de Siqueira Neto João, de Moura Diogo Turiani Hourneaux, Ribeiro Igor Braga, Barrichello Sérgio Alexandre, Harthorn Kelly E, Thompson Christopher C
Department of Surgery, Federal University of Espirito Santo, Vitoria 29075-910, Espirito Santo, Brazil.
Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, São Paulo, Brazil.
World J Gastrointest Endosc. 2020 Mar 16;12(3):111-118. doi: 10.4253/wjge.v12.i3.111.
The healthcare impact of obesity is enormous, and there have been calls for new approaches to containing the epidemic worldwide. Minimally invasive procedures have become more popular, with one of the most widely used being endoscopic sleeve gastroplasty (ESG). Although major adverse events after ESG are rare, some can cause considerable mortality. To our knowledge, there has been no previous report of biliary ascites after ESG.
A 48-year-old female with obesity refractory to lifestyle changes and prior gastric balloon placement underwent uncomplicated ESG and was discharged on the following day. On postoperative day 3, she developed abdominal pain, which led to an emergency department visit the following day. She was readmitted to the hospital, with poor general health status and signs of peritoneal irritation. Computed tomography imaging showed fluid in the abdominal cavity. Laparoscopy revealed biliary ascites and showed that the gallbladder was sutured to the gastric wall. The patient underwent cholecystectomy and lavage of the abdominal cavity and was admitted to the intensive care unit post-operatively. After 7 d of antibiotic therapy and 20 d of hospitalization, she was discharged. Fortunately, 6 mo later, she presented in excellent general condition and with a 20.2% weight loss.
ESG is a safe procedure. However, adverse events can still occur, and precautions should be taken by the endoscopist. In general, patient position, depth of tissue acquisition, location of stitch placement, and endoscopist experience are all important factors to consider to mitigate procedural risk.
肥胖对医疗保健的影响巨大，全球范围内都在呼吁采用新方法来控制这一流行病。微创手术越来越受欢迎，其中使用最广泛的一种是内镜袖状胃成形术（ESG）。尽管ESG后的主要不良事件很少见，但有些可能会导致相当高的死亡率。据我们所知，此前尚无ESG后发生胆汁性腹水的报道。
一名48岁女性，生活方式改变后肥胖仍难以控制，且曾放置过胃内气球，接受了无并发症的ESG手术，并于次日出院。术后第3天，她出现腹痛，第二天前往急诊科就诊。她再次入院，全身健康状况较差，有腹膜刺激征。计算机断层扫描成像显示腹腔内有液体。腹腔镜检查发现胆汁性腹水，并显示胆囊被缝合到胃壁上。患者接受了胆囊切除术和腹腔灌洗，术后入住重症监护病房。经过7天的抗生素治疗和20天的住院治疗后，她出院了。幸运的是，6个月后，她的总体状况良好，体重减轻了20.2%。
ESG是一种安全的手术。然而，不良事件仍可能发生，内镜医师应采取预防措施。一般来说，患者体位、组织获取深度、缝合位置以及内镜医师经验都是减轻手术风险时需要考虑的重要因素。
