Estudo longitudinal retrospectivo e comparativo sobre retirada de anel com stent plástico e metálico na intolerância alimentar pós by pass gástrico A Y de Roux

Abstract

There are 2.0 billion overweight and obese people in the world and Brazil is in fifth place in the world ranking. Rings used in Roux-en-Y gastric bypass (BGYR) procedures are related to food intolerance and complications of gastric leakage. Still, the duration in days of effective stent action is a controversial issue in the literature. Objective: Was compared the safety and efficacy of using self-expanding metallic (MS) and plastic (PS) stent to induce ring erosion followed by endoscopic removal in patients with banded BGYR to resolve food intolerance. It also analyzed the duration in days of effective stent action to induce ring erosion, symptom resolution, ring removal success rate, and stenosis formation. Methods: This was a longitudinal retrospective study with an analysis of medical records of 72 participants (18 in the MS group and 54 in the PS) who presented food intolerance and/or emesis with the use of the ring, following the STROBE rules of observational studies. Results: The 36 participants presented for each group (MS vs PS) average age of 48.4 ± 14.1 years vs 43.4 ± 12.7, being 15 vs 14 women and 3 vs 4 men. As symptoms, 14 vs 13 presented food intolerance and 4 vs 5 presented emesis. In both the SM and SP groups, all participants presented ring slinding. In addition, 10 vs 7 participants showed no complications and 8 vs 11 underwent stenosis. There was a statistically significant improvement in terms of complications in most patients using MS vs PS (mean = 1.56 ± 0.5 vs 1.72 ± 0.5), with a difference = - 0.17, 95% CI (-0.441254; 1.5) and equivalence range (1, 2), accepting the null hypothesis: p = 1.000). Regarding time, there was a statistically significant difference in the MS vs PS group, with shorter time with the use of SP, with a mean of 15.8 ± 1.8 vs 14.2 ± 1.8 days and difference = 1.61, 95% CI (0.849872; 14.3) and equivalence range (12.6; 16), accepting the Null Hypothesis: p = 1,000). Conclusion: The use of a metallic stent presented better safety and efficacy because it reduced the number of complications in relation to the plastic stent, but it took a little longer time to induce ring erosion. Still, in all participants of the MS group, the complications and symptoms were completely resolved, but the PS group presented two cases of ring migration and one case of partial ring removal.