From Early to Mid-Term Results of Endoscopic Sleeve Gastroplasty: A Retrospective Analysis of a Bariatric Center.

PURPOSE: Global obesity rates have surged, necessitating effective interventions beyond traditional bariatric and metabolic surgery (BMS). Endoscopic Sleeve Gastroplasty (ESG) has emerged as a minimally invasive alternative, addressing limitations of eligibility criteria and patient reluctance associated with BMS. This study aims to present a 3-year experience with ESG, focusing on its mid-term efficacy in weight loss. MATERIALS AND METHODS: A retrospective, single-center study included 143 consecutive ESG patients (BMI > 30 kg/m2 or > 25 kg/m2 with obesity associated-diseases) from February 2019 to March 2023. Data on demographics, comorbidities, operative details, and follow-up outcomes were collected. The primary outcome was %TWL ≥ 15% at 12 months. Secondary outcomes were an optimal clinical response (OCR) at 24 and 36 months defined by %TWL ≥ 10% or %EWL ≥ 25%. RESULTS: ESG demonstrated a mean %TWL of 14.37% at 12 months, aligning with previous studies. Early postoperative complications were minimal (2.1%), with no mortality. Follow-up revealed a peak in weight loss at 9 months, but mid-term OCR was achieved in 41.2% at 3 years. The learning curve showed efficiency improvements after 26 procedures. CONCLUSION: ESG proves effective at one year, with a %TWL of 14.37%. However, mid-term efficacy beyond 12 months remains challenging, raising questions about the durability of weight loss. Despite a low complication rate, strategies for maintaining a long-term OCR, including potential repeat ESG, warrant further investigation.

The usefulness of factor XIII levels in Crohn's disease.

BACKGROUND AND AIMS: The assessment of inflammatory activity in Crohn's disease (CD) is challenging, and no specific laboratory marker is currently available. Several studies have reported decreased serum factor XIII levels in CD patients as a function of disease activity. We aimed to determine whether the factor XIII level could be a marker for the evolution of CD. METHODS: In this prospective, single-centre trial, 129 patients were included and categorised into two groups: functional bowel disorders (FBDs, n=42) and CD (n=86). The CD group was divided into two subgroups depending on disease activity, as defined by the Crohn's Disease Activity Index score: active disease (CDa, n=41) and disease remission (CDb, n=45). The factor XIII levels were evaluated for each patient. Serial factor XIII levels were evaluated in the patients within the CDa subgroup. RESULTS: The factor XIII levels were significantly different between the FBD (117.69%) and CD (101.89%) groups (p=0.009) but there was no significant difference between the CDa and CDb subgroups (99.04% vs 104.65%, p>0.05), and the levels did not vary during follow-up for the patients in the CDa subgroup. By multivariate analysis, factor XIII levels did not correlate with the time course of disease evolution, CRP, serum fibrin levels, platelet count, disease distribution within the bowel, or the presence of a fistulising form of CD. CONCLUSIONS: Our results confirm that factor XIII levels are decreased in CD patients but cannot be recommended as a marker for the disease activity.

Preoperative infliximab treatment and postoperative complications after laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis: a case-matched study.

BACKGROUND: Infliximab offers promising new therapeutic options for treatment of moderate to severe ulcerative colitis. However, several studies suggest that it increases postoperative complication rates for patients who later require a restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). This study aimed to assess the postoperative course of patients after laparoscopic IPAA, comparing those who had and those who had not received infliximab before surgery. METHODS: The authors identified patients from their institution's IPAA database, finding 13 patients who had received preoperative infliximab treatment. Using age, gender, and type of procedure (2 or 3 stages) as criteria, they matched these cases with infliximab-naive patients drawn from the same database. The differences in perioperative data between the two groups were analyzed. Complications and their severity were assessed using the Strasberg classification. RESULTS: No significant difference was found between patients treated with and those treated without infliximab for each variable studied, namely, mean operative time (353 vs. 355 min), complication rate (23 vs. 38%), and mean hospital stay (22 vs. 25 days). CONCLUSION: The study findings showed no adverse impact from previous infliximab therapy on the laparoscopic IPAA postoperative course.