Background: Ghrelin is a peptide mainly secreted by gastric mucosa and has been implicated in the regulation of eating behavior and weight balance. Obesity and Helicobacter pylori infection are associated with changes in plasma ghrelin levels. Objective: This study was designed to evaluate the density of ghrelin-producing cells in the gastric mucosa of morbidly obese and dyspeptic non-obese patients, with and without H. pylori infection. Methods: Gastric biopsies of the antral and oxyntic mucosa were obtained from 50 morbidly obese patients (BMI O40, 21 with metabolic syndrome (MS)), 17 dyspeptic overweight subjects (25!BMI!30), and 33 lean individuals (BMI!25) and processed for histology and immunohistochemistry. Results: Ghrelin-immunoreactive cell densities in the oxyntic mucosa were similar in morbidly obese patients with MS and in overweight and lean patients, whereas morbidly obese patients without MS presented higher ghrelin-immunoreactive cell density. The number of ghrelin cells in the oxyntic mucosa was significantly lower in obese and non-obese H. pylori-infected subjects. Ghrelin-immunoreactive cells, although sparse in the antral mucosa, were found more frequently in obese patients and their numbers did not seem to be affected by H. pylori infection. Conclusions: The higher expression of ghrelin-immunoreactive cells in the oxyntic mucosa of morbidly obese patients compared with non-obese subjects or with morbidly obese subjects with MS and the finding of a higher number of small foci of ghrelin cells in the antral mucosa of obese patients may indicate an adaptive mechanism or an individual factor to be considered in the pathogenesis of obesity.

Background and study aims In March 2020, the World Health Organization declared coronavirus disease of 2019 (COVID-19) as a pandemic, mobilizing all countries to contain the disease spread. Activity in endoscopy centers globally was severely affected. We conducted a national survey aiming to assess the impact of the COVID-19 outbreak on endoscopic clinical practice in Brazil. Methods In April 2020, 3,719 associate members of SOBED (Brazilian Society of Digestive Endoscopy) were invited to respond to an electronic survey. An Internet link was established to provide access to the online questionnaire with 40 questions regarding personal profile, endoscopy unit logistics and schedule, availability and use of personal protective equipment (PPE), financial impact, and exposure to COVID-19. Results A total of 2,131 individuals (67 %) accessed the questionnaire and 1155 responses were received. After review, 980 responses were considered valid. According to almost 90 % of respondents, endoscopy activity was restricted to urgent procedures, in both public and private hospitals. All respondents increased PPE use after the outbreak, however, institutions provided adequate PPE to only 278 responders (28.7 %). Significant income loss was universally reported. A total of 10 practitioners (1 %) reported COVID-19 infection and attributed the contamination to endoscopic procedures. Conclusions Based on this nationwide survey with almost 1,000 respondents, the COVID-19 pandemic substantially reduced the activity of endoscopy units in private and public settings. The pandemic increased awareness of PPE use, but its availability was not universal and 1 % of the respondents became infected with COVID-19, allegedly due to exposure during endoscopic procedures.

BACKGROUND: Endoscopic submucosal dissection (ESD) enables en bloc excision of superficial neoplasms. Although ESD is widely practiced in Eastern countries like Japan, South Korea and China, its use in the West is supposed to be still limited to few tertiary centers. OBJECTIVE: This study aimed to investigate the clinical practice of ESD in Brazil by means of an electronic questionnaire elaborated by the Brazilian Society of Digestive Endoscopy (SOBED). METHODS: In October 2019, 3512 endoscopist members of SOBED were invited to respond to an electronic survey containing 40 questions divided into four topics: operator profile; clinical experience with ESD; adverse events and training. Informed consent was requested to all participants. The investigators reviewed all responses and considered valid if more than 50% of the questions were answered and additional information, when requested, was provided. RESULTS: A total of 155 (4.4%) qualified responses entered the study. ESD has been practiced in 22 of 26 Federation States and majority of respondents (32.2%) have 10 to 20 years of practice. ESD has been performed more frequently in private hospitals (101 individuals, 66.9%) and private ambulatory centers (41 individuals, 27.1%). ESD was performed mainly in the stomach (72%), followed by the rectum (57%) and 80% of the individuals reported less than 25 operations. Twenty-four (15.4 %) individuals reported perforation and 4 (2.5%) of them reported postoperative deaths. Approximately a quarter of responders denied hands-on training in models or visit to training centers. CONCLUSION: ESD appears to be practiced throughout the country, not only in tertiary or academic institutions and mainly in private practice. Most operators received limited training and still are at the beginning of their learning curve. The reported adverse events and mortality rates appear to be higher than Eastern reports.

No abstract

No abstract

Instituição: HOSPITAL DAS CLÍNICAS DA UFMG INTRODUÇÃO: Colonoscopia é o exame endoscópico utilizado para rastreamento, vigilância e ressecção de lesões pré-malignas, através da polipectomia, permitindo redução da incidência do câncer colorretal. Pela complexidade do procedimento, vários fatores individuais, descritos como indicadores de qualidade, podem alterar a eficácia do exame em localizar e tratar essas lesões precoces. Destacam-se o índice de detecção de adenoma e tempo de retirada do aparelho. A avaliação destes marcadores é fundamental também para mensuração da qualidade do ensino em colonoscopia. OBJETIVO: Avaliar os marcadores de qualidade em colonoscopia realizadas por médicos residentes de um hospital universitário. MÉTODO: Foram coletados dados de pacientes e colonoscopias, realizadas entre maio a julho de 2017, por 5 médicos residentes em endoscopia digestiva de um hospital universitário. RESULTADOS: Um total de 51 colonoscopias foram realizadas pelos médicos residentes, sob supervisão de preceptores endoscopistas. A média de idade foi de 55,02 anos, com 53% sendo do sexo feminino. O tempo médio de retirada do colonoscópio foi de 15 minutos e todos exames avaliados obtiveram intubação do ceco, com um total de 87,5% alcançando íleo terminal. Em nove exames (17%), foi necessária a participação do preceptor no manejo do aparelho endoscópico. Nos 42 pacientes submetidos a colonoscopia para rastreamento e vigilância, em 18 indivíduos, foram removidos 24 pólipos. A avaliação histopatológica indicou 40% de detecção de adenomas nos homens e 27% nas mulheres. Em um paciente, foi ressecado um pólipo malignizado (Haggit 3). Não houve complicações maiores nos pacientes estudados. CONCLUSÃO: A colonoscopia, como método diagnóstico e terapêutico, é essencial na prevenção secundária do câncer colorretal, mas parâmetros mínimos devem ser empregados para comprovação de eficácia em todo serviço de saúde, incluindo hospitais universitários. O ensino em colonoscopia demanda uma prática assistida e sua avaliação contínua, através de indicadores de qualidade devidamente consolidados, possibilita a melhoria na formação médica em endoscopia e, consequentemente, no cuidado da população em geral. ABCDExpress 2017;1(2):537Codigo: 64177 Acesso está disponível em www.revistaabcd.com.br e www.sbad2017.com.br Acesso pelo