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Ryou SH, Bang KB. Endoscopic management of postoperative bleeding. Clin Endosc 2023; 56:706-715. [PMID: 37915192 PMCID: PMC10665615 DOI: 10.5946/ce.2023.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
Postoperative gastrointestinal bleeding is a rare but serious complication that can lead to prolonged hospitalization and significant morbidity and mortality. It can be managed by reoperation, endoscopy, or radiological intervention. Although reoperation carries risks, particularly in critically ill postoperative patients, minimally invasive interventions, such as endoscopy or radiological intervention, confer advantages. Endoscopy allows localization of the bleeding focus and hemostatic management at the same time. Although there have been concerns regarding the potential risk of creating an anastomotic disruption or perforation during early postoperative endoscopy, endoscopic management has become more popular over time. However, there is currently no consensus on the best endoscopic management for postoperative gastrointestinal bleeding because most practices are based on retrospective case series. Furthermore, there is a wide range of individual complexities in anatomical and clinical settings after surgery. This review focused on the safety and effectiveness of endoscopic management in various surgical settings.
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Affiliation(s)
- Sung Hyeok Ryou
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ki Bae Bang
- Department of Internal Medicine, H+ Yangji Hospital, Seoul, Korea
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Seki Y, Kasama K, Yokoyama R, Maki A, Shimizu H, Park H, Kurokawa Y. Bariatric surgery versus medical treatment in mildly obese patients with type 2 diabetes mellitus in Japan: Propensity score-matched analysis on real-world data. J Diabetes Investig 2022; 13:74-84. [PMID: 34265175 PMCID: PMC8756306 DOI: 10.1111/jdi.13631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/27/2022] Open
Abstract
AIMS/INTRODUCTION To compare glycemic control 1 year after treatment in patients with mildly obese (body mass index 27.5-34.9 kg/m2 ) type 2 diabetes mellitus who underwent bariatric surgery (BS) to those who received medical treatment (MT) in Japan. MATERIALS AND METHODS A retrospective study using real-world data was carried out in electronic medical records from a tertiary care hospital and in the Japanese Medical Data Center Inc. claim database from 2008 to 2019. Each patient was propensity score-matched between the BS and the MT group by age, sex, body mass index, glycated hemoglobin and type 2 diabetes mellitus duration, and compared from the index date to the 1 year post-index. RESULTS The study included 78 patients in the BS group and 238 patients in the MT group. The mean body mass index in the BS and the MT group was 32.1 and 32.0 kg/m2 , respectively. In the BS group, the patients underwent either laparoscopic sleeve gastrectomy with or without duodenojejunal bypass. The diabetes remission rate (glycated hemoglobin <6.5% without diabetes medication) at 1 year was 59.0% in the BS group and 0.4% in the MT group (P < 0.0001). Optimal glycemic control of glycated hemoglobin <7.0% was achieved in 75.6% in the BS group and in 29.0% in the MT group (P < 0.0001). The median monthly drug costs for metabolic syndrome decreased from $US126.5 (at baseline) to $US0.0 (at 1 year) in the BS group, whereas it increased from $US52.4 to $US58.3 in the MT group. CONCLUSIONS BS for mildly obese patients with type 2 diabetes mellitus is more clinically- and cost-effective than MT in Japan.
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Affiliation(s)
- Yosuke Seki
- Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
| | - Renzo Yokoyama
- Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
| | - Akihiro Maki
- Johnson & Johnson K.K. Medical CompanyTokyoJapan
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Management of gastric intestinal metaplasia in patients undergoing routine endoscopy before bariatric surgery. Updates Surg 2021; 74:1383-1388. [PMID: 34586611 DOI: 10.1007/s13304-021-01181-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Routine preoperative endoscopic evaluation for bariatric surgery is controversial; however, for patients undergoing endoscopy, some findings may alter surgical management. Gastric intestinal metaplasia (GIM) is found in up to 11.7% of the general population. When associated with determined risk factors, GIM has a risk of progressing to gastric cancer. The aim of our study was to assess the prevalence of GIM and possible associated factors in those undergoing bariatric surgery. We performed a retrospective chart review of patients who underwent primary sleeve gastrectomy or Roux-en-Y gastric bypass at our institution between January 1, 2016 and June 30, 2020. Baseline characteristics and preoperative endoscopic findings were obtained from all patients. Histopathologic analysis of sleeve gastrectomy specimens was reviewed. We identified 753 patients. Mean (SD) age and body mass index were 49.0 (13.1) years and 43.9 (7.1) kg/m2, respectively. Procedures consisted of 411 (54.6%) gastric bypasses and 342 (45.4%) sleeve gastrectomies. Esophagitis and Barrett esophagus were found in 18.1% and 5.0% of patients, respectively. Preoperative gastric biopsy identified Helicobacter pylori in 6.4% and GIM in 2.7%. Regression analysis found an association of Barrett esophagus (odds ratio 4.60; 95% CI 1.25-16.82) and age ≥ 60 years (odds ratio 2.67; 95% CI 1.04-6.90) with preoperative findings of GIM. Histopathologic analysis of sleeve gastrectomy specimens identified H. pylori in 1.8% and GIM in 0.9%. Older age and Barrett esophagus were associated with GIM in preoperative gastric biopsy. This association emphasizes the importance of a diligent examination during preoperative endoscopy.
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Zarrin A, Sorathia S, Choksi V, Kaplan SR, Kasmin F. Endoscopic approach to gastric remnant outlet obstruction after gastric bypass: A case report. World J Gastrointest Endosc 2020; 12:297-303. [PMID: 32994860 PMCID: PMC7503611 DOI: 10.4253/wjge.v12.i9.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/04/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute gastric remnant bleeding is a rare complication of bariatric surgery. Furthermore, acute bleeding from the gastric remnant resulting in gastric remnant outlet obstruction has not been described previously. Endoscopic management of gastric remnant bleed has been challenging due to difficulty accessing the excluded stomach. Traditionally, this necessitates surgical intervention. Recently, however, the adoption of endoscopic ultrasound-directed transgastric intervention provides an alternative approach to management.
CASE SUMMARY A 65-year-old male with a prior gastric bypass presented with the sudden onset of progressive abdominal distension, nausea, and melena of two days duration. His imaging illustrated a massively distended stomach. A nasogastric tube did not result in drainage of fluid or decompression of his abdomen. His endoscopy revealed a normal-appearing gastro-jejunal anastomosis and confirmed the distended "fluid"-filled gastric remnant. An endoscopic ultrasound-directed gastrogastrostomy was created to decompress the gastric remnant. Two liters of blood was suctioned before a large adherent clot was visualized in the gastric antrum. The patient underwent emergent angiography with embolization of the gastroduodenal artery. He was discharged with a stable hemoglobin level and resolution of symptoms. Healing superficial gastric ulcers were visualized on a follow-up endoscopy. Gastric biopsies were consistent with Helicobacter pylori infection for which the patient was treated, and successful eradication was achieved.
CONCLUSION This patient benefited from a timely diagnosis and effective therapy of an acute gastric remnant obstruction from a bleeding ulcer with endoscopic ultrasound-directed transgastric intervention.
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Affiliation(s)
- Arash Zarrin
- Department of Internal Medicine, Aventura Hospital and Medical Center, Miami, FL 33180, United States
| | - Sufian Sorathia
- Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States
| | - Vivek Choksi
- Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States
| | - Steven Robert Kaplan
- Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States
| | - Franklin Kasmin
- Department of Gastroenterology, Aventura Hospital and Medical Center, Miami, FL 33180, United States
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Seki Y, Kasama K, Tanaka T, Baba S, Ito M, Kurokawa Y. Early gastric cancer successfully treated by endoscopic submucosal resection 1 year after laparoscopic sleeve gastrectomy with duodenal-jejunal bypass. Asian J Endosc Surg 2019; 12:357-361. [PMID: 30015399 DOI: 10.1111/ases.12630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/20/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
Abstract
This case involved a 64-year-old female patient with a BMI of 35.3 kg/m2 and poorly controlled type 2 diabetes mellitus. Preoperative upper gastrointestinal endoscopy revealed chronic, atrophic gastritis. Helicobacter pylori antibody was negative. The patient underwent laparoscopic sleeve gastrectomy with duodenal-jejunal bypass as a metabolic surgery to treat obesity and type 2 diabetes mellitus. At 1 year postoperatively, routine endoscopy detected a flat elevated lesion at the distal gastric sleeve, near the posterior wall of the antrum; biopsy revealed adenocarcinoma. Endoscopic submucosal resection was performed without complication. This case shows the advantage of laparoscopic sleeve gastrectomy with duodenal-jejunal bypass in screening the excluded stomach as compared to laparoscopic Roux-en-Y gastric bypass. Therefore, laparoscopic sleeve gastrectomy with duodenal-jejunal bypass can be a viable alternative to laparoscopic Roux-en-Y gastric bypass for regions where gastric cancer is endemic.
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Affiliation(s)
- Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Tatsuro Tanaka
- Department of Gastroenterology, Yotsuya Medical Cube, Tokyo, Japan
| | - Satoshi Baba
- Department of Gastroenterology, Yotsuya Medical Cube, Tokyo, Japan
| | - Masayoshi Ito
- Department of Gastroenterology, Yotsuya Medical Cube, Tokyo, Japan
| | - Yoshimochi Kurokawa
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
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Seki Y, Kasama K, Yasuda K, Yokoyama R, Porciuncula JP, Kurokawa Y. The Effects of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass on Japanese Patients with BMI < 35 kg/m2 on Type 2 Diabetes Mellitus and the Prediction of Successful Glycemic Control. Obes Surg 2018; 28:2429-2438. [DOI: 10.1007/s11695-018-3179-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Seki Y, Kasama K, Umezawa A, Kurokawa Y. Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Type 2 Diabetes Mellitus. Obes Surg 2018; 26:2035-2044. [PMID: 26749411 DOI: 10.1007/s11695-016-2057-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB), which has been positioned as a novel bariatric procedure, is the combination of vertical sleeve gastrectomy and proximal intestinal bypass and is theoretically expected to have strong anti-diabetic effect. Also, preserving the pylorus, a physiological valve, leads to less occurrence of dumping syndrome and anastomotic stenosis which are often problematic after laparoscopic Roux-en-Y gastric bypass (LRYGB), a gold standard. The purpose of this study was to investigate the clinical effects of LSG-DJB on obese patients with type 2 diabetes mellitus (T2DM). METHODS Consecutive 75 obese patients (female 44/male 31) associated with T2DM who underwent LSG-DJB and were followed up for at least 1 year were analyzed. The mean age was 45.5 ± 8.6 years, and the mean preoperative body weight (BW) and body mass index (BMI) were 108.4 ± 21.4 kg and 39.6 ± 7.3 kg/m(2), respectively. The mean hemoglobin A1c (HbA1c) at the first visit was 9.0 ± 1.9 %, and the duration of T2DM from diagnosis was 7.2 ± 6.2 years. Thirty-six out of the 75 patients (48 %) were treated with insulin preoperatively. All patients were evaluated and managed under a strict multidisciplinary team approach. The follow-up rate at 1 year was 89 %. RESULTS At 1 year, the mean BW and BMI significantly dropped to 74.6 ± 16.9 kg and 27.5 ± 5.7 kg/m(2), respectively. The mean percent of excess weight loss (%EWL) and percent of total body weight loss (%TWL) were 99.4 ± 42.4 and 31.6 ± 8.8 %, respectively. Consequently, 68.7 % of the patients achieved HbA1c less than 6 %, and 82.1 % of them achieved HbA1c less than 6.5 % without diabetes medications. Glycemic control of HbA1c less than 7 % was achieved in 91.0 % of the patients. The percentage of patients who satisfied the American Diabetes Association (ADA)-defined composite endpoints for cardiovascular disease (CVD) risk factor control increased from 0 % (at baseline) to 31 % (at 1 year). A meal tolerance test revealed significant reduction of glucose area under the curve (AUC) and increase of insulin AUC postoperatively. CONCLUSIONS LSG-DJB for obese patients with T2DM has strong anti-diabetic effect in the short-term; however, a larger number of patients with a longer follow-up period are needed for definitive conclusions.
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Affiliation(s)
- Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Akiko Umezawa
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yoshimochi Kurokawa
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
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Abstract
BACKGROUND Bariatric surgery has increased in popularity, with Roux-en-Y Gastric Bypass (RYGB) being one of the most frequently performed. This leads to many cases in which the stomach is removed from routine gastroscopy access, sometimes being a major source of concern. Performing enteroscopy in these patients is technically difficult. We present our experience with 24 cases in which the aim was to access the detached stomach. METHODS Retrospective analysis on RYGB enteroscopy procedures aimed to access the detached stomach. Data recorded: demographic parameters, indication, gas insufflation, time to bypass stomach, total procedure and recovery times, and endoscopic and pathological findings. RESULTS This study included 24 patients who underwent RYGB in the previous 3-36 months. Indications were chronic abdominal pain, refractory anemia, or unexplainable weight loss. Detached stomach was accessed in 79% of patients. Access time ranged from 25 to 55 min. Recovery time for all procedures was 86.66 min on average and shorter with CO2 insufflation (42.5 min). All detached stomachs showed macroscopic gastritis; four of them were Helicobacter pylori positive. Significant findings included three patients with jejunojejunostomy stenosis and one patient with a marginal gastrojejunal ulcer, which was later diagnosed with Signet ring cell carcinoma of the proximal anastomosis. CONCLUSIONS We present the feasibility and importance of enteroscopy of the detached stomach and believe that this procedure should be performed more frequently. A high index of suspicion is needed for postoperative symptoms in order to exclude significant pathologies and reassure symptomatic patients that there is no abnormality in the bypassed stomach.
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Seki Y, Kasama K, Haruta H, Watanabe A, Yokoyama R, Porciuncula JPC, Umezawa A, Kurokawa Y. Five-Year-Results of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Weight Loss and Type 2 Diabetes Mellitus. Obes Surg 2017; 27:795-801. [PMID: 27644433 DOI: 10.1007/s11695-016-2372-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel bariatric surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect. This is a follow-up of our institution's previous report on the short-term effects of LSG-DJB on type 2 diabetes mellitus (T2DM), which a 68.7 % remission (HbA1c <6 % without diabetes medication) rate 1 year after surgery. The aforementioned result was comparable to the reported remission rates of laparoscopic Roux-en-Y gastric bypass. However, the durability of remission remains unknown. OBJECTIVE The objective of this study is to investigate the medium-term (up to 5 years) effects of LSG-DJB on weight loss and T2DM. METHODS In this analysis, consecutive 120 patients (female to male ratio = 61:59, mean age = 44.8 years) with T2DM who underwent LSG-DJB from April 2007 to November 2013 and were followed up beyond 1 year were included. The preoperative mean body weight and BMI were 105.7 kg and 38.5 kg/m2, respectively. The mean HbA1c and fasting blood glucose values were 8.9 % and 194 mg/dL, respectively. The mean duration of T2DM was 7.3 years. Fifty-five patients (46 %) were being treated with insulin prior to surgery. RESULTS The follow-up rate was 97.5 % at 1 year, 73.3 % at 3 years, and 50.0 % at 5 years. The mean body weight was 74.9 kg at 1 year, 76.8 kg at 3 years, and 72.8 kg at 5 years (p < 0.001, compared to the baseline). The mean percent of total body weight loss (%TWL) was 28.9, 28.6, and 30.7 % at 1, 3, and 5 years, respectively. Remission of T2DM was achieved at 63.6, 55.3, and 63.6 % at 1, 3, and 5 years, respectively. Among those who achieved diabetes remission at 1 year, 10.8 % of them experienced recurrence during the subsequent follow-up period. CONCLUSION Although recurrence of T2DM is observed in some patients over time, LSG-DJB is an effective procedure for achieving significant weight loss and improvement of glycemic control, and the effects seem to be durable up to 5 years.
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Affiliation(s)
- Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Hidenori Haruta
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Atsushi Watanabe
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Renzo Yokoyama
- Center for Clinical Research, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
| | | | - Akiko Umezawa
- Department of Surgery, Yotsuya Medical Cube, Tokyo, Japan
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Haenen FW, Gys B, Moreels T, Michielsen M, Gys T, Lafullarde T. Linitis plastica of the bypassed stomach 7 years after Roux-en-Y gastric bypass: a case report. Acta Chir Belg 2017; 117:391-393. [PMID: 27397038 DOI: 10.1080/00015458.2016.1192839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Laparoscopic Roux-en-Y gastric bypass (RYGB) is currently the preferred surgical procedure to treat morbid obesity. It has proven its effects on excess weight loss and its positive effect on comorbidities. One of the main issues, however, is the post-operative evaluation of the bypassed gastric remnant. In literature, cancer of the excluded stomach after RYGB is rare. We describe the case of a 52-year-old woman with gastric linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass, diagnosed by means of laparoscopy and Single-Balloon enteroscopy, and it is clinical importance. Linitis plastica of the excluded stomach after RYGB is a very rare entity. This case report shows the importance of long-term post-operative follow-up, and the importance of single-balloon enteroscopy for visualization of the bypassed stomach remnant, when other investigations remain without results. This case report is only the second report of a linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass.
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Affiliation(s)
- Filip Wn Haenen
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Ben Gys
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Tom Moreels
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Maartje Michielsen
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Tobie Gys
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
| | - Thierry Lafullarde
- Department of General and Abdominal Surgery, St. Dimpna General Hospital, Geel, Belgium
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A Novel Endoscopic Technique to Diagnose Gastric Cancer in Excluded Stomach after Roux-en-Y Gastric Bypass. ACG Case Rep J 2017; 4:e36. [PMID: 28331875 PMCID: PMC5356153 DOI: 10.14309/crj.2017.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 12/06/2016] [Indexed: 11/21/2022] Open
Abstract
Access to the bypassed portion of the stomach after Roux-en-Y gastric bypass remains a challenge. We present a case of 64-year-old woman who presented with gastric outlet obstruction. We used a novel endoscopic technique to access the bypassed stomach by creating a jejunogastrostomy using a specialized stent, which allowed the insertion of a pediatric gastroscope to examine the bypassed portion of the stomach. Stomach biopsies revealed poorly differentiated adenocarcinoma with signet cell features.
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Abstract
Since the introduction of double-balloon enteroscopy 15 years ago, flexible enteroscopy has become an established method in the diagnostic and therapeutic work-up of small bowel disorders. With appropriate patient selection, diagnostic and therapeutic yields of 70% to 85% can be expected. The complication rates with diagnostic and therapeutic DBE are estimated at approximately 1% and 3% to 4%, respectively. Appropriate patient selection and device selection, as well as skill, are the key issues for successful enteroscopy. However, technical developments and improvements mean that carrying out enteroscopy is likely to become easier.
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Affiliation(s)
- Andrea May
- Department of Gastroenterology, Sana Klinikum Offenbach GmbH, Starkenburgring 66, Offenbach am Main 63069, Germany.
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Seki Y, Kasama K, Hashimoto K. Long-Term Outcome of Laparoscopic Sleeve Gastrectomy in Morbidly Obese Japanese Patients. Obes Surg 2016; 26:138-45. [PMID: 25986429 DOI: 10.1007/s11695-015-1728-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recently, laparoscopic sleeve gastrectomy (LSG) as a standalone bariatric procedure has rapidly gained popularity worldwide mainly because of its technical simplicity and the relatively good short-term outcome. In Japan, according to a domestic survey, 71 % of the bariatric procedures performed were LSG. However, the number of studies reporting long-term results are still not enough; particularly, data for Asian patients are scarce. OBJECTIVE The objective of this study was to evaluate the long-term outcomes for LSG in morbidly obese Japanese regarding weight loss and safety. METHODS Between October 2005 and July 2013, 179 morbidly obese Japanese patients (Female 89/Male 90) underwent LSG as a standalone procedure. The mean age was 40.7 years (range, 20-72 years), and the mean preoperative body weight and body mass index (BMI) were 120.4 kg (range, 71.4-231.6 kg) and 43.3 kg/m(2) (range, 30.9-76.5 kg/m(2)), respectively. All patients were evaluated and managed under a strict multidisciplinary team approach. RESULTS The mean BMI declined to 30.0 ± 8.7 kg/m(2) at 1 year, 29.1 ± 8.6 kg/m(2) at 2 years, 28.8 ± 8.7 kg/m(2) at 3 years, 29.3 ± 9.2 kg/m(2) at 4 years, and 32.7 ± 13.6 kg/m(2) at 5 years or more (p < 0.001). The mean percent total body weight loss (%TWL) achieved was 32.4 ± 12.9 % at 1 year, 34.3 ± 12.9 % at 2 years, 34.4 ± 11.6 % at 3 years, 32.8 ± 10.9 % at 4 years, and 29.5 ± 11.8 % at 5 years or more. Super morbidly obese patients and patients whose gastric tube was created using a thicker (45 Fr.) bougie had a tendency to achieve less weight loss. Early and late complications occurred in 16 patients (8.9 %) and in seven patients (3.9 %), respectively. Revision surgeries were required in six patients (3.4 %). The reasons for revision surgery were insufficient weight loss in five patients and intractable gastroesophageal reflux disease (GERD) in one patient. CONCLUSION LSG for Japanese morbidly obese patients is safe, effective, and acceptably durable up to 5 years although some complications unique to the procedure such as leakage from the staple line and intractable GERD occur. For super morbidly obese patients, other surgical options may be required.
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Affiliation(s)
- Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Kenkichi Hashimoto
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
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Abstract
Laparoscopic Roux-en-Y gastric bypass (RYGB) is widely applied in the treatment of morbid obesity. Health personnel meeting these patients should thus be familiar with the potential clinical consequences of the modified anatomy induced by the surgery. After a RYGB, the stomach is left in situ after the closure of the upper part of the organ. This blind-ended gastric remnant may cause complications and surgical emergencies, but also opportunities for diagnostic and therapeutic intervention. The present review focuses on complications related to the gastric remnant including bleeding and acute dilatation in the early postoperative period and later adverse events such as gastroduodenal peptic disease, tumors, gastrogastric fistulas, and late dilatation. Opportunities offered by the remnant, including minimal invasive or open access for enteral nutrition, and therapeutic and diagnostic access to the bile ducts, the duodenum, and the gastric remnant, which is challenged by the modified anatomy, are discussed. Reversal of the gastric bypass and gastrointestinal reconstruction after esophageal resection have been commented on. The review aims to improve the awareness of issues related to the gastric remnant for physicians involved in the treatment and the follow-up of patients after a RYGB.
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De Palma GD, Forestieri P. Role of endoscopy in the bariatric surgery of patients. World J Gastroenterol 2014; 20:7777-7784. [PMID: 24976715 PMCID: PMC4069306 DOI: 10.3748/wjg.v20.i24.7777] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/31/2013] [Accepted: 03/08/2014] [Indexed: 02/06/2023] Open
Abstract
Obesity is an increasingly serious health problem in nearly all Western countries. It represents an important risk factor for several gastrointestinal diseases, such as gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett's esophagus, esophageal adenocarcinoma, Helicobacter pylori infection, colorectal polyps and cancer, non-alcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma. Surgery is the most effective treatment to date, resulting in sustainable and significant weight loss, along with the resolution of metabolic comorbidities in up to 80% of cases. Many of these conditions can be clinically relevant and have a significant impact on patients undergoing bariatric surgery. There is evidence that the chosen procedure might be changed if specific pathological upper gastrointestinal findings, such as large hiatal hernia or Barrett's esophagus, are detected preoperatively. The value of a routine endoscopy before bariatric surgery in asymptomatic patients (screening esophagogastroduodenoscopy) remains controversial. The common indications for endoscopy in the postoperative bariatric patient include the evaluation of symptoms, the management of complications, and the evaluation of weight loss failure. It is of critical importance for the endoscopist to be familiar with the postoperative anatomy and to work in close collaboration with bariatric surgery colleagues in order to maximize the outcome and safety of endoscopy in this setting. The purpose of this article is to review the role of the endoscopist in a multidisciplinary obesity center as it pertains to the preoperative and postoperative management of bariatric surgery patients.
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Unexpected changes in the gastric remnant in asymptomatic patients after Roux-en-Y gastric bypass on vertical banded gastroplasty. Obes Surg 2013; 23:131-9. [PMID: 23129236 DOI: 10.1007/s11695-012-0808-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aims of this study are to evaluate the macroscopic and microscopic changes in the remnant stomach at mid-term follow-up of patients who underwent a Roux-en-Y gastric bypass on vertical banded gastroplasty (RYGB-on-VBG). The stomach could be reached through a 1.1-cm gastro-gastrostomy with an endoscope of standard size. METHODS From January 2009 to July 2010, 51 asymptomatic patients at 4 and 5 years follow-up after RYGB-on-VBG submitted to upper endoscopy. All of them were examined with standard endoscopy with collection of biopsies in gastric fundus, body, and antrum. The macroscopic and microscopic findings were analyzed according to Sydney Classification. RESULTS The endoscopy of the remnant stomach was technically easy and already showed on macroscopic examination 90 % cases of gastritis (41.2 % mild, 49 % severe) with tendency of severity in the distal stomach part. Histological analysis detected 39.2 % of active gastritis, 50.6 % of quiescent gastritis, 7.8 % of intestinal metaplasia, and 3.9 % of lymphoma-like gastritis. CONCLUSIONS The results surprised us. We found a very high rate of mucosa abnormalities after RYGB-on-VBG. All of the patients have to be regularly controlled in follow-up and treatment has to be introduced when needed. Again, we would like to ask the question: what is happening with the remnant stomach after standard RYGB, banded gastric bapass, or minigastric bypass? Did we reach the time to answer the question?
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Praveen Raj P, Kumaravel R, Chandramaliteeswaran C, Rajpandian S, Palanivelu C. Is laparoscopic duodenojejunal bypass with sleeve an effective alternative to Roux en Y gastric bypass in morbidly obese patients: preliminary results of a randomized trial. Obes Surg 2012; 22:422-6. [PMID: 21870050 DOI: 10.1007/s11695-011-0507-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The incidence of obesity and related metabolic disorders in India and that of stomach carcinoma is one of the highest in the world. Hence, one requires a procedure that allows postoperative surveillance of the stomach with the best outcomes in terms of weight control and resolution of co-morbidities. Here, we compare one such procedure, duodenojejunal bypass with sleeve against the standard Roux-en Y gastric bypass. METHODS Fifty-seven patients who were selected for a bypass procedure were randomized into two groups of laparoscopic duodenojejunal bypass with sleeve (DJB) and laparoscopic Roux en Y gastric bypass. The limb lengths were similar in both the groups, and the sleeve was done over a 36F bougie. RESULTS The mean body mass index and percent excess weight loss at the end of 3, 6, and 12 months between the groups were not statistically significant. The operating times were higher in the DJB group. The rate of resolution of diabetes, hypertension, and dyslipidemias were also similar with no statistical significance. There was 100% resolution of dyslipidemias in both groups. There was one patient in the DJB group who presented with internal herniation 1 month post-op and was managed surgically. There was no mortality in both the groups. CONCLUSION Laparoscopic duodenojejunal with sleeve gastrectomy, a procedure which combines the principles and advantages of sleeve gastrectomy and foregut hypothesis, is a safe and effective alternative to gastric bypass in weight reduction and resolution of co-morbidities especially for Asian countries. But, long-term follow-up is required.
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Affiliation(s)
- P Praveen Raj
- Department of Minimal Access Bariatric and Metabolic Surgery, Gem Hospital and Research Centre, 45 Pankaja Mill Road, Coimbatore, Tamil Nadu, 641045, India.
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Endo M, Abiko Y, Oana S, Kudara N, Kosaka T, Chiba T, Takikawa Y, Suzuki K, Sugai T. Usefulness of double-balloon endoscopy in the postoperative gastrointestinal tract. Gastroenterol Res Pract 2011; 2011:429462. [PMID: 22194738 PMCID: PMC3238371 DOI: 10.1155/2011/429462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/13/2011] [Accepted: 09/20/2011] [Indexed: 02/08/2023] Open
Abstract
Background. The small intestine has been considered to be a highly difficult organ to visualize in imaging examinations due to its anatomical location compared with the stomach and the colon. In recent years, many imaging modalities have become available, such as CT enterography, MR enterography, capsule endoscopy (CE), and double-balloon endoscopy (DBE). Patients and Methods. DBE was performed in the postoperative intestines of 91 patients (128 DBE examinations) at Iwate Medical University between 2004 and 2010. There were 61 male and 30 female patients, and their mean age was 69.7 years (range: 30-80 years). Results. A total of 124 DBE examinations were performed with endoscope insertion into the reconstructed intestines. The endoscope reached the blind end in 115 of 124 examinations, (92.7%). There were 17 patients with obscure gastrointestinal bleeding in whom 30 DBE examinations were performed. The bleeding site was identified in 12 patients (70.6%). Nine patients underwent endoscopic treatment. Hemostasis was achieved in all patients. Conclusion. DBE is very useful modality for the assessment and application of endotherapy to areas of the small bowel which have been altered by surgery.
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Affiliation(s)
- Masaki Endo
- Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Yukito Abiko
- Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Syuhei Oana
- Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Norihiko Kudara
- Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Takashi Kosaka
- Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Toshimi Chiba
- Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Yasuhiro Takikawa
- Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Kazuyuki Suzuki
- Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
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Attam R, Leslie D, Freeman M, Ikramuddin S, Andrade R. EUS-assisted, fluoroscopically guided gastrostomy tube placement in patients with Roux-en-Y gastric bypass: a novel technique for access to the gastric remnant. Gastrointest Endosc 2011; 74:677-82. [PMID: 21872717 DOI: 10.1016/j.gie.2011.05.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 05/09/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Access to the excluded gastric remnant in patients after Roux-en-Y gastric bypass for gastrostomy tube placement or therapeutic endoscopy is a technical challenge. Available techniques include interventional radiology-placed gastrostomy, deep enteroscopy, and surgical gastrostomy; however, these techniques are hampered by complications, technical complexity, or invasiveness. OBJECTIVE To describe a novel technique that uses EUS to insufflate the excluded gastric remnant for fluoroscopically guided percutaneous gastrostomy placement. DESIGN Retrospective study. SETTING University hospital. PATIENTS Ten patients who required gastrostomy placement after Roux-en-Y gastric bypass. INTERVENTIONS EUS was used to puncture the excluded stomach through the gastric pouch or jejunum. The stomach was insufflated, and a direct percutaneous gastrostomy placed under fluoroscopic guidance in the distended stomach. MAIN OUTCOME MEASUREMENTS Feasibility, safety, and efficacy of EUS-assisted, fluoroscopically guided gastrostomy tube placement. RESULTS Technical success of EUS-assisted gastrostomy was achieved in 9 of 10 patients(90%). There were no complications. LIMITATIONS Single-institution study, small sample size. CONCLUSIONS EUS-assisted, fluoroscopically guided gastrostomy tube placement may be a safe and feasible technique to obtain enteral access to the excluded gastric remnant in patients after Roux-en-Y gastric bypass at specialized centers.
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Affiliation(s)
- Rajeev Attam
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minneapolis, USA
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Early and late abdominal bleeding after Roux-en-Y gastric bypass: sources and tailored therapeutic strategies. Obes Surg 2011; 21:413-20. [PMID: 21240659 DOI: 10.1007/s11695-011-0354-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bleeding is a potentially serious complication after Roux-en-Y gastric bypass (RYGB). Preventive measures and therapeutic strategies have not been adequately defined. We reviewed data on 742 consecutive patients treated at the University of California San Francisco to identify cases of early and late bleeding (less or greater than 30 days after surgery) after RYGB. Bleeding was defined as symptoms or signs of bleeding, associated with blood transfusion. We recorded patient characteristics, details of the operative technique, diagnostic approach, therapeutic strategies, and outcomes. Twenty-six patients (3.5%) had postoperative bleeding, which mostly occurred in the first 30 days postoperatively (N=19). Hematocrit decreased significantly from preoperative values (-5.2 ± 3.1 without bleeding vs. -14.8 ± 4.7 with, p<0.01). Type 2 diabetes was more prevalent in patients who had bleeding (58% vs. 32%, p=0.03). No other patient characteristics or details of the operative technique were associated with different rates of bleeding. Therapeutic intervention other than transfusion was needed for seven patients with early bleeding (36.8%) and for all patients with late bleeding. Four patients with early bleeding required reoperation. Early bleeding source was intraluminal in four patients, intraperitoneal in five, and self-limited and of unknown location in ten. Late bleeding occurred on average at 62.6 months (range, 5 to 300 months) after index surgery, five patients required reoperation, and the source was always intraluminal. Bleeding after RYGB may be from various anatomic sites; details of the operative technique were not associated with different rates of bleeding, and therapy should be tailored to suspected location of bleeding.
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Azagury DE, Lautz DB. Endoscopic techniques in bariatric patients: Obesity basics and normal postbariatric surgery anatomy. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2010.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kasama K, Tagaya N, Kanehira E, Oshiro T, Seki Y, Kinouchi M, Umezawa A, Negishi Y, Kurokawa Y. Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass: Technique and Preliminary Results. Obes Surg 2009. [DOI: 10.1007/s11695-009-9979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kasama K, Tagaya N, Kanehira E, Oshiro T, Seki Y, Kinouchi M, Umezawa A, Negishi Y, Kurokawa Y. Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass: Technique and Preliminary Results. Obes Surg 2009; 19:1341-5. [DOI: 10.1007/s11695-009-9873-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Accepted: 05/19/2009] [Indexed: 01/12/2023]
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Laparoscopic transgastric access to the common bile duct after Roux-en-Y gastric bypass. Surg Endosc 2009; 23:1646-8. [DOI: 10.1007/s00464-009-0417-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Revised: 01/19/2009] [Accepted: 02/11/2009] [Indexed: 10/21/2022]
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Prevalence of Helicobacter pylori infection among patients undergoing bariatric surgery: a preliminary study. World J Surg 2009; 32:2026-7. [PMID: 18536991 DOI: 10.1007/s00268-008-9636-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Kasama K, Tagaya N, Kanahira E, Umezawa A, Kurosaki T, Oshiro T, Ishikawa M, Negishi Y, Kurokawa Y, Suzuki N, Kakihara Y, Taketsuka S, Horie K, Nakazato T, Kikkawa E, Kabasawa S, Fukuda Y, Sonoda K. Has laparoscopic bariatric surgery been accepted in Japan? The experience of a single surgeon. Obes Surg 2008; 18:1473-8. [PMID: 18398667 DOI: 10.1007/s11695-008-9492-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Accepted: 03/04/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obesity is steadily increasing in Asia due to factors such as a lack of exercise, adoption of a more Western diet, changing lifestyles, environments, or stresses. Even in Japan, this tendency is notable, and metabolic syndrome has become widely recognized. However, bariatric surgery is still uncommon in Japan. There are no adequate data regarding the experience and outcome of bariatric surgery in Asia. Here, we report on the current status of morbid obesity and the outcomes of bariatric surgery by a single surgeon in Japan. METHODS Between February 2002 and January 2008, we have performed laparoscopic bariatric surgery for morbid obesity in 178 cases. They consisted of laparoscopic Roux-en-Y gastric bypass (LRYGBP) in 105 cases, laparoscopic sleeve gastrectomy (LSG) in 26 cases, laparoscopic sleeve gastrectomy with duodenal jejunal bypass (LSG/DJB) in 14 cases, laparoscopic adjustable gastric banding (LAGB) in 13 cases, and laparoscopic biliopancreatic diversion with duodenal switch in one case under the same protocol of follow up. The first author of this paper performed all procedures. RESULTS One hundred and thirty-eight patients with a follow-up of over 3 months after surgery were enrolled. LRYGBP accounted for 72% of all bariatric procedures. The reduction of weight and body mass index (BMI) in LRYGBP and LSG showed similar results. These outcomes were superior to those of LAGB. Percentage of excess BMI loss (%EBMIL) of LRYGBP showed greater reductions at follow-ups 6, 9, 12, and 18 months after surgery compared to that of LRYGBP and LAGB. All procedures resulted in over 50% of %EBMIL after 18 months of follow-up. There was no postoperative mortality within 30 days after surgery. Preoperative comorbidity including diabetes mellitus, hypertension, and hyperlipidemia were resolved or improved after surgery in most patients. CONCLUSION In bariatric surgery, LRYGBP is the most effective treatment for morbid obesity, while LAGB has a low risk of postoperative complications. LSG is also a safe procedure for supermorbidly obese patients. We expect that bariatric surgery will be a common procedure for patients with morbid obesity in Japan.
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Affiliation(s)
- Kazunori Kasama
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, 2-7-7 Niban-cho, Chiyoda-ku, Tokyo, 102-0084, Japan.
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Decker GA, DiBaise JK, Leighton JA, Swain JM, Crowell MD. Nausea, bloating and abdominal pain in the Roux-en-Y gastric bypass patient: more questions than answers. Obes Surg 2008; 17:1529-33. [PMID: 18219785 DOI: 10.1007/s11695-008-9416-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bariatric surgery is the most effective treatment for severe obesity. After surgery, patients may complain of gastrointestinal symptoms but their altered anatomy can make investigations difficult to perform or interpret. In particular, the Roux-en-Y gastric bypass (RYGBP) creates an excluded segment that is not easily accessible. We present a case illustrating some of the difficulties encountered when investigating the RYGBP patient complaining of nonspecific GI symptoms. Options are discussed for examining the excluded segment, and the diagnosis and significance of small intestine bacterial overgrowth in the RYGBP patient is reviewed.
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Affiliation(s)
- G Anton Decker
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ 85259, USA.
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