Long-term follow-up evaluation of endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass.

BACKGROUND: Endoscopic sclerotherapy using sodium morrhuate has been used to treat patients with weight regain after Roux-en-Y gastric bypass whose presumed etiology is loss of restriction due to gastrojejunostomy dilation. Weight loss and stability have been demonstrated in several studies with short-term follow-up evaluation. METHODS: This retrospective review evaluated all the patients who underwent sclerotherapy for a dilated gastrojejunostomy between 2007 and 2012. RESULTS: The study identified 48 patients with a mean follow-up period of 22 months (range 12-60 months). The mean age of these patients was 47.5 ± 10.5 years, and 92 % were women. The average weight loss from the primary procedure was 132.5 ± 54.82 lb, and the average weight regain from the lowest weight to the maximum weight before sclerotherapy was 46 ± 40.32 lb. The median number of sclerotherapy sessions was two (range 1-4). The pre-procedure mean gastrojejunostomy diameter was 20 ± 3.6 mm, and the mean volume of sodium morrhuate injected per session was 12.8 ± 3.7 ml. The average weight loss from sclerotherapy to the final documented weight was 3.17 ± 19.70 lb, which was not statistically significant. The following variables in the multivariate analysis were not associated with statistically significant weight loss: volume of sodium morrhuate, patient age, gastrojejunostomy diameter, number of sclerotherapy sessions, decrease in gastrojejunostomy diameter between the first and second sessions, and number of follow-up years. Weight stabilization or loss was achieved by 58 % of our cohort, with a mean weight loss of 15.9 ± 14.6 lb in this subgroup. CONCLUSION: The long-term follow-up evaluation of patients undergoing sclerotherapy of the gastrojejunostomy for weight regain after gastric bypass showed only a marginal weight loss, which was not statistically significant in our study population, although more than 50 % of the patients achieved weight loss or stabilization.

Penetrating cardiac injury.

OBJECTIVES: To report a case of penetrating cardiac injury with patient's survival. CLINICAL PRESENTATION AND INTERVENTION: A 23-year-old man stabbed with a knife to the epigastric area just below the right costal margin was brought to the Emergency Room, Al-Adan Hospital, Kuwait, in a state of shock. Aggressive resuscitation was performed, chest X-ray showed no evidence of hemo- or pneumothorax. Exploratory laparotomy was performed revealing a severely congested liver, with no intraperitoneal hemorrhage to explain his being in a state of shock. Left thoracotomy revealed pericardial tamponade with perforation in the right ventricle and hemorrhage. A mattress suture was used to control bleeding from the right ventricle. Postoperative echography revealed a tear in the interventricular septum and papillary muscle. Open-heart surgery was performed to repair the injured tissues. The patient made an uneventful recovery. CONCLUSION: This report shows that patients with penetrating cardiac injuries and detectable vital signs on arrival at the hospital can be salvaged by prompt surgical intervention.