ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

FECAL CALPROTECTIN AND INTESTINAL METABOLITES: WHAT IS THEIR IMPORTANCE IN THE ACTIVITY AND DIFFERENTIATION OF PATIENTS WITH INFLAMMATORY BOWEL DISEASES?

2025-02-25T21:43:45.417000Z

Lins, Lucas Correia; De-Meira, Júnia Elisa Carvalho; Pereira, Camila Wanderley; Crispim, Alessandre Carmo; Gischewski, Marina Demas Rezende; Lins-Neto, Manoel Álvaro De Freitas; Moura, Fabiana Andréa;

ABSTRACT BACKGROUND: Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), lacks a known etiology. Although clinical symptoms, imaging, and colonoscopy are common diagnostic tools, fecal calprotectin (FC) serves as a widely used biomarker to track disease activity. Metabolomics, within the omics sciences, holds promise for identifying disease progression biomarkers. This approach involves studying metabolites in biological media to uncover pathological factors. AIMS: The purpose of this study was to explore fecal metabolomics in IBD patients, evaluate its potential in differentiating subtypes, and assess disease activity using FC. METHODS: Cross-sectional study including IBD patients, clinical data, and FC measurements (=200 μg/g as an indicator of active disease). RESULTS: Fecal metabolomics utilized chromatography mass spectrometry/solid phase microextraction with MetaboAnalyst 5.0 software for analysis. Of 52 patients (29 UC, 23 CD), 36 (69.2%) exhibited inflammatory activity. We identified 56 fecal metabolites, with hexadecanoic acid, squalene, and octadecanoic acid notably distinguishing CD from UC. For UC, octadecanoic and hexadecanoic acids correlated with disease activity, whereas octadecanoic acid was most relevant in CD. CONCLUSIONS: These findings highlight the potential of metabolomics as a noninvasive complement for evaluating IBD, aiding diagnosis, and assessing disease activity.

SKIN COLOR DIFFERENCES AND HEALTH-RELATED QUALITY OF LIFE PERCEPTION AFTER GASTRIC BYPASS ROUX-EN-Y: A CROSS-SECTIONAL STUDY

2025-02-25T21:43:45.417000Z

Andrade, Milca Rodrigues Vieira De; Vale, Ana Rafaela Soares Do; Silva, Mariana Sousa De Pina; Barros, João Henrique Cerqueira; Lagares, Laura Souza; Almeida, Luiz Alberto Bastos De; Aguiar, Carolina Villa Nova; Santos, Clarcson Plácido Conceição Dos;

ABSTRACT BACKGROUND: Differences in skin color have socioeconomic and health implications; however, gaps persist in understanding health-related quality of life (HRQoL) perception. AIMS: To examine whether skin color differences influence HRQoL in obese patients undergoing Roux-en-Y gastric bypass surgery. METHODS: Cross-sectional study with participants of both genders, aged 18 to 60, and three to six months postoperatively. Data were collected from October 2018 to July 2019 at a bariatric clinic in Salvador, Bahia. Skin color, Moorehead-Ardelt II Quality of Life Questionnaire (MAQOL-II) scores, anthropometric measurements, socioeconomic status, physical activity, and body image perceptions were recorded. RESULTS: Of 196 patients, 67.35% were Black. “Self-esteem” in MAQOL-II demonstrated the most significant post-surgical improvement, with 62.8% reporting “much better” outcomes. Adjusted residuals associated “much better” and “unchanged” responses with skin color. The overall MAQOL-II score indicated lower HRQoL scores (M=1.65; standard deviation - SD=0.98) for individuals with black skin compared to those with white skin. Analyzing questionnaire responses, both racial groups exhibited equal percentages (45.3%) reporting “much better” and “better” post-surgery progress. However, no statistically significant differences in HRQoL were observed when comparing skin color. CONCLUSIONS: Skin color appears not to significantly impact the HRQoL of obese patients undergoing Roux-en-Y gastric bypass.

THE USE OF ABDOMINAL CORSETS ON COLONOSCOPY: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL

2025-02-25T21:43:45.417000Z

Adali, Mert;

ABSTRACT BACKGROUND: Colonoscopy is a widely used endoscopic procedure to investigate diseases of the colon and rectum. Colonoscopy procedure has difficulties for the patient and endoscopist. AIMS: To investigate whether the use of an abdominal corset can make the colonoscopy procedure easier and faster. METHODS: This is a prospective randomised controlled study. Patients over 18 years of age who underwent elective colonoscopy in our clinic were evaluated. Patients were divided into two groups according to the use of the corset. Variables were compared between the groups. RESULTS: A total of 204 patients were included in the study. Corsets were used in 97 patients and not used in 107 patients. The need for manual compression was found to be decreased in the corset use group. There was no effect of corset use on cecal intubation time in the general population. It was found that cecal intubation time decreased with corset use in patients with body mass index - BMI<30 and male gender. CONCLUSIONS: The need for manual compression can be reduced by the use of an abdominal corset during colonoscopy. The use of an abdominal corset may make the colonoscopy procedure faster and easier for the endoscopist and the patient.

ALCOHOL USE DISORDER AND DEPRESSION IN PATIENTS AFTER UNDERGOING BARIATRIC SURGERY

2025-02-25T21:43:45.417000Z

Oliveira, Kátia Cristina; Santa-Cruz, Fernando; Leão, Luciana Melo Souza; Kreimer, Flávio; Ferraz, Álvaro Antonio Bandeira;

ABSTRACT BACKGROUND: Research indicates that patients undergoing bariatric surgery face a six to seven times higher risk of developing alcohol use disorder (AUD) compared with the population of obese individuals not undergoing surgical intervention. Studies suggest that problematic alcohol consumption encompassing depression escalates gradually after surgery. AIMS: The purpose of this study was to evaluate the impact of bariatric surgery on the incidence of AUD and depression during the postoperative period. METHODS: Prospective study that evaluated 68 patients who underwent either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). The presence of AUD and depression was assessed both pre- and post-operatively. AUD assessment utilized the AUD identification test-C score, whereas depression assessment employed the Beck Depression Inventory (BDI). RESULTS: The average age of the sample was 42.81±9.28 years, with 85.3% being female. The mean follow-up was 16.54±7.41 months. In the preoperative assessment, 92.6% of the sample fell into the low-risk category for AUD. No significant difference was observed between the RYGB and SG groups. Postoperatively, 89.7% of the sample was classified as low risk for AUD, with no significant differences compared with the preoperative assessment. Regarding depression, there was no significant difference between pre- and post-operative periods for all patients. However, a notable trend toward a reduction in “severe depression” was observed in the postoperative period for patients undergoing SG (pre: 14.0% vs. post: 7.0%, p=0.013). CONCLUSIONS: There is no significant difference in the presence of AUD and depression between pre- and post-operative assessments in patients who have undergone bariatric surgery.

PERITUMORAL BUDDING AS A PREDICTOR FOR LYMPH NODE METASTASES IN COLORECTAL CARCINOMAS: WHAT IS THE IMPORTANCE?

2025-02-25T21:43:45.417000Z

Santos, Emily Karoline Araujo Nonato Dos; Triches, Bruna Gama; Silva, Guilherme Prestes Da; Linhares, Julia Costa; Mehanna, Samya Hamad; Cavalcanti, Marcela Santos;

ABSTRACT BACKGROUND: Microscopic analysis of tumor budding (TB) may be an essential predictive tool for regional lymph node metastases in colorectal cancer, especially among patients in intermediate stages, who exhibit considerable prognostic variability. AIMS: The aim of this study was to assess the predictive power of BT regarding the presence of lymph node metastases and its association with other characteristics related to colorectal carcinoma progression. METHODS: This is a cross-sectional, retrospective study with a quantitative approach, focusing on the review of medical records and histopathological reports of patients who underwent oncologic surgery for colorectal cancer. RESULTS: A total of 153 patient records were examined, with a predominance of the 61-70 age group and a male majority (50.98%). Adenocarcinoma not otherwise specified was the most common histological type (60.78%), with the majority exhibiting moderate differentiation (87.58%). From the total sample, 97 cases (63.39%) exhibited TB, with 51.55% classified as a high budding score. Invasion of adipose tissue/subserosa was the most prevalent, occurring in 46.41% of cases. Regional lymph node metastases and angiolymphatic invasion were observed in 66 and 101 patients, respectively. Cross-tabulation analysis showed a statistically significant association between TB and lymph node metastasis (p<0.05). CONCLUSIONS: The relationship between TB and lymph node metastasis highlights the significance of this histological factor in the risk stratification and prognosis of patients with colorectal cancer, complementing TNM staging. Therefore, the assessment of tumor budding is crucial in histopathological reports, potentially influencing additional therapeutic decisions.

STANDARDIZATION OF THE WHITE TEST IN OPEN LIVER RESECTION: TOWARD NEAR-ZERO CLINICALLY SIGNIFICANT BILE LEAKAGE

2025-02-25T21:43:45.417000Z

Lazzarotto-Da-Silva, Gabriel; Grezzana-Fiilho, Tomaz De Jesus Maria; Leipnitz, Ian; Feier, Flávia Heinz; Rodrigues, Pablo Duarte; Hallal, Celina Pereira; Chedid, Marcio Fernandes; Kruel, Cleber Rosito Pinto;

ABSTRACT BACKGROUND: Biliary fistula is one of the most common complications after liver resection and is associated with significant morbidity and mortality. One of the methods used to evaluate biliary fistulas is the White test, which consists of injecting a lipid emulsion into the bile duct. However, no standard technique for performing the White test has been published. AIMS: The aim of this study was to standardize the technique for performing the White test in patients undergoing hepatectomies, with and without previous cholecystectomy, and to assess the preliminary results. METHODS: Patients over 18 years of age who were submitted to open hepatectomy were included in the study. The primary outcome was the rate of biliary fistula. Secondary outcomes were the incidence of acute pancreatitis and overall morbidity, measured by the Clavien-Dindo classification. RESULTS: The standard technique for the White test was performed on 17 patients. In total, three patients had previous cholecystectomy, and two had low insertion of the cystic duct, requiring cannulation of the hepatocholedochal duct. None of the patients developed clinically significant biliary leaks. Acute pancreatitis did not occur in any patient. One patient developed pneumonia requiring mechanical ventilation (Clavien-Dindo IV). All others had minor or no complications. CONCLUSIONS: The standardized technique for performing the White test suggests an appropriate strategy to maximize the detection of intraoperative biliary leaks.

METACHRONOUS COLORECTAL LIVER METASTASIS

2025-02-25T21:43:45.417000Z

Oliveira, Cássio Virgílio Cavalcante De; Santana, Rodolfo Carvalho; Coimbra, Felipe José Fernandez; Kow, Alfred; Pawlik, Timothy M.; Adam, Rene; Soubrane, Olivier; Herman, Paulo; Cotta-Pereira, Ricardo Lemos; ,;

ABSTRACT Deaths related to colorectal cancer are generally associated with its metastases that affect the liver (50%) through the hematogenous route. Approximately 20-25% of these patients already have synchronous metastases in the liver at the time of primary tumor diagnosis. In others, liver metastases will occur during the course of the disease and are called metachronous. Metachronous metastases are believed to have a better prognosis; however, 20-25% of metastatic cases can be resected during the course of the disease. There is a lack of consensus on the diagnostic time interval for metastases to be considered metachronous in the consulted literature. Surgical treatment of metastases and lymph nodes is indicated, and extrahepatic neoplastic disease must be carefully evaluated. Liver transplantation can benefit the patient, should be evaluated, and is indicated in some special situations.