Brazilian Intragastric Balloon Consensus Statement (BIBC): practical guidelines based on experience of over 40,000 cases

Background

Intragastric balloons (IGBs) are a minimally invasive option for obesity treatment, acting as a space-occupying device and leading to weight loss through increased satiety. This device has been growing in popularity owing to its safety profile and good weight loss results. However, there are no published guidelines that standardize the technical aspects of the procedure.

Management of gastric fistula complicating laparoscopic sleeve gastrectomy with biological glue in a combined percutaneous and endoscopic approach

Background

Laparoscopic sleeve gastrectomy (LSG) is considered as a first line treatment for morbid obesity around the globe. Leakage and subsequent gastric fistula is the most dreadful complication, which may lead to serious morbidity and even mortality.

腰椎椎间孔镜手术治疗伴神经根管狭窄的腰椎椎间盘突出症

目的退变性腰椎椎间盘突出、黄韧带肥厚、关节突关节增生内聚引起神经根管狭窄,利用椎间孔镜对神经根管进行减压。方法对20例退变性神经根管狭窄症患者行腰椎椎间孔镜下神经根管扩大成形术,记录术前术后腰腿痛疼痛视觉模拟量表(visual analogue scale,VAS)评分,采用Macnab标准评价疗效。结果 20例患者术前平均腰痛VAS评分为5分,术后即刻为1.5分,术后3个月为0.5分。术前平均腿痛VAS评分为7分,术后即刻为0.3分,术后3个月为0.1分。18例患者术后3个月的改良Macnab疗效评定为优,2例患者为良。结论对腰椎退变性神经根管狭窄症,椎间孔镜可对突出的腰椎椎间盘、关节突关节以及黄韧带进行减压,有效地扩大神经根管,可获得很好的疗效。     

经皮椎间孔镜治疗高龄腰椎椎间盘突出并神经根管狭窄的短期疗效

目的评价经皮椎间孔镜技术治疗高龄腰椎椎间盘突出并神经根管狭窄的临床效果。方法选择2012年11月~2013年6月本院收治的12例有典型根性症状及间歇性跛行的高龄患者,其中L4/L5间隙4例,L5/S1间隙3例,L3/L4/L5双间隙2例,L4/L5/S1双间隙3例,平均病程12.6个月。均采用经皮椎间孔镜技术治疗。结果 12例患者术后根性症状及间歇性跛行均明显缓解,直腿抬高试验阴性,采用疼痛视觉模拟量表(visual analogue scale,VAS)为患肢疼痛程度评分,术前为(8.1±1.3)分,术后3个月为(2.3±1.2)分,差异具有统计学意义(P0.05)。结论治疗有典型根性症状及间歇性跛行的腰椎椎间盘突出并根管狭窄的高龄患者,经皮椎间孔镜技术微创、安全、有效,合理选择手术适应证和成熟的椎间孔镜手术经验是手术成功的关键。     

Endoscopically assisted proximal radial nerve decompression: Surgical technique

State of the artThe proximal radial nerve compression syndrome includes supinator syndrome and proximal radial nerve constrictions. This article presents a new endoscopic assisted radial nerve decompression surgical technique described for the first time by Leclère et al. in 2013.Surgical techniqueEndoscopic scissor decompression of the proximal radial nerve is always performed under plexus anaesthesia. It includes 8 key steps documented in this article. We review the indications and limitations of the surgical technique.ConclusionEarly clinical results after endoscopic assisted decompression of the radial nerve appear excellent. However, they still need to be compared with conventional techniques. Clinical studies are likely to widely develop because of the mini-invasive nature of this new surgical technique.     

Propofol‐cetamina versus dexmedetomidina‐cetamina para sedação durante endoscopia digestiva alta em pacientes pediátricos: estudo clínico randomizado

Background and objectivesDay‐case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes.MethodsWe enrolled 120 patients (2−7 years in age) and randomly assigned them into two groups. Each patient received intravenous (IV) ketamine at a dose of 1 mg.kg^‐1 in addition to either propofol (1 mg.kg^‐1) or dexmedetomidine (0.5 μg.kg^‐1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored.ResultsThere was no significant difference in hemodynamics between the groups. The Propofol‐Ketamine (P‐K) group showed significantly shorter recovery times than the Dexmedetomidine‐Ketamine (D‐K) group (21.25 and 29.75 minutes respectively, p < 0.001). The P‐K group showed more oxygen desaturation. Eleven and six patients experienced SpO₂ < 92% in groups P‐K and D‐K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D‐K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P‐K group, respectively (p = 0.001). The P‐K group showed less post‐procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction.ConclusionsThe P‐K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D‐K combination showed less need for additional doses.Registration numberClinical trials.gov (NCT02863861).