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Obesity is associated with different medical conditions, such as cardiologic, respiratory, gastrointestinal, and genitourinary, and constitutes a severe health problem.
This study aimed to evaluate the use of intragastric fluid-filled balloon in the reduction of weight and other measurements related to body composition.
This is a retrospective, monocentric study involving all patients who opted for the intragastric balloon Spatz® placement from January 2018 to July 2019, with fulfillment of inclusion and exclusion criteria. The patients were analyzed after 6 and 12 months after the intragastric fluid-filled balloon placed.
A total of 121 subjects were included in this study, with 83 (68.6%) females and 38 (31.4%) males. The mean age was 36 years and height was 1.64±0.09. Weight mean and standard deviation was 89.85±14.65 kg, and body mass index was 33.05±4.03; body mass index decreased to 29.4 kg/m2 with a mean weight of 79.83 kg, after 12 months of follow-up. There were statistical differences between body mass index and the 12 months in fat percentage, fat-free mass (kg), visceral fat area, and basal metabolic rate. There was a significant variation according to gender, with males having highest reduction. The percentage of excess weight loss was 46.19, and the total weight loss was 9.24 at the end of the study.
The study demonstrated a benefit of intragastric fluid-filled balloon on weight loss after 12 months. At the end of treatment, body mass index and the measurements of body composition were significantly lower. Men benefited more than women from the treatment.
The high morbidity and mortality rates of pancreaticoduodenectomy are mainly associated with pancreaticojejunal anastomosis, the most fragile and susceptible to complications such as clinically relevant postoperative pancreatic fistula.
The alternative fistula risk score and the first postoperative day drain fluid amylase are predictors of the occurrence of clinically relevant postoperative pancreatic fistula. No consensus has been reached on which of the scores is a better predictor; moreover, their combined predictive power remains unclear. To the best of our knowledge, this association had not yet been studied.
This study assessed the predictive effect of alternative fistula risk score and/or drain fluid amylase on clinically relevant postoperative pancreatic fistula in a retrospective cohort of 58 patients following pancreaticoduodenectomy. The Shapiro-Wilk and Mann-Whitney tests were applied for assessing the distribution of the samples and for comparing the medians, respectively. The receiver operating characteristics curve and the confusion matrix were used to analyze the predictive models.
The alternative fistula risk score values were not statistically different between patients in the clinically relevant postoperative pancreatic fistula and non- clinically relevant postoperative pancreatic fistula groups (Mann-Whitney U test 59.5, p=0.12). The drain fluid amylase values were statistically different between clinically relevant postoperative pancreatic fistula and non- clinically relevant postoperative pancreatic fistula groups (Mann-Whitney U test 27, p=0.004). The alternative fistula risk score and drain fluid amylase were independently less predictive for clinically relevant postoperative pancreatic fistula, compared to combined alternative fistula risk score + drain fluid amylase.
The combined model involving alternative fistula risk score >20% + drain fluid amylase=5,000 U/L was the most effective predictor of clinically relevant postoperative pancreatic fistula occurrence following pancreaticoduodenectomy.
New therapies have revolutionized the treatment of Crohn’s disease (CD), but in some countries, the surgery rate has not changed, the frequency of emergency surgery is underestimated, and surgical risk is poorly studied.
The aim of this study was to identify risk factors and clinical indications for primary surgery in CD patients at the tertiary hospital.
This was a retrospective cohort of a prospectively collected database of 107 patients with CD from 2015 to 2021. The main outcomes were the incidence of surgery treatment, types of procedures performed, surgical recurrence, surgery free time, and risk factors for surgery.
Surgical intervention was performed in 54.2% of the patients, and most of the procedures were emergency surgeries (68.9%). The elective procedures (31.1%) were performed over 11 years after diagnosis. The main indications for surgery were ileal stricture (34.5%) and anorectal fistulas (20.7%). The most frequent procedure was enterectomy (24.1%). Recurrence surgery was most common in emergency procedures (OR 2.1; 95%CI 1.6–6.6). Montreal phenotype L1 stricture behavior (RR 1.3; 95%CI 1.0–1.8, p=0.04) and perianal disease (RR 1.43; 95%CI 1.2–1.7) increased the risk of emergency surgeries. The multiple linear regression showed age at diagnosis as a risk factor for surgery (p=0.004). The study of surgery free time showed no difference in the Kaplan-Meier curve for Montreal classification (p=0.73).
The risk factors for operative intervention were strictures in ileal and jejunal diseases, age at diagnosis, perianal disease, and emergency indications.
Colorectal cancer (CRC) is a worldwide health problem whose control depends on public policy establishment and effective prevention and screening programs. In Brazil, there are few studies related to adherence to screening methods.
The aim of this study was to evaluate the association between demographic and socioeconomic to adherence to CRC screening with fecal immunochemical test (FIT) among average-risk individuals for CRC.
In this prospective cross-sectional study, conducted between March 2015 and April 2016, 1,254 asymptomatic individuals aged 50–75 years, participating in a hospital screening campaign in Brazil, were invited to participate in the study.
The adherence rate to FIT was 55.6% (697/1,254). In the multivariable logistic regression analysis, patients aged 60–75 years (odds ratio (OR)=1.30; 95% confidence interval (CI): 1.02–1.66; p=0.03), religious belief (OR=2.04; 95% CI: 1.34–3.11; p<0.01), previous fecal occult blood test (OR=2.07; 95% CI: 1.55–2.76; p<0.01), and full/part-time working status (OR=0.66; 95% CI: 0.49–0.89; p<0.01) were independently associated with adherence to CRC screening.
The results of the present study highlight the importance of considering the labor aspects when implementing screening programs, suggesting that campaigns conducted in the workplace and repeated over the years may be more effective.
Gallbladder polyps are becoming a common finding in ultrasound. The management has to consider the potential risk of malignant lesions.
The aim of this study was to analyze the ultrasound findings in patients undergoing cholecystectomy due to gallbladder polyps and compare them for histopathological findings (HPs).
Patients with an ultrasonographic diagnosis of gallbladder polyp and who underwent cholecystectomy from 2007 to 2020 were included in the study.
A total of 447 patients were included, of whom 58% were women. The mean age was 45±12 years. The mean size of polyps in US was 7.9±3.6 mm. Notably, 9% of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p=0.003). Histopathological findings confirmed the presence of polyps in 88.4%, with a mean size of 4.8±3.4 mm. In all, 16 cases were neoplastic polyps (4.1%), 4 of them being malignancies, and all were single and larger than 10 mm. We found a significant correlation between ultrasound and histopathological findings polyp size determination (r=0.44; p<0.001). The Bland-Altman analysis obtained an overestimation of the US size of 3.26 mm. The receiver operating characteristic (ROC) curve analysis between both measures obtained an area under the receiver operating characteristic curve (AUC) of 0.77 (95%CI 0.74–0.81). Ultrasound polyps size larger than 10 mm had an odds ratio (OR) of 8.147 (95%CI 2.56–23.40) for the presence of adenoma and malignancy, with a likelihood ratio of 2.78.
There is a positive correlation and appropriate diagnostic accuracy between ultrasound size of gallbladder polyps compared to histopathological records, with a trend to overestimate the size by about 3 mm. Neoplastic polyps are uncommon, and it correlates with size. Polyps larger than 10 mm were associated with adenoma and malignancy.
The effect of neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced esophageal cancer can be determined by assessing the Becker tumor regression grade in the primary tumor, as well as in lymph nodes.
The aim of this study was to investigate the anatomopathological changes caused by neoadjuvant chemoradiotherapy and their impact on clinical parameters. Specifically, we analyzed the Becker tumor regression grade, lymph node status, and regression changes and evaluated their association with the Clavien-Dindo classification of surgical complications and overall patient survival.
This is a retrospective and observational study including 139 patients diagnosed with adenocarcinoma or squamous cell carcinoma of the esophagus and treated with either neoadjuvant chemoradiotherapy followed by surgery or surgery alone. For the 94 patients who underwent neoadjuvant chemoradiotherapy, we evaluated tumor regression by Becker tumor regression grade in primary tumors. We also analyzed lymph node status and regression changes on lymph nodes with or without metastases. Overall survival analysis was performed using Kaplan-Meier curves.
Becker tumor regression grade is associated with lower lymphatic permeation (p<0.01) and vascular invasion (p<0.001), but not with lymph node regression rate (p=0.10). Clavien-Dindo classification was associated neither with lymph node regression rate (odds ratio=0.784, p=0.795) nor with tumor regression grade (p=0.68). Patients who presented with lymphatic permeation and vascular invasion had statistically significantly lower median survival (17 vs. 30 months, p=0.006 for lymphatic permeation, and 14 vs. 29 months, p=0.024 for vascular invasion).
In our series, we were unable to demonstrate an association between Becker tumor regression grade and lymph node regression rate with any postoperative complications. Patients with lower lymphatic permeation and vascular invasion have higher overall survival, correlating with a better response in the Becker tumor regression grade system.
The preoperative nutritional state has prognostic postoperative value. Tomographic density and area of psoas muscle are validated tools for assessing nutritional status. There are few reports assessing the utility of staging tomography in gastric cancer patients in this field.
This study aimed to determine the influence of sarcopenia, measured by a preoperative staging computed tomography scan, on postoperative morbimortality and long-term survival in patients operated on for gastric cancer with curative intent.
This retrospective study was conducted from 2007 to 2013. The definition of radiological sarcopenia was by measurement of cross-sectional area and density of psoas muscle at the L3 (third lumbar vertebra) level in an axial cut of an abdominopelvic computed tomography scan (in the selection without intravascular contrast media). The software used was OsirixX version 10.0.2, with the tool “propagate segmentation”, and all muscle seen in the image was manually adjusted.
We included 70 patients, 77% men, with a mean cross-sectional in L3 of 16.6 cm2 (standard deviation+6.1) and mean density of psoas muscle in L3 of 36.1 mean muscle density (standard deviation+7.1). Advanced cancers were 86, 28.6% had signet-ring cells, 78.6% required a total gastrectomy, postoperative surgical morbidity and mortality were 22.8 and 2.8%, respectively, and overall 5-year long-term survival was 57.1%. In the multivariate analysis, cross-sectional area failed to predict surgical morbidity (p=0.4) and 5-year long-term survival (p=0.34), while density of psoas muscle was able to predict anastomotic fistulas (p=0.009; OR 0.86; 95%CI 0.76–0.96) and 5-year long-term survival (p=0.04; OR 2.9; 95%CI 1.04–8.15).
Tomographic diagnosis of sarcopenia from density of psoas muscle can predict anastomotic fistulas and long-term survival in gastric cancer patients treated with curative intent.
Bariatric surgery patients have symptoms such as “plugging.” Therefore, a possible good way to avoid these eating discomforts, typical of the early period after bariatric surgery, is to educate the patient. The Mindful Eating (ME) consists of paying attention to physical signs of hunger and satiety and developing awareness of emotional triggers related to food. In addition, conscious food choices reflect positively on the speed of chewing at mealtime.
Due to the difficulties that patients reported during consultations to controlling their bad eating habits and the lack of tools to help the bariatric patient change eating habits, we elaborated “BariMEP: A Mindful Eating Placemat for bariatric surgery patients.”
The BariMEP was written by the multidisciplinary bariatric team based on a study by Russell et al. and ME principles in order to help bariatric patients pay attention to what and how they eat at each meal.
The BariMEP has some instructions based on Mindful Eating principles: get your seat at the table; do not distract yourself; before starting to eat, try breathing sometimes; recognize the internal hunger and satiety cues; let the fork rest at each bite and chew a lot; pay attention to the smell and taste; and be as present as possible at this time with nonjudgment.
For the first time, a tool has been developed with the aim of preparing the patient for bariatric surgery. Since the BariMEP is easy to teach and cheap, we suggest that the BariMEP be included in the bariatric surgery protocol.
First, we would like to congratulate the authors of this study1 for stimulating reflection on public health policy involving the diagnosis of colorectal cancer (CRC), a topic of extreme relevance, given that it is the third most common cancer in men and the second most common cancer in women. In 2020, there were more than 1.9 million new cases of CRC6.
The benefits of CRC screening were recognized four decades ago when the American Cancer Society started recommending it. The screening was responsible for the decline in CRC incidence observed since the 1980s2.
Randomized studies have shown that screening people at medium risk, that is, those with no family history of CRC, reduces the incidence and mortality resulting from this neoplasm2,3.
In contrast to screening programs for other neoplasms, CRC screening allows the diagnosis of lesions at an early stage and the detection of pre-malignant lesions that, if removed, can prevent cancer4.
The importance of CRC screening is based not only on the possibility of early diagnosis but also on the impact of endoscopic polypectomy, which reduces mortality related to this neoplasm by more than 50%7.
The comments below discuss the methodology used in the study (NordiCC Study) and the negative impact on a diagnostic technique established in several publications due to structural errors added to the article.
Pragmatic (real-life) randomized controlled trials (RCTs) can be considered observational studies (cohorts) in which, although randomization is present, it does not give these trials the character of experimentation (associated with the term randomized clinical trial) – the rigorous individual eligibility criteria are a fundamental part of the methodology. Even when these eligibility criteria are “relaxed,” the analysis in these (pragmatic) trials must necessarily consider prognostic differences between participants, which are essential to avoid confounding and selection bias. In addition, the term pragmatic may be misused as the cohort departs from usual practice because, despite the randomization of participants being performed at the group level, the proposed interventions do not correspond to the conventional care that these patients would receive, as an invitation for colonoscopy, periodic contact, or even the creation of a control group without care (called usual care). Also, the absence of care in the usual care group (comparison) calls into question the classic concept of randomization since there is no control in this group regarding losses or migration (crossover) to colonoscopy.
Intention-to-treat analysis is prohibitive due to the extensive loss of adherence (non-compliers) of participants in the invited (screened) group, decreasing the sample in this group after randomization by more than 50%. The only possible analysis is per protocol. Furthermore, non-complier patients (who did not accept the invitation) and conventional care patients should be analyzed within the same group (not screened) and compared with participants who actually underwent colonoscopy.
Although bariatric surgery is today’s gold standard treatment for obesity, weight regain affects the success rate of the procedure. Recent studies have identified psychiatric and neurological factors as possible causes.
The aim of this study was to evaluate the influence of psychiatric diseases on the outcome and long-term success of bariatric surgeries and find a weight regain threshold that has an acceptable sensibility to mental health-related issues to be used in research and clinical studies.
This is a observational study of bariatric patients submitted to Roux-en-Y bypass or sleeve gastrectomy, with a postoperative time of 2–10 years to access weight regain, depression, and binge-eating disorder.
Of 217 patients studied, 163 were women and 54 were men, with an average postoperative time of 5.2±2.6 years. Weight regain was experienced in 35% of the patients, binge-eating disorder in 24.9%, and depression in 24%. The greater weight before surgery, body mass index (BMI), percentage increase to maximum weight loss, and time postoperatively all have a significant positive correlation with weight regain (p=0.045, p=0.026, p<0.001, and p<0.001, respectively). A significant association between binge-eating disorder, depression, and anxiety with weight regain (p=0.004, p=0.008, and p=0.001, respectively) was found.
The significant weight regain rates with significant impact on psychiatric disorders highlight the need for continuous postoperative monitoring focused on the psychiatric aspects of obesity to aid surgeries’ long-term success.
Developed by Surya MKT