Laparoscopic BPD is a safe technique; has good results without affecting the duration of the intervention; and ensures less postoperative pain with rapid functional recovery, less hospital stay, and drastic reduction of incisional hernia incidence.

Purpose Patients with mild obesity especially in absence of associated medical problems (OAMP) are commonly managed by non-surgical approaches. Laparoscopic sleeve gastrectomy (LSG) has proved itself to be effective and it is now the most performed weight loss procedure. We aimed to study the effectiveness and safety of LSG for weight loss in mild obesity. Methods A prospective cohort study. Group A; BMI (30–34.9 kg/m2), and group B; BMI ≥ 40 or BMI ≥ 35 with OAMP. Demographic data, perioperative complications, % excess weight loss (EWL), % total weight loss (TWL), nutritional profile, and evolution of OAMP were recorded and statistically analyzed. Results A total of 250 patients, with 80 patients (32%) in group A, and 170 (68%) in group B. The majority were female. The mean preoperative weight, BMI, and excess weight were 90.1 ± 9.52, 32.7 ± 1.4, and 21.5 ± 4.9 in group A, and 129.88 ± 26.12, 47.8 ± 8.2, and 62.3 ± 23.6 kg in group B respectively. The low BMI group had significantly lower OAMP, with higher pre-LSG non-surgical procedures rate. Overall post-operative morbidity rate was significantly higher in group B. %TWL was significantly lower in low BMI group. Nutritional profile was within the normal range in both groups at 3-year follow-up. Conclusion Laparoscopic sleeve gastrectomy is a safe and effective weight loss solution for mild obesity with better outcome than for higher BMI. Further studies are warranted to reconsider NIH’s statement for medicolegal aspects, and for matching the current changes in bariatric surgery practice, safety evidence, and patients’ demand. Graphical abstract

Background The technical competence of oesophagogastroduodenoscopy (OGD) is rapidly acquired but to support the practice of complete examination, the British Society of Gastroenterology (BSG) and Association of Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) strongly recommend photo-documentation of 8 standardized set stations in an OGD. Photo-documentation ensures complete examination, opportunity to inspect area of interest and serves as a legal record of adequate procedure. Methods Retrospective single center study involving review of randomly selected 100 OGD reports from 1/1/2018 till 31/3/2020 from the Endorad system. The reports on online Endorad system were reviewed for photo-documentation of 8 set stations and was also used to collect data on age, sex and the endoscopist. Microsoft Excel was used for data entry and analysis. Results Out of the 100 OGDs reviewed, 58% were males and 42% females. The mean age being 62.7 +/- 13.5. 60% of OGDs were done by surgeons, 25% by gastroenterologist and 15% by Advanced Nurse Practioner. No report had photo-documentation of all 8 stations. Most (40%) had photos of 5 stations, most common was photo evidence at retroflexion (95%) followed by photographic evidence of intubation to D2 (84%). Conclusions OGD is the gold standard test for the investigation of upper gastrointestinal symptoms, the importance lies in the early detection of cancers which maybe amenable to endoscopic treatment. For this reason its important to adhere to guidelines to improve quality in OGD

Background:The key to effective therapeutic endoscopic therapy is early dysplastic Barrett's oesophagus (BO) alteration detection. Oesophago-gastro-duodenoscopy (OGD) technical proficiency is quickly attained, but the diagnosis accuracy is still quite variable, especially in non-specialized endoscopic facilities. Objective: We aimed to evaluate the quality of endoscopic diagnosis and the adherence to guidelines of BO in our unit. Patients and Methods: A retrospective cohort analysis was done for 436 eligible endoscopic reports after independent review for confirmation of BO. Cohorts represent the complete audit cycle during the period from 01/01/2018 till 01/07/2022. Group A represented first audit data, and group B represented re-audit data. Results: A total eligible reports of 256 of BO in group A, and 180 reports in group B were reviewed. There was no significant difference between the groups regarding the age (62.7 ± 13.5 and 60.1 ± 15.1 years), male sex (68% and 70 %), and endoscopist specialty respectively. Surveillance was the most common indication (32.4% vs 35.5%), followed by Reflux (16.7% and 15%) in both groups respectively. Compliance with Prague, Paris, and Seattle protocol was significantly higher in group B (P value ≤0.05). Lack of awareness of the new guidelines, surgeon specialty, older age of the endoscopist, long segment of BO were the main factors of poor results in group A. Conclusions: In the absence of local standard protocol for endoscopic diagnosis of BO, the adherence to the guidelines was poor. Compliance with the guidelines after implementing new recommendations results in better outcomes. It is important to complete the audit cycle to ensure that the quality improvement was achieved.

Delayed gastric emptying after distal gastrectomy and reconstruction of alimentary tract with a gastroenteric anastomosis can significantly influence early and late postoperative course and the length of hospital stay. The purpose of this study was to compare the effect on postoperative functional recovery of two different Roux-en-Y reconstructions: at the gastric greater curvature and at the transected gastric staple line in the Scopinaro's biliopancreatic diversion. We conducted comparative study; 80 patients were enrolled and divided in two groups: group A (RY-GC) and group B (RY-SL) with 40 patients in each group. We compared the early postoperative functional recovery for both groups measuring four parameters: gastric stasis indicated with the volume of the gastric fluid collected per 24 h, day of removal of the nasogastric tube, day of starting the oral intake, and day of hospital discharge. There was statistically significant (p < 0.001) reduction in gastric fluid volume in favor of the RY-GC group starting from the first postoperative day resulting in earlier removal of nasogastric tube with earlier starting of oral feeding than RY-SL group, with no symptoms of stasis required nutrition suspension; while three patients in RY-SL group experienced persistence of nausea and vomiting and needed nutrition suspension for several days. There was statistically significant (p < 0.001) reduction in the hospital stay for RY-GC group. Roux-en-Y reconstruction at the greater curvature ensures a rapid functional recovery with early hospital discharge. The use of stapler devices made this method easier and safer and no complications have arisen with mechanical anastomoses.

Background About one third of gastro-oesophageal reflux disease (GORD) patients were found to have atypical or extra-oesophageal symptoms (EOS), which represent a diagnostic and therapeutic challenge. The efficacy of the current treatment strategy used to control these symptoms is still controversial. Anti-reflux surgery has been shown to significantly improve respiratory symptoms associated with GORD. Objective: The aim of the current study was to evaluate the outcomes of laparoscopic fundoplication to control GORDrelated EOS. Patient and methods: A prospective cohort study was conducted and included patients diagnosed with GORD with or without EOS or predominant EOS who were referred from Respiratory or ENT Departments. All participants underwent laparoscopic fundoplication surgery. Data about patients' demographics, body mass index (BMI), GORD/EOS presenting symptoms, 24 pH/manometry results, oesphagogastroduodenscopy findings, perioperative outcomes, quality of life using gastrointestinal quality of life Index (GIQOLI) questionnaire, patient's satisfaction using modified Visick score, and EOS severity using reflux symptom index (RSI) preoperatively, and 6 months postoperatively were collected and statistically analyzed. Results: A total number of 103 were included with mean age of 45.6 (SD 8.7) years, and 60% of the study's population was female. Mean BMI was 27.25 (SD 3.6). Heart burn was the main symptoms in all patients (71.9%), while chronic cough was the main EOS (27%). The mean operative time was 96 (SD 19.21) minutes, and mean hospital stay was 1.21 (SD 0.42) day. There was significant improvement in quality of life [65.7 (SD 11.6) and 118 (SD 12.8)] and reflux score [93.76 (SD 0.8) and 1.7 (SD 0.6)], RSI score for EOS [19.89 (SD 14.7) and 4.3 (SD5.3)] preoperatively and 6 month postoperatively respectively. Conclusion Laparoscopic fundoplication is a feasible option to control EOS associated with GORD with significant improvement of quality of life and reflux symptom index. Further larger studies are still warranted to evaluate the benefits on the long term.

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