INTRAGASTRIC BALLOON AND IMPACT ON WEIGHT LOSS: EXPERIENCE IN QUITO, EQUADOR.

BACKGROUND: Obesity is associated with different medical conditions, such as cardiologic, respiratory, gastrointestinal, and genitourinary, and constitutes a severe health problem. AIMS: This study aimed to evaluate the use of intragastric fluid-filled balloon in the reduction of weight and other measurements related to body composition. METHODS: This is a retrospective, monocentric study involving all patients who opted for the intragastric balloon Spatz® placement from January 2018 to July 2019, with fulfillment of inclusion and exclusion criteria. The patients were analyzed after 6 and 12 months after the intragastric fluid-filled balloon placed. RESULTS: A total of 121 subjects were included in this study, with 83 (68.6%) females and 38 (31.4%) males. The mean age was 36 years and height was 1.64±0.09. Weight mean and standard deviation was 89.85±14.65 kg, and body mass index was 33.05±4.03; body mass index decreased to 29.4 kg/m2 with a mean weight of 79.83 kg, after 12 months of follow-up. There were statistical differences between body mass index and the 12 months in fat percentage, fat-free mass (kg), visceral fat area, and basal metabolic rate. There was a significant variation according to gender, with males having highest reduction. The percentage of excess weight loss was 46.19, and the total weight loss was 9.24 at the end of the study. CONCLUSIONS: The study demonstrated a benefit of intragastric fluid-filled balloon on weight loss after 12 months. At the end of treatment, body mass index and the measurements of body composition were significantly lower. Men benefited more than women from the treatment.

Hybrid management with graham patch repair assisted with an OVESCO endoscopic system for a post-Nissen fundoplication gastric fistula: A case report.

INTRODUCTION AND IMPORTANCE: Gastric fistula is a complication in gastrointestinal surgery. For decades, patients with gastric fistulas were treated surgically, with high morbidity and mortality. Minimally invasive treatment through endoscopic therapy with stents and interventionism has allowed improvements. We present a case of successful hybrid laparoscopy and endoscopy for the treatment of a post-Nissen fundoplication gastric fistula. CASE PRESENTATION: A 44-year-old male underwent laparoscopic Nissen fundoplication surgery; at 10 days post-surgery, he presented with oral intolerance, abdominal pain, and laboratory results showing an inflammatory response. Imaging studies indicated intra-abdominal collection; therefore, a laparoscopy revision was performed; transoperative endoscopy confirmed intra-abdominal collection and a gastric fistula. In turn, we performed closure with an omentum patch through the fistula fixed with OVESCO by endoscopy, with successful results. CLINICAL DISCUSSION: Gastric fistula is a difficult complication to treat because exposure to secretions causes inflammation. Endoscopic techniques are described for the closure of gastrointestinal fistulas; however, several aspects must be considered for their use. Hybrid laparoscopic and endoscopic treatment in the same surgery can be useful and served as a novel and successful option in our case. CONCLUSION: Hybrid treatment with endoscopy and laparoscopy can be considered an optional approach for the management of gastric fistulas greater than 1 cm and of several days of evolution.

Intragastric balloon and impact on weight loss: experience in quito, equador / Balão intragástrico e impacto na perda de peso: experiência em quito, equador

ABSTRACT BACKGROUND: Obesity is associated with different medical conditions, such as cardiologic, respiratory, gastrointestinal, and genitourinary, and constitutes a severe health problem. AIMS: This study aimed to evaluate the use of intragastric fluid-filled balloon in the reduction of weight and other measurements related to body composition. METHODS: This is a retrospective, monocentric study involving all patients who opted for the intragastric balloon Spatz® placement from January 2018 to July 2019, with fulfillment of inclusion and exclusion criteria. The patients were analyzed after 6 and 12 months after the intragastric fluid-filled balloon placed. RESULTS: A total of 121 subjects were included in this study, with 83 (68.6%) females and 38 (31.4%) males. The mean age was 36 years and height was 1.64±0.09. Weight mean and standard deviation was 89.85±14.65 kg, and body mass index was 33.05±4.03; body mass index decreased to 29.4 kg/m2 with a mean weight of 79.83 kg, after 12 months of follow-up. There were statistical differences between body mass index and the 12 months in fat percentage, fat-free mass (kg), visceral fat area, and basal metabolic rate. There was a significant variation according to gender, with males having highest reduction. The percentage of excess weight loss was 46.19, and the total weight loss was 9.24 at the end of the study. CONCLUSIONS: The study demonstrated a benefit of intragastric fluid-filled balloon on weight loss after 12 months. At the end of treatment, body mass index and the measurements of body composition were significantly lower. Men benefited more than women from the treatment.

RESUMO RACIONAL: A obesidade está associada a diferentes condições médicas, tais como cardiológicas, respiratórias, gastrointestinais, geniturinárias entre outras e constituem um grave problema de saúde. OBJETIVOS: Avaliar o emprêgo do balão intragástrico na redução de peso e em outras medidas relacionadas à composição corporal. MÉTODOS: Estudo retrospectivo, monocêntrico, incluindo todos os pacientes que optaram pela colocação de balão intragástrico Spatz® entre janeiro de 2018 e julho de 2019, com cumprimento dos critérios de inclusão e exclusão. RESULTADOS: Cento e vinte e um indivíduos foram recrutados neste estudo. A média de idade foi de 36 anos e estatura de 1,64±0,09, sendo 83 (68,6%) do sexo feminino e 38 (31,4%) do sexo masculino. A média do peso e o desvio padrão foram de 89,85±14,65 kg e o índice de massa corporal foi de 33,05±4,03. Após 12 meses, o índice de massa corporal diminuiu para 29,4 kg/m2 com um peso médio de 79,83 kg. Foram registradas diferenças estatísticas no índice de massa corporal, no percentual de gordura, massa livre de gordura (kg), área de gordura visceral e taxa metabólica basal. Houve variação significativa de acordo com o sexo, sendo o masculino com maior redução. O porcentual de perda de excesso de peso foi de 46,19% e de perda de peso total de 9,24 %ao final do estudo. CONCLUSÕES: O estudo demonstrou benefícios do balão intragástrico na perda de peso após 12 meses de colocação do balão. Ao final do tratamento, o índice de massa corporal e as medidas de composição corporal foram significativamente menores. Os homens se beneficiaram mais do que as mulheres do tratamento.

Severity Markers of Acute Appendicitis: Diagnostic Test Study / Marcadores de severidad de la apendicitis aguda: estudio de prueba diagnóstica

Abstract Introduction: Acute appendicitis (AA) is one of the most frequent abdominal surgical pathologies globally, with appendectomy being the most performed emergency surgery. Aim: To determine potential markers of AA severity for diagnostic purposes and timely management, thus avoiding possible complications. Materials and methods: This research relies on a randomized sample of 239 patients diagnosed with AA at the Orinoquía Regional Hospital, Colombia. We analyzed blood count, C-reactive protein (CRP), and neutrophil/lymphocyte ratio (NLR) records and established their relationship with the AA surgical findings described by Guzmán-Valdivia. Results: In the emergency department, these reactants can provide an approximate diagnosis as markers of the AA severity, with CRP > 15 mg/dL (diagnostic accuracy of 76.15 %) and NLR > 85 % (diagnostic accuracy of 61.09 %) having the best initial operating performance. Regarding complications such as intestinal perforation, we found a statistical relationship; CRP > 15 mg/dL and NLR > 85 % were the markers with the highest predictive performance, with OR 14.46 and OR 2. 17, respectively, regarding Guzmán-Valdivia's findings. Conclusions: CRP and NLR > 85 % are the acute phase reactants with the best diagnostic characteristics to predict potential AA complications.

Resumen Introducción: la apendicitis aguda (AA) es una de las patologías quirúrgicas abdominales más frecuentes en el mundo, siendo la apendicectomía, la cirugía de emergencia más realizada a nivel mundial. Objetivo: determinar los posibles marcadores de severidad en la apendicitis aguda con fines diagnósticos y para el manejo oportuno de la apendicitis y, de esta manera, evitar posibles complicaciones. Metodología: esta investigación se basó de una muestra aleatorizada de un total de 239 pacientes con diagnóstico de apendicitis aguda en el Hospital Regional de Orinoquía, Colombia. Se analizaron registros de cuadro hemático, proteína C reactiva (PCR) e índice de neutrófilo/linfocito (INL), y se estableció la relación de los mismos con los hallazgos quirúrgicos de apendicitis aguda descritos por Guzmán-Valdivia. Resultados: en el servicio de urgencias, estos reactantes son capaces de realizar una aproximación en el diagnóstico y como marcadores de la severidad de la AA, siendo la PCR > 15 mg/dL (precisión diagnóstica 76,15 %) y el porcentaje de neutrófilos > 85 % (precisión diagnóstica 61,09 %) los de mejor rendimiento operativo inicial. En cuanto a las complicaciones, como la perforación intestinal, se encontró en relación estadística, que la PCR > 15 mg/dL y el porcentaje de neutrófilos > 85 % fueron los marcadores con mayor rendimiento predictivo, con OR 14,46 y OR 2,17, respectivamente. Lo anterior en relación con los hallazgos descritos por Guzmán-Valdivia. Conclusiones: la elevación de la PCR y del porcentaje de neutrófilos > 85 % son los reactantes de fase aguda que presentan mejores características diagnósticas y para predecir posibles complicaciones de la apendicitis aguda.

Learning Process Effectiveness During the COVID-19 Pandemic: Teleproctoring Advanced Endoscopic Skills by Training Endoscopists in Endoscopic Sleeve Gastroplasty Procedure.

BACKGROUND AND AIMS: The COVID-19 pandemic has led health institutions to cancel many of the activities including training in different fields. Most practices and training programs have been encouraged to use teleproctoring as an alternative method to enhance physician's ability and assure training. We aimed to evaluate remote training program for endoscopy sleeve gastroplasty (ESG). METHODS: Ten consecutive patients underwent an endoscopic sleeve gastroplasty procedure guided by a proctor expert using an online platform. A stepwise approach was created to assure skill acquisition. RESULTS: All cases were safely performed with no serious adverse events under teleproctoring. The average surgical and suturing times significantly decreased during the training model. From the first 5 cases to the last 5 ones, the endoscopic procedure time decreased from 120 to 93.4 min while suturing time from 92.8 to 68.4 min. The effect size was large in both cases, and the changes were meaningful according to the fitted learning curves. CONCLUSIONS: The proposed teleproctoring program was effective to deliver advanced endoscopic skills such as endosuturing for ESG, despite the restrictions imposed by the COVID-19 pandemic.