High rate of de novo esophagitis 5 years after sleeve gastrectomy: a prospective multicenter study in Spain.

BACKGROUND: Major concerns years after the sleeve gastrectomy (SG) include weight regain, development of hiatal hernia (HH) and gastroesophageal reflux disease, with esophagitis and Barrett's esophagus (BE). Both problems could be related, and the incidence of asymptomatic patients is troubling. OBJECTIVE: To study the incidence of reflux symptoms, esophagitis, BE, HH, and asymptomatic pathology and their relationship with weight regain in patients 5 years after undergoing SG at different bariatric centers in Spain. SETTING: Public and private hospitals with bariatric surgery units. METHODS: Prospective, multicenter, nonrandomized study involving 13 Spanish hospitals with a cumulative experience of 4,500 patients having undergone the SG procedure and patients who had been subjected to the procedure at least 5 years previously along with preoperative gastroscopy. The clinical history, preoperative gastroscopy, and technical details of the SG were recorded. A specific clinical questionnaire was given that recorded the intake volume, perception of satiety, and gastroesophageal reflux (GER) symptoms. Gastroscopy, pH-metry, and manometry studies were carried out, and the data were analyzed statistically. The study has been authorized by the official Spanish ethics committee CEI/CEIm Hospital Universitario Gran Canaria Dr Negrín (code 2019-216-1). RESULTS: One hundred and five patients who underwent SG and who had with at least 5 years of follow-up were included. All procedures were performed laparoscopically. The mean age of patients was 51.1 years, and 70.5% were women. The mean characteristics of the SG procedure were a 37.2F probe, at 4.6 cm from the pylorus, and a crura closure was performed in 5 cases. There were no major complications (Clavien-Dindo grade >3) or deaths. The average preoperative body mass index was 46.3 kg/m2, the minimum reached was 20.6 kg/m2, whereas the average after 5 years was of 34.5 kg/m2. GER, HH, and esophagitis symptoms went from 17.1%, 28.6%, and 5.7%, respectively, before the SG to 76%, 30.5%, and 31.4%, respectively, 5 years after the procedure. Symptoms persisted over the years in 37.1% of cases and presented de novo in 52.8% of cases. Fifty-three percent of manometries (n = 27, total 51) and 64% of pH-metries (n = 32, total 53; DeMeester average score was 65) were pathologic 5 years after the procedure. Concerning gastroscopies, 5 years after the procedure, HH was found in 33 patients (30.5% of total) and esophagitis in 32 patients (31.4% of total). Eighty patients (76%) had GER symptoms, and 25 patients (24%) were asymptomatic. Only 1 patient (.9%) developed BE. CONCLUSIONS: Our study has confirmed a high rate of both persistent and de novo esophagitis and hiatal hernia, many of which were asymptomatic, 5 years after SG had been performed. Weight regain and a striking increase in gastric capacity are risk factors indicative of esophagitis, even when patients are asymptomatic. We consider a control gastroscopy and the preventive use of proton pump inhibitors necessary in these cases regardless of symptoms. We recommend that a control gastroscopy should be performed in all cases regardless of symptoms 5 years after SG. Further studies are needed to validate these recommendations.

Variabilidad clínica del tumor carcinoide evolucionado / Clinical variability of carcinoid tumor. Our casuistics of advanced-stage carcinoid tumor

La presentación clínica del tumor carcinoide depende de su grado de malignidad, localización, volumen tumoral, funcionalidad y el tiempo de evolución del proceso. Se discuten nuestros casos de tumor carcinoide evolucionado y las nuevas aportaciones diagnósticas y terapéuticas. Se trata de 5 pacientes (3 mujeres y 2 varones). Un caso correspondió a tumor carcinoide hepático único sin síndrome carcinoide y 4 a tumores ileales avanzados con metástasis hepáticas de diverso grado (3 con síndrome carcinoide). Un caso de crisis carcinoide se manifestó durante la inducción anestésica. Los estudios morfológicos y de localización consistieron en la gammagrafía marcada con octreótido, la tomografía computarizada espiral, la resonancia magnética y la ecografía intraoperatoria. El estudio bioquímico funcional incluyó 5-HIA en plasma y orina, 5-HT y serotonina plasmática. El estudio inmunohistoquímico incluyó la determinación de cromogranina A. Los tratamientos incluyeron: sandostatina LAR (long-acting release), resección radical de tumores ileales, hepatectomía, embolización intraarterial de metástasis hepáticas y biopsia diagnóstica. Dos pacientes fallecieron tras el diagnóstico. Los 3 pacientes tratados tienen un seguimiento de 12, 13 y 17 meses (AU)