ABSTRACT BACKGROUND: The effect of weight loss (WL) on histopathological aspects of non-alcoholic fatty liver disease (NAFLD) may provide further insights into the dynamics of hepatic recovery after WL. OBJECTIVE: To analyze the effects of pre-operative WL on insulin resistance- and NAFLD-related histology in individuals undergoing bariatric surgery (BS) with or without pre-operative WL. DESIGN AND SETTING: A matched cross-sectional study was conducted at a public university hospital and a private clinic in Campinas, Brazil. METHODS: An analytical, observational, cross-sectional study was conducted using prospectively collected databases of individuals who underwent BS and liver biopsy at either a public tertiary university hospital (with pre-operative WL) or a private clinic (without pre-operative WL). Random electronic matching by gender, age, and body mass index (BMI) was performed and two paired groups of 24 individuals each were selected. RESULTS: Of the 48 participants, 75% were female. The mean age was 37.4 ± 9.6. The mean BMI was 38.9 ± 2.6 kg/m2. Fibrosis was the most common histopathological abnormality (91.7%). Glucose was significantly lower in the WL group (92 ± 19.1 versus 111.8 ± 35.4 mg/dL; P = 0.02). Significantly lower frequencies of macrovesicular steatosis (58.3% versus 95.8%; P = 0.004), microvesicular steatosis (12.5% versus 87.5%; P < 0.001), and portal inflammation (50% versus 87.5%; P = 0.011) were observed in the WL group. CONCLUSION: Pre-operative WL was significantly associated with lower frequencies of macro- and mi- crovesicular steatosis, portal inflammation, and lower glycemia, indicating an association between the recent trajectory of body weight and histological aspects of NAFLD. BACKGROUND (WL nonalcoholic non alcoholic NAFLD (NAFLD OBJECTIVE preoperative pre operative resistance NAFLDrelated related (BS SETTING crosssectional cross sectional Campinas Brazil METHODS analytical observational . gender (BMI 2 selected RESULTS 4 participants 75 female 374 37 37. 96 9 6 9.6 389 38 38. 26 2. kgm2 kgm kg m2 m kg/m2 91.7%. 917 91.7% 91 7 (91.7%) 92 (9 191 19 1 19. 1118 111 8 111. 354 35 35. mg/dL mgdL mg dL 0.02. 002 0.02 0 02 0.02) 58.3% 583 58 3 (58.3 95.8% 958 95 0.004, 0004 0.004 , 004 0.004) 12.5% 125 12 5 (12.5 87.5% 875 87 0.001, 0001 0.001 001 0.001) 50% 50 (50 0.011 0011 011 CONCLUSION Preoperative Pre macro mi glycemia 9. kg/m 91.7 (91.7% ( 11 00 0.0 58.3 (58. 95.8 000 0.00 12.5 (12. 87.5 (5 0.01 01 91. (91.7 0. 58. (58 95. 12. (12 87. (91. (1 (91

ABSTRACT Background: Recently, significant associations between non-alcoholic fatty liver disease (NAFLD) and extra-hepatic cancer have been reported. Objective: To carry out a comprehensive review of the current evidence in the literature on the association between NAFLD and extra-hepatic cancer. Methods: A narrative literature review was performed through an online search for the MeSH terms “fatty liver” and “cancer” in MEDLINE (via PubMed) and LILACS (via BVS). Original studies that described the impact of NAFLD on different types of extra-hepatic malignancies were included. Results: After careful analysis, nine prospective cohort studies, one retrospective cohort study, three case-control studies, and three cross-sectional studies were selected. Conclusion: There is consistent evidence on the association between NAFLD and extra-hepatic carcinogenesis, especially in relation to colorectal, gastric, pancreatic, breast, prostate, and bladder cancers. Background Recently nonalcoholic non alcoholic (NAFLD extrahepatic extra hepatic reported Objective Methods “cancer via PubMed BVS. BVS . BVS) included Results analysis study casecontrol case control crosssectional cross sectional selected Conclusion carcinogenesis colorectal gastric pancreatic breast prostate cancers

RESUMO Contexto: Recentemente, associações significativas entre a doença hepática gordurosna não-alcoólica (DHGNA) e neoplasias extra-hepáticas têm sido descritas. Objetivo: Realizar uma revisão abrangente acerca das evidências atuais na literatura sobre a associação entre DHGNA e neoplasias extra-hepáticas. Métodos: Uma revisão narrativa de literatura foi realizada através da busca on-line pelos descritores “fígado gorduroso” e “câncer” em MEDLINE (através do PubMed) e LILACS (através da BVS). Estudos originais que descreveram o impacto da DHGNA em diferentes tipos de neoplasias malignas extra-hepáticas foram incluídos. Resultados: Após análise criteriosa, nove estudos prospectivos de coorte, um coorte histórica, três estudos de caso-controle, e três estudos transversais foram selecionados. Conclusão: Existem evidências consistentes a respeito da associação entre DHGNA e a carcinogênese extra-hepática, especialmente em relação aos cânceres de cólon e reto, estômago, pâncreas, mama, próstata e bexiga. Contexto Recentemente nãoalcoólica não alcoólica (DHGNA extrahepáticas extra hepáticas descritas Objetivo extrahepáticas. hepáticas. Métodos online on line fígado gorduroso câncer “câncer PubMed BVS. BVS . BVS) incluídos Resultados criteriosa histórica casocontrole, casocontrole caso controle, controle caso-controle selecionados Conclusão extrahepática, extrahepática hepática, extra-hepática reto estômago pâncreas mama bexiga

ABSTRACT Background: Non-invasive markers have been developed to assess the presence and severity of liver abnormalities related to non-alcoholic fatty liver disease (NAFLD). Objective: To analyze the diagnostic accuracy of non-invasive NAFLD markers (NAFLD liver fat score [NLFS], non-invasive non-alcoholic steatohepatitis detection score [NI-NASH-DS] and fibrosis score based on four variables [FIB-4]) in individuals with obesity undergoing bariatric surgery. Methods: A descriptive retrospective cross-sectional study was carried out enrolling 91 individuals who underwent bariatric surgery at a tertiary-level public university hospital. Non-invasive NAFLD markers were calculated using laboratory tests, clinical and anthropometric variables and diagnostic accuracy tests were calculated comparing them in relation to the gold-standard test for this analysis (histopathological evaluation). Results: A total of 85.7% of the participants were female and mean age was 39.1±9.8 years. The average body mass index was 38.4±3.6 kg/m2. At histopathological examination, 84 (92.3%) patients presented with steatosis, 82 (90.1%) with some type of fibrosis; 21 (23.1%) patients were diagnosed with NASH according to the NAFLD activity score criteria. The overall accuracy of NLFS score was 58.2% for general hepatic steatosis and 61.5% for moderate to severe steatosis. The overall accuracy of FIB-4 was 95.4% for advanced fibrosis. NI-NASH-DS had a 74.7% overall accuracy for NASH. Conclusion: In a population of individuals with obesity, the FIB-4 score had high overall accuracy in assessing the presence of advanced liver fibrosis, whereas the NFLS and NI-NASH-DS had moderate accuracies for the assessment of steatosis and NASH, respectively. Background Noninvasive Non invasive nonalcoholic non alcoholic NAFLD. . (NAFLD) Objective noninvasive NLFS, , [NLFS] NINASHDS NI DS [NI-NASH-DS FIB4 FIB 4 [FIB-4] Methods crosssectional cross sectional 9 tertiarylevel tertiary level hospital goldstandard gold standard evaluation. evaluation evaluation) Results 857 85 7 85.7 39198 39 1 8 39.1±9. years 38436 38 3 6 38.4±3. kgm2 kgm kg m2 m kg/m2 examination 92.3% 923 92 (92.3% 90.1% 901 90 (90.1% 2 23.1% 231 23 (23.1% criteria 582 58 58.2 615 61 5 61.5 FIB- 954 95 95.4 747 74 74.7 Conclusion respectively [NLFS [FIB-4 85. 3919 39.1±9 3843 38.4±3 kg/m 92.3 (92.3 90.1 (90.1 23.1 (23.1 58. 61. 95. 74. [FIB- 391 39.1± 384 38.4± 92. (92. 90. (90. 23. (23. [FIB 39.1 38.4 (92 (90 (23 39. 38. (9 (2 (

RESUMO Contexto: Marcadores não-invasivos foram desenvolvidos para avaliar a presença e a gravidade de anormalidades hepáticas relacionadas à doença hepática gordurosa não-alcoólica (DHGNA). Objetivo: Analisar a acurácia diagnóstica de marcadores não-invasivos de DHGNA (escore de gordura hepática da DHGNA [NLFS], escore não-invasivo de detecção de esteato-hepatite não-alcoólica [NI-NASH-DS] e escore de fibrose de 4 variáveis [FIB-4]) em indivíduos obesos submetidos à cirurgia bariátrica. Métodos: Foi realizado um estudo descritivo retrospectivo transversal com 91 indivíduos submetidos à cirurgia bariátrica em um hospital universitário público de nível terciário. Marcadores não-invasivos de DHGNA foram calculados por meio de exames laboratoriais, variáveis clínicas e antropométricas; testes de acurácia diagnóstica foram calculados comparando-os em relação ao exame padrão-ouro para essa análise (avaliação histopatológica). Resultados: Um total de 85,7% dos participantes eram do sexo feminino e a média de idade foi de 39,1±9,8 anos. O índice de massa corporal médio foi de 38,4±3,6 kg/m2. Ao exame histopatológico, 84 (92,3%) pacientes apresentavam esteatose, 82 (90,1%) com algum grau de fibrose; 21 (23,1%) pacientes foram diagnosticados com esteato-hepatite não-alcoólica (EHNA) de acordo com os critérios do escore de atividade da DHGNA. A acurácia global do escore NLFS foi de 58,2% para esteatose hepática e 61,5% para esteatose moderada a grave. A acurácia global do FIB-4 foi de 95,4% para fibrose avançada. NI-NASH-DS apresentou uma acurácia global de 74,7% para EHNA. Conclusão: Em uma população de indivíduos com obesidade, o escore FIB-4 teve alta acurácia global para avaliar a presença de fibrose hepática avançada, enquanto o NFLS e o NI-NASH-DS tiveram acurácias moderadas para avaliar a esteatose e EHNA, respectivamente. Contexto nãoinvasivos não invasivos nãoalcoólica alcoólica . (DHGNA) Objetivo NLFS, , [NLFS] nãoinvasivo invasivo esteatohepatite esteato hepatite NINASHDS NI NASH DS [NI-NASH-DS FIB4 FIB [FIB-4] Métodos 9 terciário laboratoriais antropométricas comparandoos comparando padrãoouro padrão ouro avaliação histopatológica. histopatológica histopatológica) Resultados 857 85 7 85,7 39198 39 1 8 39,1±9, anos 38436 38 3 6 38,4±3, kgm2 kgm kg m2 m kg/m2 histopatológico 92,3% 923 92 (92,3% 90,1% 901 90 (90,1% 2 23,1% 231 23 (23,1% EHNA (EHNA 582 58 58,2 615 61 5 61,5 grave FIB- 954 95 95,4 avançada 747 74 74,7 Conclusão obesidade respectivamente (DHGNA [NLFS [FIB-4 85, 3919 39,1±9 3843 38,4±3 kg/m 92,3 (92,3 90,1 (90,1 23,1 (23,1 58, 61, 95, 74, [FIB- 391 39,1± 384 38,4± 92, (92, 90, (90, 23, (23, [FIB 39,1 38,4 (92 (90 (23 39, 38, (9 (2 (

ABSTRACT BACKGROUND: Evidence on the effect of one-anastomosis gastric bypass (OAGB) on renal function is limited. OBJECTIVE: To compare the evolution of estimated renal function observed 1 year after OAGB and Roux-en-Y gastric bypass (RYGB) in individuals with obesity. DESIGN AND SETTING: Observational, analytical, and retrospective cohort study. Tertiary-level university hospital. METHODS: This study used a prospectively collected database of individuals who consecutively underwent bariatric surgery. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR), according to the Chronic Kidney Disease Epidemiology Collaboration. The one-year variation in the eGFR was compared between the procedures. RESULTS: No significant differences in age, sex, obesity-associated conditions, or body mass index were observed among individuals who underwent either OAGB or RYGB. OAGB led to a significantly higher percentage of total (P = 0.007) and excess weight loss (P = 0.026). Both OAGB and RYGB led to significantly higher values of eGFR (103.9 ± 22 versus 116.1 ± 13.3; P = 0.007, and 102.4 ± 19 versus 113.2 ± 13.3; P < 0.001, respectively). The one-year variation in eGFR was 11 ± 16.2% after OAGB and 16.7 ± 26.3% after RYGB (P = 0.3). Younger age and lower baseline eGFR were independently associated with greater postoperative improvement in renal function (P < 0.001). CONCLUSION: Compared with RYGB, OAGB led to an equivalent improvement in renal function 1 year after the procedure, along with greater weight loss. BACKGROUND oneanastomosis one anastomosis (OAGB limited OBJECTIVE RouxenY Roux en Y (RYGB obesity SETTING Observational analytical Tertiarylevel Tertiary level hospital METHODS surgery eGFR, , (eGFR) Collaboration oneyear procedures RESULTS sex obesityassociated conditions 0.007 0007 0 007 0.026. 0026 0.026 . 026 0.026) 103.9 1039 103 9 (103. 2 1161 116 116. 13.3 133 13 3 1024 102 4 102. 1132 113 113. 0001 001 0.001 respectively. respectively respectively) 162 16 16.2 167 7 16. 263 26 26.3 0.3. 03 0.3 0.3) 0.001. 0.001) CONCLUSION procedure (eGFR 0.00 000 00 002 0.02 02 103. 10 (103 13. 26. 0. 0.0 (10 (1 (

ABSTRACT Background: Studies assessing quality of life (QoL) after one anastomosis gastric bypass (OAGB) are currently scarce. Objective: To analyze the main weight loss outcomes and QoL in individuals undergoing OAGB during a 2-year follow-up. Methods: This is a retrospective study based on a prospectively collected database including individuals which underwent OAGB at a tertiary-level university hospital. After 2-years, excess weight loss was assessed, and post-surgical therapeutical success was determined using Reinhold’s criteria. QoL was assessed through the Bariatric Analysis and Reporting Outcomes System (BAROS). Results: Out of 41 participants, 90.2% were female and the average age was 38±8.3 years old. The average body mass index significantly decreased from 37.1±5.6 kg/m2 to 27±4.5 kg/m2 after 2-years (P< 0.001). The mean percentage of excess weight loss was 84.6±32.5%. Regarding weight loss outcomes, 61% were considered “excellent”, while 26.8% were “good” according to Reinhold’s criteria. With regards to QoL assessed by BAROS, most individuals achieved a score classified as either “excellent” (26.8%), “very good” (36.6%), or “good” (31.7%). The highest degrees of satisfaction achieved were in the domains “self-esteem” and “work capacity”, in which 75.6% and 61%, respectively, were classified as “much better”. Conclusion: OAGB associated with significant weight loss and resolution of obesity-related medical conditions, as well as relevant QoL improvement assessed by the BAROS system. Background (QoL (OAGB scarce Objective 2year year 2 followup. followup follow up. up follow-up Methods tertiarylevel tertiary level hospital 2years, 2years years, postsurgical post surgical Reinholds Reinhold s criteria BAROS. . (BAROS) Results 4 participants 902 90 90.2 3883 38 8 3 38±8. old 37156 37 1 5 6 37.1±5. kgm2 kgm kg m2 m kg/m 2745 27 27±4. P< P (P 0.001. 0001 0.001 0 001 0.001) 846325 84 32 84.6±32.5% 61 excellent, excellent , 268 26 26.8 good “good “excellent 26.8%, (26.8%) very 36.6%, 366 36.6% 36 (36.6%) 31.7%. 317 31.7% 31 7 (31.7%) selfesteem self esteem “self-esteem work capacity, capacity capacity” 756 75 75.6 respectively much better. better better” Conclusion obesityrelated obesity related conditions system (BAROS 9 90. 388 38±8 3715 37.1±5 274 27±4 000 0.00 00 84632 84.6±32.5 26. (26.8% 36.6 (36.6% 31.7 (31.7% 75. 38± 371 37.1± 27± 0.0 8463 84.6±32. (26.8 36. (36.6 31. (31.7 37.1 0. 846 84.6±32 (26. (36. (31. 37. 84.6±3 (26 (36 (31 84.6± (2 (3 84.6 ( 84.

RESUMO Contexto: Existem poucos estudos que analisaram a qualidade de vida (QV) após o bypass gástrico de anastomose única (BGAU). Objetivo: Analisar os principais resultados de perda de peso e QV em indivíduos submetidos ao BGAU ao longo de 2 anos de seguimento. Métodos: Este é um estudo retrospectivo baseado em um banco de dados coletado prospectivamente que incluiu indivíduos submetidos ao BGAU em um hospital universitário de nível terciário. Após 2 anos, foi analisado o percentual de perda do excesso de peso (%PEP) e o sucesso terapêutico pós-cirúrgico foi classificado através critérios de Reinhold. A qualidade de vida foi avaliada por meio do Bariatric Analysis and Reporting Outcomes System (BAROS). Resultados: Dos 41 participantes, 90,2% eram do sexo feminino e a idade média foi de 38±8,3 anos. O índice de massa corporal médio diminuiu significativamente de 37,1±5,6 kg/m2 para 27±4,5 kg/m2 após 2 anos (P<0,001). O %PEP médio foi de 84,6±32,5%. Quanto à avaliação dos resultados de perda de peso, 61% foram considerados “excelentes”, enquanto 26,8% foram “bons” segundo os critérios de Reinhold. Com relação à QV avaliada pelo BAROS, a maioria dos indivíduos obteve escores classificados como “excelente” (26,8%), “muito bom” (36,6%) ou “bom” (31,7%). Os maiores graus de satisfação alcançados foram nos domínios “autoestima” e “capacidade para o trabalho”, nos quais 75,6% e 61%, respectivamente, foram classificados como “muito melhor”. Conclusão: O BGAU associou-se à significativa perda de peso e resolução de comorbidades, bem como melhora relevante da qualidade de vida avaliada pelo sistema BAROS. Contexto (QV BGAU. . (BGAU) Objetivo seguimento Métodos terciário PEP (%PEP póscirúrgico pós cirúrgico Reinhold BAROS (BAROS) Resultados 4 participantes 902 90 90,2 3883 38 8 3 38±8, 37156 37 1 5 6 37,1±5, kgm2 kgm kg m2 m kg/m 2745 27 27±4, P<0,001. P0001 P P<0,001 0 001 (P<0,001) 846325 84 32 84,6±32,5% 61 excelentes, excelentes , “excelentes” 268 26 26,8 bons “bons excelente “excelente 26,8%, (26,8%) muito bom 36,6% 366 36 (36,6% “bom 31,7%. 317 31,7% 31 7 (31,7%) autoestima “autoestima capacidade trabalho, trabalho trabalho” 756 75 75,6 respectivamente melhor. melhor melhor” Conclusão associouse associou se comorbidades (BGAU (BAROS 9 90, 388 38±8 3715 37,1±5 274 27±4 P000 P<0,00 00 (P<0,001 84632 84,6±32,5 “excelentes 26, (26,8% 36,6 (36,6 31,7 (31,7% 75, 38± 371 37,1± 27± P00 P<0,0 (P<0,00 8463 84,6±32, (26,8 36, (36, 31, (31,7 37,1 P0 P<0, (P<0,0 846 84,6±32 (26, (36 (31, 37, P<0 (P<0, 84,6±3 (26 (3 (31 P< (P<0 84,6± (2 ( (P< 84,6 (P 84,

ABSTRACT Background: Currently, there is conflicting evidence linking Helicobacter pylori (HP) infection with weight loss and endoscopic findings after Roux-en-Y gastric bypass (RYGB). Objective: To identify correlations between HP infection and its eradication with weight loss and endoscopic findings after RYGB. Methods: This is an observational retrospective cohort study based on a prospectively collected database of individuals who underwent RYGB from 2018-2019 at a tertiary university hospital. HP infection and the HP eradication therapy outcomes were correlated with post-operative weight loss and endoscopic findings. Individuals were classified according to the status of HP infection into four groups: no infection; successful eradication; refractory infection; and new-onset infection. Results: Of 65 individuals, 87% were female and the mean age was 39±11.2 years. Body mass index significantly decreased from 36.2±3.6 to 26.7±3.3 kg/m2 one year after RYGB (P<0.0001). The percentage of total weight loss (%TWL) was 25.9±7.2% and the percentage of excess weight loss was 89.4±31.7%. HP infection prevalence decreased from 55.4% to 27.7% (p=0.001); 33.8% never had HP infection, 38.5% were successfully treated, 16.9% had refractory infection and 10.8 % had new-onset HP infection. %TWL was 27.3±7.5% in individuals who never had HP, 25.4±8.1% in the successfully treated, 25.7±5.2% in those with refractory infection, and 23.4±6.4% in the new-onset HP infection group; there were no significant differences among the four groups (P=0.6). Pre-operative HP infection significantly associated with gastritis (P=0.048). New-onset HP infections significantly associated with a lower frequency of jejunal erosions after surgery (P=0.048). Conclusion: No effects of the HP infection on weight loss were identified in individuals undergoing RYGB. A higher prevalence of gastritis was observed in individuals with HP infection before RYGB. New-onset HP infection after RYGB was a protective factor for jejunal erosions. Background Currently (HP RouxenY Roux en Y . (RYGB) Objective Methods 20182019 2018 2019 2018-201 hospital postoperative post operative newonset new onset Results 6 87 39112 39 11 2 39±11. years 36236 36 3 36.2±3. 26733 26 7 26.7±3. kgm2 kgm kg m2 m kg/m P<0.0001. P00001 P P<0.0001 0 0001 (P<0.0001) TWL (%TWL 25972 25 9 25.9±7.2 894317 89 4 31 89.4±31.7% 554 55 55.4 277 27 27.7 p=0.001 p0001 p 001 (p=0.001) 338 33 8 33.8 385 38 5 38.5 treated 169 16 16.9 108 10 10. 27375 27.3±7.5 25481 1 25.4±8.1 25752 25.7±5.2 23464 23 23.4±6.4 group P=0.6. P06 P=0.6 (P=0.6) Preoperative Pre P=0.048. P0048 P=0.048 048 (P=0.048) Newonset New Conclusion (RYGB 2018201 201 2018-20 3911 39±11 3623 36.2±3 2673 26.7±3 P0000 P<0.000 000 (P<0.0001 2597 25.9±7. 89431 89.4±31.7 55. 27. p=0.00 p000 00 (p=0.001 33. 38. 16. 2737 27.3±7. 2548 25.4±8. 2575 25.7±5. 2346 23.4±6. P0 P=0. (P=0.6 P004 P=0.04 04 (P=0.048 201820 20 2018-2 391 39±1 362 36.2± 267 26.7± P000 P<0.00 (P<0.000 259 25.9±7 8943 89.4±31. p=0.0 p00 (p=0.00 273 27.3±7 254 25.4±8 257 25.7±5 234 23.4±6 P=0 (P=0. P00 P=0.0 (P=0.04 20182 2018- 39± 36.2 26.7 P<0.0 (P<0.00 25.9± 894 89.4±31 p=0. p0 (p=0.0 27.3± 25.4± 25.7± 23.4± P= (P=0 (P=0.0 36. 26. P<0. (P<0.0 25.9 89.4±3 p=0 (p=0. 27.3 25.4 25.7 23.4 (P= P<0 (P<0. 25. 89.4± p= (p=0 23. (P P< (P<0 89.4 (p= (P< 89. (p

RESUMO Contexto: Há evidências conflitantes na literatura atual ligando a infecção por Helicobacter pylori (HP) com a perda de peso e achados endoscópicos após o bypass gástrico em Y de Roux (BGYR). Objetivo: Identificar correlações entre infecção por Helicobacter pylori HP e seu tratamento de erradicação com perda de peso e achados endoscópicos após BGYR. Métodos: Trata-se de um estudo retrospectivo e observacional de coorte histórica, baseado em um banco de dados coletados prospectivamente de indivíduos submetidos ao BGYR de 2018 a 2019 em um hospital terciário universitário. A infecção pelo HP e os resultados da terapia de erradicação do HP foram correlacionados com a perda de peso pós-operatória e os achados endoscópicos. Os indivíduos foram classificados de acordo com o status de infecção pelo HP em quatro grupos: ausência de infecção; erradicação bem-sucedida; infecção refratária; e infecção nova. Resultados: Dos 65 indivíduos, 87% eram do sexo feminino e a média de idade foi de 39±11,2 anos. O índice de massa corporal diminuiu significativamente de 36,2±3,6 para 26,7±3,3 kg/m2 um ano após BGYR (P<0,0001). O percentual de perda de peso foi 25,9±7,2% e o percentual de perda do excesso de peso foi 89,4±31,7%. A prevalência de infecção por HP diminuiu de 55,4% para 27,7% após a cirurgia (P=0,001); 33,8% nunca tiveram infecção por HP, 38,5% tiveram um tratamento bem-sucedido, 16,9% tiveram infecção refratária e 10,8% tiveram nova infecção por HP. Infecção pré-operatória por HP associou-se significativamente à presença de gastrite (P=0,048). Infecções por HP de início recente associaram-se significativamente com menor frequência de erosões jejunais após a cirurgia (P=0,048). Conclusão: Não foram identificados efeitos da infecção por HP na perda de peso em indivíduos submetidos ao BGYR. Maior prevalência de gastrite foi observada em indivíduos com infecção por HP antes da cirurgia. A infecção por HP de início recente após BGYR foi um fator protetor para erosões jejunais. Contexto (HP . (BGYR) Objetivo Métodos Tratase Trata se histórica 201 universitário pósoperatória pós operatória grupos bemsucedida bem sucedida bem-sucedida Resultados 6 87 39112 39 11 2 39±11, anos 36236 36 3 36,2±3, 26733 26 7 26,7±3, kgm2 kgm kg m2 m kg/m P<0,0001. P00001 P P<0,0001 0 0001 (P<0,0001) 25972 25 9 25,9±7,2 894317 89 4 31 89,4±31,7% 554 55 55,4 277 27 27,7 P=0,001 P0001 001 (P=0,001) 338 33 8 33,8 385 38 5 38,5 bemsucedido, bemsucedido sucedido, sucedido bem-sucedido 169 16 16,9 108 10 10,8 préoperatória pré associouse associou P=0,048. P0048 P=0,048 048 (P=0,048) associaramse associaram Conclusão (BGYR 20 3911 1 39±11 3623 36,2±3 2673 26,7±3 P0000 P<0,000 000 (P<0,0001 2597 25,9±7, 89431 89,4±31,7 55, 27, P=0,00 P000 00 (P=0,001 33, 38, 16, 10, P004 P=0,04 04 (P=0,048 391 39±1 362 36,2± 267 26,7± P<0,00 (P<0,000 259 25,9±7 8943 89,4±31, P=0,0 P00 (P=0,00 (P=0,04 39± 36,2 26,7 P<0,0 (P<0,00 25,9± 894 89,4±31 P=0, P0 (P=0,0 36, 26, P<0, (P<0,0 25,9 89,4±3 P=0 (P=0, P<0 (P<0, 25, 89,4± P= (P=0 P< (P<0 89,4 (P= (P< 89, (P

ABSTRACT BACKGROUND: A possible direct link between nonalcoholic fatty liver disease (NAFLD) and Helicobacter pylori (H. pylori) infection has recently emerged. OBJECTIVE: This study aimed to analyze associations between the presence of histologically demonstrated NAFLD aspects with H. pylori infection in individuals with obesity undergoing bariatric surgery. DESIGN AND SETTING: An observational analytical cross-sectional study was conducted based on data collected from the medical records of individuals undergoing bariatric surgery at a tertiary university hospital in 2019. METHODS: NAFLD was assessed through histological examination of wedge liver biopsies collected during the proceedings. H. pylori infection was analyzed through the association of the urease test and histological examination performed in biopsies routinely collected during preoperative esophagogastroduodenoscopy. RESULTS: Of the 88 participants, 85% were female, and the average age was 39.1 ± 8.4 years. H. pylori infection was present in 61.4% of the patients. The mean body mass index was 36.6 ± 3.4 kg/m2. The most prevalent histopathological aspects of NAFLD were macrovesicular steatosis (92%), hepatocellular ballooning (92%), lobular inflammation (93.2%), portal inflammation (96.6%), and fibrosis (93.2%). No histopathological aspect of NAFLD was found to be significantly associated with H. pylori infection. CONCLUSION: In this study population, H. pylori infection was not significantly associated with the histopathological aspects of NAFLD in individuals with obesity undergoing bariatric surgery. BACKGROUND (NAFLD H (H emerged OBJECTIVE SETTING crosssectional cross sectional 2019 METHODS proceedings esophagogastroduodenoscopy RESULTS 8 participants 85 female 391 39 1 39. 84 4 8. years 614 61 61.4 patients 366 36 6 36. 34 3 3. kgm2 kgm kg m2 m kg/m2 92%, 92 92% , (92%) 93.2%, 932 93.2% 93 2 (93.2%) 96.6%, 966 96.6% 96 (96.6%) 93.2%. . CONCLUSION population 201 61. kg/m 9 (92% 93.2 (93.2% 96.6 (96.6% 20 (92 93. (93.2 96. (96.6 (9 (93. (96. ( (93 (96

ABSTRACT BACKGROUND: The association of gastric plication with fundoplication is a reliable option for the treatment of individuals with obesity associated with gastroesophageal reflux disease. AIMS: To describe weight loss, endoscopic, and gastroesophageal reflux disease-related outcomes of gastric plication with fundoplication in individuals with mild obesity. METHODS: A retrospective cohort study was carried out, enrolling individuals who underwent gastric plication with fundoplication at a tertiary private hospital from 2015–2019. Data regarding perioperative and weight loss outcomes, endoscopic and 24-hour pH monitoring findings, and gastroesophageal reflux disease-related symptoms were analyzed. RESULTS: Of 98 individuals, 90.2% were female. The median age was 40.4 years (IQR 32.1–47.8). The median body mass index decreased from 32 kg/m2 (IQR 30,5–34) to 29.5 kg/m2 (IQR 26.7–33.9) at 1–2 years (p<0.05); and to 27.4 kg/m2 (IQR 24.1–30.6) at 2–4 years (p=0.059). The median percentage of total weight loss at 1–2 years was 7.8% (IQR −4.1–14.7) and at 2–4 years, it was 16.4% (IQR 4.3–24.1). Both esophageal and extra-esophageal symptoms showed a significant reduction (p<0.05). A significant decrease in the occurrence of esophagitis was observed (p<0.01). The median DeMeester score decreased from 30 (IQR 15.1–48.4) to 1.9 (IQR 0.93–5.4) (p<0.0001). CONCLUSIONS: The gastric plication with fundoplication proved to be an effective and safe technique, leading to a significant and sustained weight loss in addition to endoscopic and clinical improvement of gastroesophageal reflux disease. BACKGROUND disease AIMS diseaserelated related METHODS out 20152019 2015 2019 2015–2019 24hour hour 24 findings analyzed RESULTS 9 902 90 2 90.2 female 404 40 4 40. IQR 32.1–47.8. 321478 32.1–47.8 . 1 47 8 32.1–47.8) 3 kgm2 kgm kg m2 m kg/m 30,5–34 30534 5 34 295 29 29. 26.7–33.9 267339 26 7 33 12 1– p<0.05 p005 p 0 05 (p<0.05) 274 27 27. 24.1–30.6 241306 6 2– p=0.059. p0059 p=0.059 059 (p=0.059) 78 7.8 −4.1–14.7 41147 14 164 16 16.4 4.3–24.1. 43241 4.3–24.1 4.3–24.1) extraesophageal extra p<0.05. p<0.01. p001 p<0.01 01 (p<0.01) 15.1–48.4 151484 15 48 19 1. 0.93–5.4 09354 93 p<0.0001. p00001 p<0.0001 0001 (p<0.0001) CONCLUSIONS technique 2015201 201 2015–201 90. 32147 32.1–47. 30,5–3 3053 26.7–33. 26733 p<0.0 p00 (p<0.05 24.1–30. 24130 p=0.05 (p=0.059 7. −4.1–14. 4114 16. 4324 4.3–24. (p<0.01 15.1–48. 15148 0.93–5. 0935 p0000 p<0.000 000 (p<0.0001 201520 20 2015–20 3214 32.1–47 30,5– 305 26.7–33 2673 p<0. p0 (p<0.0 24.1–30 2413 p=0.0 (p=0.05 −4.1–14 411 432 4.3–24 15.1–48 1514 0.93–5 093 p000 p<0.00 00 (p<0.000 20152 2015–2 321 32.1–4 30,5 26.7–3 267 p<0 (p<0. 24.1–3 241 p=0. (p=0.0 −4.1–1 41 43 4.3–2 15.1–4 151 0.93– 09 (p<0.00 2015– 32.1– 30, 26.7– p< (p<0 24.1– p=0 (p=0. −4.1– 4.3– 15.1– 0.93 32.1 26.7 (p< 24.1 p= (p=0 −4.1 4.3 15.1 0.9 32. 26. (p 24. (p= −4. 4. 15. 0. −4 −

RESUMO RACIONAL: A associação de plicatura gástrica com fundoplicatura é uma opção atrativa para o tratamento de indivíduos com obesidade associada à doença do refluxo gastroesofágico. OBJETIVOS: Descrever a evolução ponderal, clínica, endoscópica e de pHmetria após a gástrica com fundoplicatura em indivíduos com obesidade grau I e doença do refluxo gastroesofágico. MÉTODOS: Um estudo de coorte histórica foi realizado, incluindo indivíduos que realizaram gástrica com fundoplicatura em um hospital privado terciário de 2015 a 2019. Os dados sobre os resultados perioperatórios e de perda de peso, achados endoscópicos e de pHmetria de 24 horas e sintomas relacionados à doença do refluxo gastroesofágico foram analisados. RESULTADOS: Dos 98 indivíduos, 90,2% eram do sexo feminino. A idade mediana foi de 40,4 (IQR 32,1–47,8) anos. A mediana do índice de massa corporal diminuiu de 32 (IQR 30,5–34) kg/m2 para 29,5 (IQR 26,7–33,9) kg/m2 em 1–2 anos (p<0,05); de 2 a 4 anos, foi de 27,4 (IQR 24,1–30,6) kg/m2 (p=0,059). A mediana da porcentagem da perda total de peso em 1-2 anos foi de 7,8% (IQR −4,1–14,7) e em 2-4 anos, foi de 16,4% (IQR 4,3–24,1). Tanto os sintomas esofágicos quanto os extras esofágicos apresentaram redução significativa (p<0,05). Observou-se diminuição significativa na ocorrência de esofagite (p<0,01). A pontuação mediana do escore de DeMeester diminuiu de 30 (IQR 15,1–48,4) para 1,9 (IQR 0,93–5,4) (p<0,0001). CONCLUSÕES: A associação entre plicatura gástrica e fundoplicatura laparoscópica mostrou-se uma técnica eficaz e segura, levando a perda de peso significativa, bem como melhora endoscópica e clínica da doença do refluxo gastroesofágico. RACIONAL OBJETIVOS ponderal MÉTODOS realizado 201 2019 analisados RESULTADOS 9 902 90 90,2 feminino 404 40 40, IQR 32,1–47,8 321478 1 47 8 3 30,5–34 30534 5 34 kgm2 kgm kg m2 m kg/m 295 29 29, 26,7–33,9 267339 26 7 33 12 1– p<0,05 p005 p 0 05 (p<0,05) 274 27 27, 24,1–30,6 241306 6 p=0,059. p0059 p=0,059 . 059 (p=0,059) 1- 78 7,8 −4,1–14,7 41147 14 2- 164 16 16,4 4,3–24,1. 43241 4,3–24,1 4,3–24,1) p<0,05. Observouse Observou se p<0,01. p001 p<0,01 01 (p<0,01) 15,1–48,4 151484 15 48 19 1, 0,93–5,4 09354 93 p<0,0001. p00001 p<0,0001 0001 (p<0,0001) CONCLUSÕES mostrouse mostrou segura 20 90, 32,1–47, 32147 30,5–3 3053 26,7–33, 26733 p<0,0 p00 (p<0,05 24,1–30, 24130 p=0,05 (p=0,059 7, −4,1–14, 4114 16, 4324 4,3–24, (p<0,01 15,1–48, 15148 0,93–5, 0935 p0000 p<0,000 000 (p<0,0001 32,1–47 3214 30,5– 305 26,7–33 2673 p<0, p0 (p<0,0 24,1–30 2413 p=0,0 (p=0,05 −4,1–14 411 432 4,3–24 15,1–48 1514 0,93–5 093 p000 p<0,00 00 (p<0,000 32,1–4 321 30,5 26,7–3 267 p<0 (p<0, 24,1–3 241 p=0, (p=0,0 −4,1–1 41 43 4,3–2 15,1–4 151 0,93– 09 (p<0,00 32,1– 30, 26,7– p< (p<0 24,1– p=0 (p=0, −4,1– 4,3– 15,1– 0,93 32,1 26,7 (p< 24,1 p= (p=0 −4,1 4,3 15,1 0,9 32, 26, (p 24, (p= −4, 4, 15, 0, −4 −

Abstract BACKGROUND: The long-term effects of bariatric surgery on the course of non-alcoholic fatty hepatopathy (NAFLD) are not fully understood. OBJECTIVE: To analyze the evolution of NAFLD characteristics through noninvasive markers after Roux-en-Y gastric bypass (RYGB) over a five-year period. DESIGN AND SETTING: Historical cohort study; tertiary-level university hospital. METHODS: The evolution of NAFLD-related characteristics was evaluated among 49 individuals who underwent RYGB, with a five-year follow-up. Steatosis was evaluated through the hepatic steatosis index (HSI), steatohepatitis through the clinical score for non-alcoholic steatohepatitis (C-NASH) and fibrosis through the NAFLD fibrosis score (NFS). RESULTS: 91.8% of the individuals were female. The mean age was 38.3 ± 10 years and average body mass index (BMI), 37.4 ± 2.3 kg/m2. HSI significantly decreased from 47.15 ± 4.27 to 36.03 ± 3.72 at 12 months (P < 0.01), without other significant changes up to 60 months. C-NASH significantly decreased from 0.75 ± 1.25 to 0.29 ± 0.7 at 12 months (P < 0.01), without other significant changes up to 60 months. NFS decreased from 1.14 ± 1.23 to 0.27 ± 0.99 at 12 months (P < 0.01), and then followed a slightly ascending course, with a marked increase by 60 months (0.82 ± 0.89), but still lower than at baseline (P < 0.05). HSI variation strongly correlated with the five-year percentage total weight loss (R = 0.8; P < 0.0001). CONCLUSION: RYGB led to significant improvement of steatosis, steatohepatitis and fibrosis after five years. Fibrosis was the most refractory abnormality, with a slightly ascending trend after two years. Steatosis improvement directly correlated with weight loss.

RESUMO Contexto: A infecção por Helicobacter pylori tem sido descrita como causa de complicações pós-operatórias após cirurgia bariátrica (CB), especialmente úlceras marginais. O método ideal para a triagem pré-operatória ainda não foi determinado. Objetivo: Analisar a acurácia diagnóstica do teste endoscópico de urease para detecção de H. pylori em indivíduos submetidos à CB e as principais alterações endoscópicas e histológicas observadas nessa população. Métodos: Foi realizado um estudo transversal a partir de um banco de dados de prontuários de 232 indivíduos submetidos à CB entre 2016 e 2019 em um hospital universitário terciário. Dados clínicos, antropométricos e endoscópicos foram analisados. Foi considerado como método padrão-ouro para calcular as variáveis de acurácia diagnóstica o exame histopatológico por colorações de hematoxilina-eosina e Giemsa. Resultados: 87,5% dos participantes eram do sexo feminino; a média de idade foi de 38,5±9,5 anos e o índice de massa corporal médio foi de 37,6±3,8 kg/m2. O achado endoscópico mais comum foi gastrite (50,9%) com predomínio da forma erosiva leve (25%). Ao exame histológico, 59,1% dos participantes apresentaram infecção confirmada por H. pylori. A infecção por H. pylori foi associada a maiores frequências de duodenite endoscópica (23,4% vs 12,6%; P=0,04), gastrite crônica histológica (100% vs 56,8%; P<0,0001) e gastrite aguda histológica (58,4% vs 2,1%; P<0,0001). O teste de urease teve sensibilidade de 79,6% e especificidade de 97,9%, levando à acurácia global de 87,1%. Conclusão: O teste endoscópico de urease tem alta acurácia para triagem pré-operatória da infecção por H. pylori em candidatos à CB. A infecção por H. pylori foi significativamente associada a alterações endoscópicas (duodenite) e histopatológicas (gastrite crônica e ativa).

ABSTRACT Background: Helicobacter pylori infection has been reported to lead to post-operative complications after bariatric surgery (BS), especially marginal ulcers. The optimal method for pre-operative screening is yet to be determined. Objective: To analyze the diagnostic accuracy of the endoscopic urease test for the detection of H. pylori in individuals undergoing BS and the main endoscopic and histological changes within this population. Methods: A cross-sectional study was carried out based on a database from medical records of 232 individuals who underwent BS between 2016 and 2019 at a tertiary university hospital. Clinical, anthropometric, and endoscopic data were analyzed. The gold-standard method considered to calculate diagnostic accuracy variables was histopathological examination through hematoxylin-eosin/Giemsa stains. Results: 87.5% of the participants were female; mean age was 38.5±9.5 years and average body mass index was 37.6±3.8 kg/m2. The commonest endoscopic finding was gastritis (50.9%) with a predominance of the mild erosive form (25%). Upon histological examination, 59.1% of the participants had confirmed H. pylori infection. H. pylori infection was associated with higher frequencies of endoscopic duodenitis (23.4% vs 12.6%; P=0.04), histological chronic gastritis (100% vs 56.8%; P<0.0001) and histological acute gastritis (58.4% vs 2.1%; P<0.0001). The urease test had a sensitivity of 79.6% and a specificity of 97.9%, leading to an overall accuracy of 87.1%. Conclusion The endoscopic urease test is highly accurate for pre-operative screening of H. pylori infection in individuals who undergo BS. H. pylori infection was significantly associated with endoscopic (duodenitis) and histopathological (chronic and active gastritis) changes.

RESUMO Contexto Marcadores não-invasivos são ferramentas úteis e práticas para avaliar a doença hepática gordurosa não alcoólica (DHGNA), porém, a biópsia hepática continua sendo o método padrão-ouro. A biópsia pode ser facilmente obtida em indivíduos submetidos à cirurgia bariátrica, mas não há evidências definitivas acerca da relação entre custos, riscos e benefícios de sua realização sistemática. Objetivo Comparar a acurácia diagnóstica de métodos não-invasivos com a biópsia hepática para detecção e estadiamento da DHGNA em obesos submetidos à cirurgia bariátrica. Métodos Trata-se de um estudo transversal, observacional e descritivo que envolveu indivíduos que se submeteram à cirurgia bariátrica de 2018 a 2019 em um hospital universitário público terciário. Ultrassonografia (US), índice de esteatose hepática (HSI), Escore Clínico de Esteato-hepatite Não-Alcoólica (C-NASH), Índice de Hipertensão, alanina aminotransferase (ALT) e resistência à insulina (HAIR), Razão entre aspartato aminotransferase (AST) e plaquetas (APRI), Escore de Fibrose da DHGNA (NFS) e índice de massa corporal (IMC), relação AST/ALT e diabetes (BARD) foram os métodos comparados com o exame histopatológico de biópsias hepáticas em cunha coletadas durante a cirurgia. Resultados De 104 indivíduos analisados, 91 (87,5%) eram do sexo feminino. A média de idade foi de 34,9±9,7 anos. Não houve morbidade relacionada à biópsia. As respectivas acurácias globais de cada marcador analisado foram: US (79,81% para esteatose), HSI (79,81% para esteatose), HAIR (40,23% para esteato-hepatite), C-NASH (22,99% para esteato-hepatite), APRI (94,23% para fibrose avançada), NFS (94,23% para fibrose avançada) e BARD (16,35% para fibrose avançada). Discussão: Considerando a alta prevalência de doença hepática nesta população, mesmo os mais acurados destes marcadores não apresentaram poder discricionário suficiente para detectar e/ou descartar os aspectos da DHGNA que foram desenvolvidos para avaliar em comparação com a biópsia hepática, que é segura e de fácil obtenção nestes pacientes. Conclusão A biópsia hepática em cunha durante a cirurgia bariátrica auxilia no diagnóstico e estadiamento da DHGNA, apresenta baixo risco e custos aceitáveis e, dadas as limitações dos métodos não-invasivos, é justificável e deve ser considerada na rotina bariátrica.

ABSTRACT Background Non-invasive markers are useful and practical tools for assessing non-alcoholic fatty liver disease (NAFLD), but liver biopsy remains the gold-standard method. Liver biopsy can be easily obtained on individuals undergoing bariatric surgery, but there is no ultimate evidence on the relationship between costs, risks and benefits of its systematic performance. Objective To compare the diagnostic accuracy of non-invasive methods with liver biopsy for detection and staging of NAFLD in obese individuals undergoing bariatric surgery. Methods This is a cross-sectional, observational and descriptive study which enrolled individuals who underwent bariatric surgery from 2018 through 2019 at a public tertiary university hospital. Ultrasound scan, hepatic steatosis index, Clinical Non-Alcoholic Steatohepatitis Score (C-NASH), hypertension, alanine aminotransferase (ALT) and insulin resistance (HAIR), aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), NAFLD Fibrosis Score (NFS) and body mass index, AST/ALT ratio, and diabetes (BARD) were the methods compared with the histopathological examination of wedge liver biopsies collected during surgery. Results Of 104 individuals analyzed, 91 (87.5%) were female. The mean age was 34.9±9.7 years. There was no biopsy-related morbidity. The respective overall accuracies of each marker analyzed were: ultrasound scan (79.81% for steatosis), hepatic steatosis index (79.81% for steatosis), HAIR (40.23% for steatohepatitis), C-NASH (22.99% for steatohepatitis), APRI (94.23% for advanced fibrosis), NFS (94.23% for advanced fibrosis), and BARD (16.35% for advanced fibrosis). Discussion Given the high prevalence of liver disease within this population, even the most accurate markers did not present enough discretionary power to detect and/or rule out the NAFLD aspects they were designed to assess in comparison with liver biopsy, which is safe and easy to obtain in these patients. Conclusion Wedge liver biopsy during bariatric surgery helps to diagnose and stage NAFLD, presents low risks and acceptable costs; given the limitations of non-invasive methods, it is justifiable and should be considered in bariatric routine.

Abstract BACKGROUND: The long-term effects of bariatric surgery on the course of non-alcoholic fatty hepatopathy (NAFLD) are not fully understood. OBJECTIVE: To analyze the evolution of NAFLD characteristics through noninvasive markers after Roux-en-Y gastric bypass (RYGB) over a five-year period. DESIGN AND SETTING: Historical cohort study; tertiary-level university hospital. METHODS: The evolution of NAFLD-related characteristics was evaluated among 49 individuals who underwent RYGB, with a five-year follow-up. Steatosis was evaluated through the hepatic steatosis index (HSI), steatohepatitis through the clinical score for non-alcoholic steatohepatitis (C-NASH) and fibrosis through the NAFLD fibrosis score (NFS). RESULTS: 91.8% of the individuals were female. The mean age was 38.3 ± 10 years and average body mass index (BMI), 37.4 ± 2.3 kg/m2. HSI significantly decreased from 47.15 ± 4.27 to 36.03 ± 3.72 at 12 months (P < 0.01), without other significant changes up to 60 months. C-NASH significantly decreased from 0.75 ± 1.25 to 0.29 ± 0.7 at 12 months (P < 0.01), without other significant changes up to 60 months. NFS decreased from 1.14 ± 1.23 to 0.27 ± 0.99 at 12 months (P < 0.01), and then followed a slightly ascending course, with a marked increase by 60 months (0.82 ± 0.89), but still lower than at baseline (P < 0.05). HSI variation strongly correlated with the five-year percentage total weight loss (R = 0.8; P < 0.0001). CONCLUSION: RYGB led to significant improvement of steatosis, steatohepatitis and fibrosis after five years. Fibrosis was the most refractory abnormality, with a slightly ascending trend after two years. Steatosis improvement directly correlated with weight loss.

SUMMARY Obesity is a disease characterized by the accumulation of abnormal or excessive fat that can damage health. Bariatric surgery, an effective and safe way to treat this disease, requires multidisciplinary monitoring with an educational nature to change lifestyle. Adherence to routine physical activity can be a part of adopting a healthier lifestyle and can assist in the treatment of this disease and its related comorbidities. OBJECTIVE: Thus, the aim of this study was to analyze the correlation between the evolution of anthropometric variables and the domains of quality of life at different times, including at one year after bariatric surgery in very active and irregularly active individuals. METHODS: This was a longitudinal, observational, prospective, and analytical study. The collected data included anamnesis, level of physical activity (International Physical Activity Questionnaire Short Form), height, weight, body mass index (BMI), average waist circumference, percentage of fat, and the World Health Organization Quality of Life Assessment Bref. RESULTS: Seven female individuals were evaluated and divided into two groups: a very active group and an irregularly active group. In the very active individuals, significant results were found in the evolutionary variables: weight (p<0.001); body mass index (p<0.001); average waist circumference (p<0.001); percentage of fat (p<0.001); and quality of life general (p=0.001). In the irregularly active individuals, a significant result was found only in one evolutionary variable: body mass index (p<0.001). CONCLUSION: Thus, it is evident that the improvement and maintenance of good health is more effective in bariatric individuals who maintain a routine with regular physical activity.

ABSTRACT BACKGROUND: The role of transient obstructive cholestasis on liver histology remains undetermined. OBJECTIVE: To investigate whether transient cholestasis impairs liver histology. DESIGN AND SETTING: Cross-sectional study at a public university hospital (UNICAMP), Brazil. METHODS: 169 individuals undergoing cholecystectomy, with or without cholestasis. were enrolled. Histopathological findings were correlated with clinical and biochemical characteristics. RESULTS: Biliary hepatopathy was more frequent in individuals with resolved cholestasis than in those with active obstruction or no jaundice (P < 0.01), as also were fibrosis and ductular proliferation (P = 0.02). Cholestasis was commoner in individuals with resolved obstruction than in those with no history (P < 0.01) or active cholestasis (P < 0.05). Biliary hepatopathy was associated with longer duration of cholestasis (P < 0.001) and higher bilirubin levels (P = 0.02) in individuals with active obstruction; with lower body mass index (P = 0.02) and longer cholestasis (P < 0.001) in individuals with resolved obstruction; and with longer cholestasis (P < 0.001) and longer interval between endoscopic retrograde cholangiopancreatography and surgery (P = 0.03) overall. In individuals with active obstruction, duration of cholestasis (R = 0.7; P < 0.001) and bilirubin levels (R = 0.6; P = 0.004) were independently correlated with cholestasis severity. Duration of cholestasis (R = 0.7; P < 0.001) was independently correlated with ductular proliferation severity. CONCLUSIONS: Transient cholestasis was associated with significant histopathological changes, even after its resolution. Longer duration of obstruction correlated with greater severity of histopathological changes, especially cholestasis and ductular proliferation. This emphasizes the need for early treatment of obstructive cholestasis.

RESUMO Introdução: atualmente, a cirurgia bariátrica é o único tratamento que leva à perda de peso prolongada e sustentada e diminuição da morbimortalidade em indivíduos obesos mórbidos. O bypass em Y-de-Roux causa perda de peso restringindo a ingestão de alimentos associada à redução da absorção intestinal, além de múltiplos efeitos endócrinos e sacietógenos. O desvio biliopancreático promove a perda de peso principalmente devido à diminuição da absorção dos nutrientes ingeridos. Ambos os procedimentos excluem partes do trato gastrointestinal. Objetivo: descrever 4 casos de cirurgia revisional após cirurgia bariátrica primária, devido a graves complicações nutricionais, bem como realizar uma revisão da literatura sobre esse assunto. Métodos: foi realizada uma análise retrospectiva dos pacientes do banco de dados do serviço de cirurgia bariátrica da Unicamp e revisão da literatura. Resultados: foram identificados 4 pacientes, 2 mulheres e 2 homens, com média de idade de 48 anos, o IMC antes da cirurgia revisional eram em média 23,7. Os pacientes haviam sido submetidos em 3 casos a cirurgia de Scopinaro e 1 caso ao bypass gástrico em Y-de-Roux. As cirurgias revisionais foram de revisão, conversão e reversão. Um paciente evoluiu a óbito. Em relação a revisão da literatura, foram selecionados 12 artigos (11 relatos de casos e 1 série de casos). Outros cinco artigos originais importantes foram incluídos. Conclusão: felizmente, a cirurgia revisional raramente é necessária, mas, quando indicada, apresenta alta morbidade. São cirurgias de revisão, reversão ou conversão, de acordo com a gravidade do paciente e a cirurgia primária realizada.

ABSTRACT Introduction: bariatric surgery is currently the only treatment that leads to long-term and sustained weight loss and decreased morbidity and mortality in morbidly obese individuals. Roux-en-Y bypass causes weight loss by restricting food intake associated with reduced intestinal absorption, in addition to multiple endocrine and satiogenic effects. Biliopancreatic diversion promotes weight loss mainly due to poor absorption of the nutrients ingested. Both procedures exclude parts of the gastrointestinal tract. Objective: to describe four cases of revisional surgery after primary bariatric surgery, due to serious nutritional complications, and to review the literature regarding this subject. Methods: a retrospective analysis of patients of Unicamps bariatric center database and review of the literatures were performed. Results: four patients were identified, 2 women and 2 men, with a mean age of 48 years. The mean body mass index before revisional surgery was 23.7 kg/m2. Three patients underwent Scopinaro biliopancreatic diversion, and onde patient underwent Roux-en-Y gastric bypass. The revisional surgeries were revision, conversion, and reversion. One patient died. For the review of the literature 12 articles remained (11 case reports and 1 case series). Another five important original articles were included. Conclusion: fortunately, revision surgery is rarely necessary, but when indicated it has increased morbidity, It can be revision, reverion or conversion according to the severity of the patient and the primary surgery performed.