Introduction: The prevalence of obesity in children and adults has increased worldwide exponentially over the past two decades, becoming an important issue of global public health. Objective: To describe the growth and nutritional status of adolescents of  public schools. Method: Epidemiological, cross-sectional study, a representative sample of students aged 10 to 14 years of the public schools of the Metropolitan Region of Grande Vitória (MRGV), State of Espírito Santo, Brazil. Data on gender, age, skin colour/race, pubertal stage, socioeconomic class, weight and height were obtained. In the nutritional evaluation, the Height/Age (H/A) and Body Mass Index/Age (BMI/A) indexes, in z-score, of the WHO reference (2007) were considered. For statistical analysis, we used the Qui-square test and Student's t test (Mann-Whitney test for non-normal distribution), and significance level of p <0.05. Study approved by the Institutional Research Ethics Committee. Results: There were assessed 818 adolescents, with average age of 12.8 ± 1.1 years, female predominance (58.3%), mixed skin colour/race (41.7%), post-pubertal stage (53, 4%) and socioeconomic class C (59.5%). It was identified very low stature in 0.4% and low stature in 1.8% of adolescents. Overweight was diagnosed in 227 (27.7%) students, represented by overweight (18.7%), obesity (8.4%) and severe obesity (0.6%); While 0.2% presented severe thinness and 2.7% thinness.  The mean z-score of girls' height (p = 0.024) was higher than the WHO reference, as well as the BMI z-score of girls (p = 0.0001) and boys (p = 0.0002). Conclusion: Adolescents of public schools of MRGV achieve adequate growth, even higher, on average, proposed by WHO (2007). However, they also present a high prevalence of overweight, indicating that the region is at an advanced stage of nutritional transition.

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Organized pancreatic and peripancreatic collections are complications of pancreatitis and should be treated when symptomatic or complicated. When feasible, the endoscopic ultrasound approach presents high efficacy and low morbidity and mortality, making it the first likely option. Among the available accessories for endoscopic drainage, the lumen-apposing metal stent can be a better option, with a low migration rate; furthermore, it allows endoscopic necrosectomy. Here, we present the case of complex walled-off necrosis treated with two lumen-apposing metal stents in the same procedure.A 41-year-old male patient with walled-off necrosis presented with delayed gastric emptying and obstruction of the main biliary duct. Magnetic resonance imaging and endoscopic ultrasound revealed two non-communicating collections. We opted for endoscopic ultrasound-guided drainage with the deployment of two simultaneous lumen-apposing metal stents: one transduodenal and the other transgastric, with clinical improvement. After three weeks, endoscopic retrograde cholangiopancreatography showed a biliary fistula communicating with the periduodenal collection, which was treated with a biliary plastic stent. An endoscopic necrosectomy was performed, and the metal stents were removed. Control magnetic resonance imaging demonstrated improvement. The patient was asymptomatic at the six-month follow-up.The treatment of symptomatic complex walled-off necrosis remains a challenge and may require multiple endoscopic approaches; moreover, surgical treatment may be necessary in case of failure. In the present report, we demonstrate that the deployment of two lumen-apposing metal stents in the same procedure is feasible when necessary as it was associated with technical success and short-term clinical success.

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BACKGROUND AND AIMS: Self-expanding metal stents (SEMS) are an effective palliative endoscopic therapy to reduce dysphagia in esophageal cancer. Gastroesophageal reflux disease (GERD) is a relatively common complaint after non-valved conventional self-expanding metal stent placement. Therefore, valved self-expanding metal stents (SEMS-V) were designed to reduce the rate of GERD symptoms. We aim to perform a systematic review and meta-analysis comparing the two stents. MATERIAL AND METHODS: This is a systematic review and meta-analysis including only randomized clinical trials (RCT) comparing the outcomes between SEMS-V and non-valved self-expanding metal stents (SEMS-NV) following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were analyzed with the Review Manager Software. Quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation guidelines. RESULTS: Ten randomized clinical trials including a total of 467 patients, 234 in the SEMS-V group and 233 in the SEMS-NV group, were included. There were no statistically significant differences regarding GERD qualitative analysis (RD -0.17; 95% CI -0.67, 0.33; p = 0.5) and quantitative analysis (SMD -0.22; 95% CI -0.53, 0.08; p = 0.15) technical success (RD -0.03; 95% CI -0.07, 0.01; p = 0.16), dysphagia improvement (RD -0.07; 95% CI -0.19, 0.06; p = 0.30), and adverse events (RD 0.07; 95% CI -0.07, 0.20; p = 0.32). CONCLUSION: Both SEMS-V and SEMS-NV are safe and effective in the palliation of esophageal cancer with similar rates of GERD, dysphagia relief, technical success, adverse events, stent migration, stent obstruction, bleeding, and improvement of the quality of life.

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