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Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure with significant complications. Splenic hematoma is an extremely rare but known complication following ERCP that has been increasingly reported in the past several years. We report the case of a 44-year-old patient with a history of sleeve gastrectomy who underwent an ERCP that was complicated by both acute pancreatitis and splenic hematoma. She was managed conservatively under close monitoring in the intensive care unit. Clinicians should be aware of this potentially life-threatening complication to make a prompt diagnosis and begin early appropriate management.

No description available.

No description available.

Bariatric surgery is an effective procedure type for morbidly obese patients when all else fails. Because obesity is a chronic disease, prolonged assessment and understanding of the credibility of procedure types and their effects on bariatric surgery outcomes are essential, yet current evidence shows decreasing utilization of one of the dominant procedure types. To better compare outcomes of procedure type, this research was designed to control for volume, hospital size, age, gender, season, month, year, and ethnicity. The goal of the study was to compare the outcomes of laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) bariatric surgery using the epidemiologic triad model. This study was a retrospective cross-sectional review of Nationwide Inpatient Sample (NIS) from 2009 to 2014. Univariate and multivariate logistic regression were conducted to analyze the data. This study was based on a secondary analysis previously collected from NIS data. A convenience sample of 73,086 patients who underwent bariatric surgery using ICD-9 diagnosis and procedure codes was used. Multiple logistic regression analysis indicated that LAGB (odds ratio [OR] =.043) and LSG (OR =.030) were positively associated with in-hospital mortality. Similarly, LAGB (OR =.041) and LSG (OR =.425) were positively correlated to length of stay (LOS). Finally, LAGB (OR = .461) and LSG (OR = .480) was positively related to reoperation. LAGB, when compared to LSG for LOS, had a substantial advantage over biliopancreatic diversion. The LOS findings may contribute to patients' value proposition, including cost reduction for third party insurance payers and for the community.

La sleeve gastrectomie (SG) est une opération qui consiste à réduire le volume de l’estomac. L’hypothèse que d’autres mécanismes indépendants de la perte de poids sont impliqués dans l’amélioration des complications métaboliques de l’obésité après SG a été émise. L’effet de la SG chez des souris soumis à un régime High Fat Diet a été étudié chez trois groupes d’animaux : SG, sham pair fed (SPF) et sham. Le test de tolérance au glucose montrait une amélioration de l’insulinorésistance des animaux SG à J23. Au niveau hépatique les animaux SG montraient une diminution significative de la stéatose. Il existe donc des mécanismes améliorant les complications hépatiques et métaboliques de l’obésité qui sont en partie indépendants de la réduction de l’apport calorique. Dans le second volet nous avons étudié l’évolution à long terme des lésions hépatiques liées à la NASH chez des patients obèses morbides avec une NASH lors de la chirurgie bariatrique. Dix patients d’une cohorte prospective ont été inclus. La deuxième biopsie a été réalisée à une médiane de 57 mois après le RYGB. La perte de poids moyenne était de –13,3 points de l’IMC lors du suivi. La rémission du syndrome métabolique et du diabète a été observée chez 71,6 % et 100 % des patients respectivement. Le NAS score a été amélioré chez tous les patients. Le taux sérique moyen du fragment clivé de la cytokératine 18 (M30), marqueur de l’apoptose hépatocytaire, était significativement abaissé. Le RYGB a permis une amélioration à long terme des lésions hépatocytaires liées à la NASH chez les patients obèses morbides. L’amélioration post-opératoire de la souffrance hépatocytaire corrèle avec la baisse du taux sérique du M30. / The mechanisms responsible for weight loss and improvement of metabolic disturbances have not been completely elucidated. We investigated the effect of sleeve gastrectomy (SG) on body weight, adipose tissue depots, glucose tolerance, and liver steatosis independent of reduced caloric intake in high-fat-diet-induced obese mice. Mice fed a high fat diet were divided into 3 groups: SG, sham-operated ad libitum fed and sham-operated pair fed. SG mice showed improved glucose tolerance and lower levels of liver steatosis. This was associated with a decrease in the ratios of the weight of pancreas, epididymal and inguinal adipose tissues to body weight. Reduced white adipose tissue inflammation, modification of adipose tissue development, and ectopic fat are potential mechanisms that may account for the reduced caloric intake independent effects of SG. We also investigated long-term impact of RYGB surgery on liver complications in morbidly obese patients with NASH. Ten morbidly obese patients with biopsy-proven NASH were followed after RYGB and underwent a second liver biopsy. The median interval between the RYGB and second liver biopsy was 57 months. Clinical and biological data were obtained at baseline and ≥40 months after RYGB. RYGB was associated with significant weight loss, improved hepatic steatosis, resolution of hepatic inflammation and hepatocyte ballooning. Hepatocyte apoptosis, as evaluated by serum K18 fragment improved within the first year and at 57 months. Hepatic fibrosis resolved in 90% of cases. RYGB in morbidly obese patients with NASH is associated with a long-term beneficial impact on hepatic steatosis, inflammation, injury and, possibly, fibrosis.

BACKGROUND: Bariatric surgery is an effective weight loss treatment modality for people with morbid obesity, however, there may be a negative impact on postoperative bone health. This review summarizes changes of different bone mineral density dual-energy x-ray absorptiometry measurements, with specific attention to the laparoscopic sleeve gastrectomy and the roux-en-y gastric bypass. METHODS: PubMed and the Cochrane Library searches yielded 156 articles published before November 2017. The articles were evaluated based on the following inclusion criteria: focus on laparoscopic sleeve gastrectomy or roux-en-y gastric bypass and bone health, written in English, full-length article, studied participants for one-to-two years, and included statistical measurements. RESULTS: Of the 156 studies that were initially screened, 16 full-length articles were included in the final analysis. The articles described a lower loss of bone density at the lumbar spine, femoral neck, forearm, and total hip after laparoscopic sleeve gastrectomy when compared to roux-en-y gastric bypass, however, these studies lack statistical power due to the small sample sizes of less than 10 participants. CONCLUSION: The number of bariatric surgeries continues to increase worldwide, however, the literature provides limited studies that evaluate the effects of bariatric surgery on bone health, more than two-years postoperative. Further study is necessary to determine the mechanisms of bone loss after bariatric surgery, with great attention to differences in bone health between sexes.

Submitted by Edineia Teixeira (edineia.teixeira@unioeste.br) on 2017-12-18T17:12:18Z No. of bitstreams: 2 Angélica_capelassi2016.pdf: 1330041 bytes, checksum: 1450f27720ae9da87b224a8f974b2a87 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-12-18T17:12:18Z (GMT). No. of bitstreams: 2 Angélica_capelassi2016.pdf: 1330041 bytes, checksum: 1450f27720ae9da87b224a8f974b2a87 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-06-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Obesity is a risk factor in the development of many diseases such as diabetes and hypertension. In addition, it is associated with the development of diseases in the gastrointestinal tract (GIT) such as gastroesophageal reflux and gastritis. Bariatric surgery has proved to be the only effective long-term treatment modality sustained effects for the treatment of morbid obesity and its comorbidities. Studies have shown that bariatric procedures affect the morphology and function of the GIT. Few studies have investigated the effects of sleeve gastrectomy (SG), a restrictive technique that reduces the size of the stomach on the GIT. Thus, our objective was to analyze the effect of SG on gastric histopathology and the morphology of the small intestine (duodenum, jejunum and ileum) in obese rats fed a cafeteria diet. For this study, 8-week-old Wistar rats were divided into two groups: control (CTL), which received standard diet, and cafeteria (CAF), which received cafeteria diet to induce obesity. After two months, the CAF group underwent pseudo-surgery (CAF PS) or sleeve gastrectomy (CAF SG). At three months after surgery obesity was verified and stomach, duodenum, jejunum and ileum were collected and analyzed. Body weight and retroperitoneal and perigonadal fat pads were higher in CAF PS animals compared to the CTL. The SG did not influence these parameters. Regarding the morphology of the stomach, we observed that the CTL animals showed normal morphology of this organ, while the CAF PS animals showed changes in the gastric mucosa with the presence of hyperemia, mild inflammatory infiltrate and diffuse in the mucosa and submucosa, as well as mild erosion of the gastric mucosa and atrophy. The SG exacerbated changes in the stomach. CAF SG animals showed severe erosion of the gastric mucosa, edema, moderate and diffuse inflammatory infiltrate in the mucosa and submucosa, as well as atrophy of the muscular layer and the body of the mucosa. In relation to morphometry of the small intestine, no changes were found in the duodenum, jejunum and ileum of CAF PS and CTL animals. However, CAF SG animals showed increase in total thickness of the duodenum, as well as increase in the thickness of the mucosa and submucosa layer and villi. The jejunum and ileum showed no change. In the summary cafeteria diet causes changes in the gastric mucosa without changing the small intestine. The SG, three months after the procedure, exacerbates gastric alterations and promotes changes in the duodenum morphometry. / A obesidade é um fator de risco para o desenvolvimento de várias doenças, tais como diabetes e hipertensão. Além disso, está associada com o desenvolvimento de doenças no trato gastrointestinal (TGI), como refluxo gastroesofágico e gastrite. A cirurgia bariátrica tem provado ser a única modalidade de tratamento eficaz com efeitos sustentados por longo prazo para o tratamento da obesidade mórbida e suas comorbidades. Estudos demonstram que os procedimentos bariátricos alteram a morfologia e o funcionamento do TGI. Poucos estudos investigam os efeitos da gastrectomia vertical (GV), uma técnica restritiva que reduz o tamanho do estômago, sobre o TGI. Dessa forma, nosso objetivo foi analisar o efeito da GV sobre a histopatologia gástrica e a morfologia do intestino delgado (duodeno, jejuno e íleo) em ratos obesos pela dieta de cafeteria. Para este trabalho, ratos Wistar com 8 semanas de vida foram divididos em dois grupos: controle (CTL), que recebeu dieta padrão, e cafeteria (CAF), que recebeu dieta de cafeteria para indução da obesidade. Após dois meses, o grupo CAF foi submetido à pseudo-cirurgia (CAF PC) ou à gastrectomia vertical (CAF GV). Três meses após o procedimento cirúrgico foi realizada a avaliação da obesidade e o estômago, duodeno, jejuno e íleo foram coletados e analisados. O peso corporal e o peso das gorduras retroperitonial e perigonadal foi maior nos animais CAF PC em comparação com os CTL. A GV não influenciou estes parâmetros. Em relação a morfologia do estômago, observamos que os animais CTL apresentaram morfologia normal desse órgão, enquanto os animais CAF PC apresentaram alterações na mucosa gástrica com presença de hiperemia, infiltrado inflamatório leve e difuso na mucosa e submucosa, bem como.leve erosão da mucosa gástrica e atrofia. A GV exacerbou as alterações no estômago. Os animais CAF GV apresentaram erosão intensa da mucosa gástrica, edema, infiltrado inflamatório moderado e difuso na mucosa e submucosa, bem como atrofia da camada muscular e da mucosa do órgão. Em relação a morfometria do intestino delgado, nenhuma alteração foi encontrada no duodeno, jejuno e íleo entre os animais CAF PC e CTL. Entretanto, os animais CAF GV apresentaram aumento da espessura total do duodeno, bem como, aumento na espessura da camada mucosa e submucosa e na altura das vilosidades. O jejuno e o íleo não apresentaram modificações. Assim, concluímos que, a dieta de cafeteria promove alterações na mucosa gástrica sem modificar o intestino delgado. A GV, três meses após o procedimento, exacerba as alterações gástricas e promove modificações na morfometria do duodeno

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(EN) Research in the field of obesity, diabetes mellitus and their complications in recent years is increasingly focused on pathophysiological mechanisms of their onset and potential prevention and treatment. The aim of the present work was to evaluate the effects of two different interventions - sleeve gastrectomy and physical activity - on anthropometric, biochemical, hormonal parameters and mRNA expression of proinflammatory factors in subcutaneous adipose tissue along with mRNA expression in peripheral blood monocytes in patients who underwent sleeve gastrectomy. A total of 15 obese women with hypertension were included into the physical activity study. These patients underwent a 3-month training program, which included 30 minutes of aerobic exercise three times a week. 13 obese women were included into sleeve gastrectomy study and were followed-up for 2 years after surgery. Our results indicate that in both studies obese groups had at baseline significantly increased mRNA expression of proinflammatory cytokines, adipokines, chemokines and chemokine receptors relative to control groups. Both interventions decreased body weight and low-grade inflammation. Physical activity had no significant effect on blood pressure, lipid profile and mRNA expression of the components of the renin-...