Peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery: Techniques and efficacy

AIM: To investigate the techniques and efficacy of peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery.METHODS: An extensive English language literature search was conducted using Pub Med, MEDLINE, Medscape and Google to identify peer-reviewed original and review articles using the keywords "bariatric endoscopic suturing", "overstitch bariatric surgery", "endoscopic anastomotic reduction", "bariatric surgery", "gastric bypass", "obesity", "weight loss". We identified articles describing technical feasibility, safety, efficacy, and adverse outcomes of overstitch endoscopic suturing system for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass(RYGB). All studies that contained material applicable to the topic were considered. Retrieved peer-reviewed original and review articles were reviewed by the authors and the data extracted using a standardized collection tool. Data were analyzed using statistical analysis as percentages of the event. RESULTS: Four original published articles which met our search criteria were pooled. The total number cases were fifty-nine with a mean age of 46.75 years(34-63 years). Eight of the patients included in those studies were males(13.6%) and fifty-one were females(86.4%). The mean time elapsed since the primary bypass surgery was 5.75 years. The average pre-endoscopic procedure body mass index(BMI) was 38.68(27.5-48.5). Mean body weight regained post-RYGB surgery was 13.4 kg from their post-RYGB nadir. The average pouch length at the initial upper endoscopy was 5.75 cm(2-14 cm). The pre-intervention anastomotic diameter was averaged at 24.85 mm(8-40 mm). Average procedure time was 74 min(50-164 min). Mean post endoscopic intervention anastomotic diameter was 8 mm(3-15 mm). Weight reduction at 3 to 4 mo post revision noted to be anaverage of 10.1 kg. Average overall post revision BMI was recorded at 37.7. The combined technical and clinical success rate was 94.9%(56/59) among studied participants. CONCLUSION: Endoscopic suturing can be technically feasible, effective and safe for transoral outlet reduction in patients with weight regain following RYGB.

Assessment of Feedstock Options for Biofuels Production in Ghana

In the wake of climate change and increasing fossil fuel prices, biofuels are becoming attractive to agricultural dependent economies in sub-Saharan Africa and other regions of the world. This study evaluates the energy production potential of biomass resources grown on the available arable agricultural land under two principal scenarios: using 2.5% and 5% of the available arable land for energy crop expansion. Using conservative biofuel yields from crops in the sub-region, a 2.5% of uncultivated arable land dedicated to four traditional crops grown in Ghana namely maize, cassava, sweet sorghum and oil palm could potentially replace 9.3% and 7.2% of transportation fuels by 2020 and 2030 respectively. Using 5% of the uncultivated arable land to cultivate the above four crops and jatropha could potentially produce biofuel to replace 17.3% of transport fuels by 2020 and 13.3% by 2030. In order to enrol such a scheme, government is encouraged to put in place appropriate structures to ensure that, the industry meet international sustainability standards.

Primary hepatic peripheral T-cell lymphoma associated with Epstein-Barr viral infection

Primary hepatic peripheral T-cell lymphoma(H-PTCL) is one of the rarest forms of non-Hodgkin lymphoma. We report a patient who presented with worsening jaundice, abdominal pain, and vomiting. Laboratory values were significant for elevated total bilirubin, alkaline phosphatase, and liver aminotransferases. Following a liver biopsy, histopathology revealed several large dense clusters of atypical T-lymphocytes which were CD2+, CD3+, CD5+, CD7-, CD4+, CD8-, CD56-, CD57-, CD30+ by immunohistochemistry. The proliferation index was approximately 70% by labeling for ki67/mib1. The above histological profile was consistent with peripheral T-cell lymphoma of the liver. Epstein-Barr viral serology indicated a remote infection, a likely risk factor for PTCL. Bone marrow biopsy was negative for malignancy, further supporting hepatic origin.

Autoimmune hepatitis in the setting of human immunodeficiency virus infection: A case series

Liver injury in the setting of human immunodeficiency virus(HIV) infection is more commonly attributed to viral hepatitis or highly active antiretroviral treatment(HAART) toxicity. The severity of liver injury is an important cause of morbidity and mortality. The emergence of autoimmune diseases, particularly autoimmune hepatitis(AIH) in the setting of HIV infection, is rare. Previous reports indicate that elevated liver enzymes are a common denominator amongst these patients. We present two patients with HIV infection, on HAART, with virological suppression. Both patients presented with elevated liver enzymes, and following liver biopsies, were diagnosed with AIH. The clinical course of these patients underscore the therapeutic value of corticosteroids, and in some cases, addition of immunosuppression for AIH treatment.

肝胆管类圆虫病表现为食管胃十二指肠镜和超声内镜下的壶腹病变

Strongyloidiasis is an intestinal infection caused by the parasitic nematodes of the Strongyloides species,most commonly Strongyloides stercoralis.We report a case of a 66-year-old immigrant male from Haiti who presented with complaints of diarrhea and an unintentional 80-lb weight loss over the past 5 years.Stool examination was positive for strongyloidiasis.Following albendazole therapy,esophagogastroduodenoscopy(EGD)showed a unique ampullary lesion.Histopathology of the ampullary lesion showed reactive epithelium with Strongyloides larva.In addition,endoscopic ultrasound(EUS)detected a large pancreatic cyst.Both these findings were absent on EGD 5 years previously,prior to the onset of his symptoms.This paper documents a rare case of an ampullary lesion and pancreatic cyst secondary to hepatobiliary strongyloidiasis in a non-Human Immunodeficiency Virus(HIV)patient.We review the epidemiology,life cycle,clinical presentation and treatment of strongyloidiasis.