Endoscopia digestiva alta em 218 pacientes no primeiro ano de pós-operatório da cirurgia de capella: descrição e associação dos dados clínicos e achados endoscópicos

Abstract

Obesity is a common disease both in developed and developing countries. Many are the conditions that combined with it pose serious challenges to public health. Selected patients may choose to undergo bariatric surgery, seen currently as the most effective treatmentagainst obesity. Despite the success of this surgical approach in the areas of weight loss, improved co-morbidity, and enhanced quality of life, a group of patients will still develop digestive disorders, unsatisfactory or excessive weight loss, or still regain weight postoperatively. Those are referred to the digestive endoscopy service. This study aims to describe and correlate the clinical data and endoscopic findings in the first year of post-op of a group of 218 patients who underwent the Capella procedure and were interviewed and submitted to digestive endoscopy. Out of the 218 patients, 186 (85.3%) presented one or more clinical sings that called for endoscopic examination, while 32 (14.7%) underwent endoscopy for control purposes. Vomiting was reported by 50% of the patients and ranked first among clinical findings, followed by epigastric pain (32%). One hundred and forty patients (64.2%) were normal to endoscopic examination and alterations were found on 78 (35.8%) of them. The most commonly found alteration was food impaction (8.3%), followed by marginal ulcer (5.5%). The variables of interest were elected based on the purposes of the study and tested for the strength of their association and correlation. Statistically significant association was found between the following variables: control with normal endoscopic examination; epigastric pain with marginal ulcer; acute vomiting withstenosis at the anastomosis, food impaction, stenosis, and gastric ring slippage; inadequate weight loss with fistula and enlarged ring; post-op weight gain with large pouch. Although clinical suspect, no association was verified between the following variables: excessive weight loss with stenosis at the anastomosis and food impaction, gastric ring stenosis or ring slippage; clinical data variables with uréase tests, histologic tests for H. pylori and inflammation of the gastric pouch; erosion and marginal ulcer with uréase tests and histologic exams for H. pylori. Based on the information gathered in this study, we may conclude that: 1. the clinical data that most points patients to the need for endoscopic examination isvomiting, and the most commonly found endoscopic alteration is food impaction. 2. if symptoms are not present and weight loss has been satisfactory, there is no need to perform endoscopic examination in patients who underwent the Capella procedure. 3. the association between clinical data and endoscopic alterations is weak. Nonetheless,absence of vomiting, mainly in its acute form, practically excludes stenosis at the anastomosis, stenosis and gastric ring slippage, and food impaction from the diagnostic scene. Likewise, absence of epigastric pain excludes the diagnosis for marginal ulcer. 4. there is no need to perform histologic exams and uréase tests on the gastric pouch as no association was found between clinical data or marginal ulcer and infection of the gastric pouch by H. pylori.