe tratamiento definitivo conocido, siendo la pérdida de peso mediante dieta y ejercicio lo que por el momento se recomienda para su tratamiento. En relación a esto, en los últimos años se propone la cirugía bariátrica como posible terapia debido a su éxito en la pérdida de peso a largo plazo. Existen datos que demuestran la mejoría del NAFLD tras cirugía bariátrica, los cuales se extraen a partir de estudios observacionales que analizan fundamentalmente los cambios analíticos e histológicos en los pacientes obesos sometidos a cirugía bariátrica y al mismo tiempo enfermos por NAFLD. Sin embargo, no existen aún ensayos clínicos randomizados ni evidencia suficiente que avale estos efectos en la enfermedad por hígado graso, y en opinión de las últimas guías, aún es pronto para considerar a la cirugía bariátrica como tratamiento establecido para el NAFLD. Este trabajo, a partir de un modelo animal de enfermedad por NAFLD creado en ratas alimentadas con una fórmula de dieta rica en grasas, pretende añadir información a la ya existente acerca de la enfermedad y su tratamiento. En él se han querido evaluar los cambios propios de la enfermedad a un nivel bioquímico, histológico, hormonal, molecular y de expresión génica, y analizar después cuáles son los efectos de la cirugía bariátrica en comparación al tratamiento estándar actual, la dieta hipocalórica, a todos estos niveles. De él se puede extraer que la cirugía bariátrica, concretamente la técnica de la gastrectomía vertical o "sleeve gastrectomy" (SG), es superior a la dieta hipocalórica para el tratamiento de fases iniciales de NAFLD. Su superioridad radica en una mayor pérdida de peso, reversión de signos histopatológicos de la enfermedad, mejoría del daño endotelial sinusoidal hepático, disminución de hiperleptinemia e insulinorresistencia, y también reducción del riesgo cardiovascular mediante la disminución del colesterol total, los triglicéridos en plasma y la mejoría global del NAFLD en sí.Non-alcoholic fatty liver disease or NAFLD is the leading cause of chronic liver disease worldwide. It is considered the hepatic manifestation of the metabolic syndrome, and its etiopathogenesis involves several factors that are not yet fully understood (dietary, metabolic, genetic, environmental, immunological and even microbiological factors, among others). Currently, there is no known definitive treatment, being the weight loss through diet and exercise the only strategy recommended. Relative to this, in recent years bariatric surgery is proposed as a possible therapy due to its long-term success in weight loss. There is data showing the improvement of NAFLD after bariatric surgery, which is extracted from observational studies that fundamentally analyze the analytical and histological changes in obese patients undergoing bariatric surgery (and which are patients with NAFLD at the same time). However, there are no randomized clinical trials or sufficient evidence to support these apparently good effects in fatty liver disease, and according to the latest guidelines, it is still early to consider bariatric surgery as an established treatment for NAFLD. This work aims to add information to the existing evidence about the disease and its treatment. It is based on an animal model of NAFLD created in rats fed a high-fat diet formula. We wanted to evaluate the changes of the disease to a biochemical, histological, hormonal, molecular level and of gene expression, and to analyze which are the effects of the bariatric surgery in comparison to the current standard treatment, the hypocaloric diet. It can be inferred from this that bariatric surgery, specifically the vertical gastrectomy technique (SG), is superior to the hypocaloric diet for the treatment of initial phases of NAFLD. Its superiority lies in greater weight loss, reversion of histopathological signs of the disease, improvement of hepatic sinusoidal endothelial damage, decrease in hyperleptinemia and insulin resistance, and also reduction of cardiovascular risk through the reduction of total cholesterol, triglycerides in plasma and global improvement of the NAFLD itself

ESDE-MIE fellowship. a descriptive analysis of the first experiences

Esophageal resection is a high-risk and technically demanding procedure, with a long proficiency-gain curve. The European Society Diseases of the Esophagus (ESDE)-Minimally Invasive Esophagectomy (MIE) training program was launched in 2018 for European surgeons willing to train and to begin a career undertaking MIE. The aim of this study was to evaluate the first experience of the ESDE-MIE fellowship and relate this to the initially predetermined core principles and objectives of the program. Between October 2021 and May 2022, the participating fellows, in collaboration with the ESDE Educational Committee, initiated a survey to assess the outcome and experience of these fellowships. Data from each individual fellowship were analysed and reported in a descriptive manner. Between 2018 and 2022, in total, five fellows have completed the ESDE-MIE fellowship program. Despite the COVID-19 outbreak just the year after its launch, predetermined clinical and research goals were achieved in all cases. Each of the fellows were able to assist in a median of 40 (IQR 27-69) MIE and/or Robot assisted (RA)MIE procedures, of a total median of 115 (IQR 83-123) attended Upper GI cases. After the fellowship, MIE has been fully adopted by the fellows who returned to their home institutions as Upper GI surgeons. The fellowship was concluded by the European Union of Medical Specialists (UEMS) Multidisciplinary Joint Committee (MJC) certification in Upper GI Surgery, which was successfully obtained by all who took part. Based on the experience of the first five fellows, the ESDE-MIE training fellowship meets with the expected needs even despite the COVID-19 outbreak in 2019. Furthermore, these fellows have returned home and integrated MIE into their independent surgical practice, affirming the ability of this program to train the next generation of MIE surgeons, even in the most challenging of circumstances

Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement

UNLABELLED: This Delphi exercise aimed to gather consensus surrounding risk factors, diagnosis, and management of chyle leaks after esophagectomy and to develop recommendations for clinical practice. BACKGROUND: Chyle leaks following esophagectomy for malignancy are uncommon. Although they are associated with increased morbidity and mortality, diagnosis and management of these patients remain controversial and a challenge globally. METHODS: This was a modified Delphi exercise was delivered to clinicians across the oesophagogastric anastomosis collaborative. A 5-staged iterative process was used to gather consensus on clinical practice, including a scoping systematic review (stage 1), 2 rounds of anonymous electronic voting (stages 2 and 3), data-based analysis (stage 4), and guideline and consensus development (stage 5). Stratified analyses were performed by surgeon specialty and surgeon volume. RESULTS: In stage 1, the steering committee proposed areas of uncertainty across 5 domains: risk factors, intraoperative techniques, and postoperative management (ie, diagnosis, severity, and treatment). In stages 2 and 3, 275 and 250 respondents respectively participated in online voting. Consensus was achieved on intraoperative thoracic duct ligation, postoperative diagnosis by milky chest drain output and biochemical testing with triglycerides and chylomicrons, assessing severity with volume of chest drain over 24 hours and a step-up approach in the management of chyle leaks. Stratified analyses demonstrated consistent results. In stage 4, data from the Oesophagogastric Anastomosis Audit demonstrated that chyle leaks occurred in 5.4% (122/2247). Increasing chyle leak grades were associated with higher rates of pulmonary complications, return to theater, prolonged length of stay, and 90-day mortality. In stage 5, 41 surgeons developed a set of recommendations in the intraoperative techniques, diagnosis, and management of chyle leaks. CONCLUSIONS: Several areas of consensus were reached surrounding diagnosis and management of chyle leaks following esophagectomy for malignancy. Guidance in clinical practice through adaptation of recommendations from this consensus may help in the prevention of, timely diagnosis, and management of chyle leaks