Comparative analysis of the duodenojejunal microbiome with the oral and fecal microbiomes reveals its stronger association with obesity and nutrition.

The intestinal microbiota is increasingly recognized as a crucial player in the development and maintenance of various chronic conditions, including obesity and associated metabolic diseases. While most research focuses on the fecal microbiota due to its easier accessibility, the small intestine, as a major site for nutrient sensing and absorption, warrants further investigation to determine its microbiota composition and functions. Here, we conducted a clinical research project in 30 age- and sex-matched participants with ( = 15) and without ( = 15) obesity.

Endoscopy management of sleeve gastrectomy stenosis: what we learned from 202 consecutive patients.

Background: Gastric sleeve stenosis (GSS) is described in 1%-4% of patients.

Objective: To evaluate the role of endoscopy in the management of stenosis after laparoscopic sleeve gastrectomy using a standardized approach according to the characteristic of stenosis.

Setting: Retrospective, observational, single-center study on patients referred from several bariatric surgery departments to an endoscopic referral center.

Long-term Outcomes of Combined Endoscopic-Radiological Approach for the Management of Complete Transection of the Biliary Tract.

Background: Complete transection of the main bile duct (CTMD) is a major complication during hepato-bilio-pancreatic (HBP) surgery and is associated with high morbidity and mortality. In recent years, a combined endoscopic-radiological approach (CERA) for minimally invasive treatment of CTMD has been introduced, but evidence on its long-term outcomes is limited. Our aim is to report efficacy, safety, and long-term outcomes of CERA for the management of post-surgical CTMD in a tertiary referral center.

Endoscopic Management of Bariatric Surgery Complications According to a Standardized Algorithm.

Background And Aims: Endoscopy is effective in management of bariatric surgery (BS) adverse events (AEs) but a comprehensive evaluation of long-term results is lacking. Our aim is to assess the effectiveness of a standardized algorithm for the treatment of BS-AE.

Patients And Methods: We retrospectively analyzed 1020 consecutive patients treated in our center from 2012 to 2020, collecting data on demographics, type of BS, complications, and endoscopic treatment.

Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients.

Background: Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases.

Objectives: To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG.

Aortic injuries following stents in bariatric surgery: our experience.

Background: Due to the large number of laparoscopic sleeve gastrectomy (LSG) performed over the last decade, the management of the leak following LSG has been increasingly reported. The role of covered Self Expandable Metal Stents (cSEMS) for the treatment of the leak is still controversial because of the poor tolerance and high risk of complications.

Objectives: The aim of the present study was to analyze the foregut wall perforation and aorta injuries, a very rare but potentially fatal complication, related to the treatment of the leak following LSG using cSEMS.

Submucosal Tunnel Endoscopic Resection of Gastric Lesion Before Obesity Surgery: a Case Series.

Background: Submucosal tumors (SMTs) of the gastrointestinal tract are a rare pathological entity comprising a wide variety of neoplastic and non-neoplastic lesions. Even if most SMTs are benign tumors (e.g.

Long-term placement of lumen-apposing metal stent after endoscopic ultrasound-guided duodeno- and jejunojejunal anastomosis for direct access to excluded jejunal limb.

Background:  Management of biliary disorders in patients with altered anatomy may be challenging. Endoscopic ultrasound (EUS)-guided gastrointestinal anastomosis using a lumen-apposing metal stent (LAMS) was introduced to allow endoscopic retrograde cholangiography (ERC) in such cases. However, the appropriate stent indwelling time remains uncertain.

Temporary Trans-gastric Stent Deployment Over a 20 French Gastrostomy for Single-Stage Endoscopic Retrograde Cholangiopancreatography After Gastric Bypass.

Introduction: Treatment of pancreato-biliary disorders after gastric bypass is challenging due to altered anatomy. Several techniques have been proposed to overcome this condition; however, none has emerged as the gold standard treatment. Furthermore, a decision-making algorithm evaluating when and why apply one technique over another is still lacking.

Endoscopic Internal Drainage Coupled to Prompt External Drainage Mobilization Is an Effective Approach for the Treatment of Complicated Cases of Sleeve Gastrectomy.

Introduction: Despite advances in treating gastric staple line leaks after bariatric surgical procedures, chronic leaks have been reported. Failure of their treatment frequently leads to radical surgery. We aimed to describe a strategy for preventing occurrence of chronic gastric leaks after complicated sleeve gastrectomy in patients necessitating relaparoscopy and external drainage as a first step of gastric leak management.

Endoscopic Fistula-jejunostomy for Chronic Gastro-jejunal Fistula After Sleeve Gastrectomy.

Introduction: Proximal gastric leak is one of the most common complications after laparoscopic sleeve gastrectomy (LSG). Endoscopy is the gold standard treatment for acute staple-line leaks. Surgery is the most effective treatment modality in case of chronic fistula.

EUS-Guided Transrectal Evacuation of Organized Pelvic Collection Following Roux-en-Y Gastric Bypass After Failure of Radiological and Surgical Approach.

Introduction: Postoperative collections are an important cause of morbidity following obesity surgery. Surgical revision is most often required if general sepsis is present. Conservative treatment consists of broad spectrum antibiotics and percutaneous drainage of any collection.

Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery.

Background: Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications.

Revision of biliary sphincterotomy by re-cut, balloon dilation or temporary stenting: comparison of clinical outcome and complication rate (with video).

 Revision of endoscopic retrograde cholangiopancreatography (ERCP) may be necessary following previous biliary endoscopic sphincterotomy for recurrent biliary symptoms related to biliary stone recurrence, cholangitis or post-biliary endoscopic sphincterotomy (bEST) papillary stenosis and cholestasis. The aim of this retrospective study was to evaluate the clinical outcome and complication rate associated with re-cut, balloon dilation and biliary metal stenting in revision ERCP.  From January 2010 to January 2015, 139 subjects with stigma of a previous sphincterotomy required a revision ERCP (64 Men/75 Women; mean age 71 years; range 32 - 101 years).

Endoscopic Drainage of Intra-Abdominal Collection after Bariatric Surgery.

Introduction: Symptomatic intra-abdominal collection after bariatric surgery occurs in up to 5% of cases. Surgical, percutaneous, or endoscopic drainage are the feasible approaches.

Materials And Methods: In this video, we show the case report of a 50-year-old woman who underwent to gastric omega bypass on a previous sleeve gastrectomy.

Pneumatic dilation for functional helix stenosis after sleeve gastrectomy: long-term follow-up (with videos).

Background: A large number of patients who undergo laparoscopic sleeve gastrectomy present with surgical complications. Stenosis, in particular, occurs in .7%-4% of cases.

Double Pigtail Stent Insertion for Healing of Leaks Following Roux-en-Y Gastric Bypass. Our Experience (with Videos).

Background: Roux-en-Y gastric bypass (RYGB) is complicated by a leak in 0-4.3% of cases. Treatment by fully covered stents has been reported to be associated with some life-threatening complications.