The DJBL is safe when implanted for 1 year, and results in significant weight loss and improvements in cardiometabolic risk factors. These results suggest that this device may be suitable for the treatment of morbid obesity and its related comorbidities. This study was registered at www.clinicaltrials.gov (NCT00985491).

SEES is a feasible, safe, and effective management of post BS leaks, although patients may also require prosthesis revision and abdominal exploration. Primary SEES placement is associated with a shorter leak resolution time.

An autopsy study of gall-bladder cancer in Chile has been published (Nervi et al., 1988). We have reported, based on mortality data (Armijo, 1979), and on clinical data which are consistent, that the incidence of gall-bladder cancer in Chile underwent a constant and marked increase during the period 1970 -1985(Serra et al., 1986, 1987a.Other Chilean studies corroborate these findings (Amat and Amat, 1983). This contradicts the basic assumption (Nervi et al., 1988) that the incidence of this type of cancer was constant during the period [1970][1971][1972][1973][1974][1975][1976][1977][1978][1979]. The second assumption, namely that Chilean autopsies reflect the true incidence of the disease in the country, is also debatable, since autopsy cases are a selected and very small proportion (4.3%) of all subjects dying in the corresponding cities during 1970-1979 (14,768 autopsies over 340,176 deaths registered in Santiago, Concepcidn and Valdivia) (Chile, 1970(Chile, -1979 which is very different from the reported European situation (Zahor, et al., 1974). If sex and age were considered, more arguments could be raised on the representativeness of the Chilean autopsies.Both the above points make the international comparison carried out by Nervi et al. (1988) controversial, and their conclusions that "the population at risk of gall-bladder cancer is lower in our country (Chile) than in Sweden-Czechoslovakia" and that "the study does not support the hypothesis that the high frequency of gall-bladder cancer is primarily related to specific environmental or ethnic etiologic factors in Chile" appear to be based on insufficient evidence. Furthermore, it is not the absence of the gall-bladder, even within a representative sample, but mostly the prevalence of gallstones and other undetermined risk factors that may be acting on all individuals of the corresponding populations.On the contrary, the magnitude and characteristics of the increased incidence of gall-bladder cancer in Chile during the last 15 to 20 years strongly suggest an influence of classical environmental etiologic factors or other environmental factors, subject to human intervention (Hardy, 1983). One of these, which appears to be important in Chile, is the frequency of cholecystectomy. Such a hypothesis has been advocated by different groups (Brode'n and Bengtsson, 1980;Diehl and Beral, 1981). We have also found a negative correlation between biliary and gall-bladder cancer mortality. Actual trends in incidence of this type of cancer in Chile are clearly reflected by the national mortality rates for gall-bladder cancer which, in turn, are based on reliable medical certification and population data, published annually by the Ministry of Health and the National Institute of Statistics. The last 1970 and 1982 censuses have been corrected by 6.2% and 1.5% respectively for censal omission (Table I and Fig. I ) .The problem is thus not only to explain the high frequency of gall-bladder cancer in Chile, which is well established (Puffer and Griffth, 1967; Norambuen...

This epidemiological study in Chile shows a marked increase in biliary-tract cancer based on mortality data, from an age-adjusted rate (1970 world population) of 5.1 per 100,000 in 1970 to 12.0 per 100,000 in 1988. There is an increased risk of this cancer in all age groups but especially in young adults (15-44 years). The female ratio of 3:1 persists. The increase in biliary-tract cancer in 1970-1985 was particularly important for young women but occurred in all female age groups whereas in men it was mostly in the elderly (65 years and more) and less in the middle-aged (45-64 years); no changes were observed in young men. Regional differences have begun to be appreciated. One of the factors which may account for this impressive and unexpected increase is the remarkable decrease in cholecystectomy rates. Less than 20% of the 154% increase in biliary-tract cancer mortality in the period 1970-1985 could be attributed to population aging. Improvements in diagnostic methods did not appear to be an important contributing factor. Other factors that could affect this increase in the incidence to epidemic levels include: an increase in the prevalence of cholelithiasis, an increase in the number of typhoid carriers and possible environmental carcinogens.

No abstract