Volume 77 - 2014 - Fasc.1 - Letters
Irvingia gabonensis (African Mango) : Innocent Magic Formula ?
The trend over the past 20 years has shown an increase in the prevalence of obesity of six to seven percent every 10 years (1). Conventional dietary and behavioral treat- ment have failed in long-term management of obesity and dietary supplements to treat obesity appeal to many patients as a magic formula who desire weight loss.
One of the most commonly used dietary supplement is Irvingia gabonensis (African mango) (IG), a mango-like fruit that comes from the forest tree found in West Africa (2,3). It has been widely used by the general population to manage obesity. IG works by inhibiting adipogenesis by increasing adiponectin levels, decreas- ing leptin levels and down-regulating peroxisome prolif- erator-activated receptor gamma (PPAR-gamma) which is responsible for the differentiation of adipocytes. In addition, IG has also been used to treat hypercholesterol- emia (3). Although many people have taken IG capsules, the issue of potential toxicity at the usual doses has not been reported.
Aorto-gastric fistula caused by an esophageal stent used in the treament of bariatric surgery's complications
We recently observed an unusual complication related to the use of an esophageal stent.
MM, man of 52 years, with history of diabetes type 2, dyslipidemia, arterial hypertension and ischemic heart disease, underwent in 1999 of an adjustable ring gastro- plasty to correct morbid obesity. He also underwent a cholecystectomy and an appendectomy complicated by peritonitis.
On May 2013, a gastric bypass was performed to treat recurrence of obesity. This procedure was complicated in June by epigastric pain and vomiting. Gastro-jejunal anastomosis stenosis and gastro-gastric fistula were quickly diagnosed. An endoscopic balloon dilation was performed. In July, regarding recurrence of stenosis and fistula persistence, we decided to implant a Niti-S Beta Taewong type esophageal stent (1).
Non-surgical treatment of a giant ileal lipoma by endoloop ligation (loop-and- let-go)
Endoloop (detachable snare loop) was first developed by Pontecorvo and Pesce in 1986 (1). It is mainly used in the endoscopic mechanical hemostasis of postpolypec- tomy bleeding. Herein we present a novel application of endoloop ligation and review some important hints about its use.
A 56-year-old man underwent colonoscopy at another hospital because of hematochezia necessitating two units of blood transfusion which showed a giant ileal peduncu- lated polyp. Biopsies revealed non-specific findings. He was referred to our hospital for surgical treatment. Colo- noscopy demonstrated that the polyp was originating approximately from the last 10th cm of the terminal ileum, had a thick stalk, extending through the ileocecal valve into the proximal ascending colon and filling approxi- mately half of its volume. It had a smooth and patchy hyperemic-hemorrhagic surface. After giving informa- tion about the advantage and disadvantages of the proce- dure and obtaining consent of the patient, the polyp was tightly ligated at the base of its stalk by using an endoloop (MAJ-254, Olympus) through a standart, single accesso- ry channel colonoscope. Polyp mucosa was congested soon after after ligation. The procedure was performed in an outpatient setting and no immediate complications were observed. The patient was discharged one hour after the procedure and informed to follow his stool and bring the polyp in a biopsy specimen bottle.
Retrieval of impacted esophageal stent in the ileum with double balloon enteros- copy : a novel technique
A 36-year-old man presented with a two day history of epigastric abdominal pain and vomiting. His medical -history-was-significant-for-a-sleeve-gastrectomy-in-2010 complicated by post-operative gastroesophageal junction leak with four prior attempts at endoscopic stent therapy with- OverStitchTM- fixation.- - A- plain- film- of- the- chest identified-three-proximally-placed-self-expandable-stents at- 25-cm- from- entry.- Additionally,- one- Niti-S- stent (Taewong Medical, Seoul, Korea) was noted to have migrated distally to the ileum. Esophagogastroduodenos- copy-(EGD)-was-carried-out-and-the-three-proximal-stents were-removed-under-fluoroscopic-guidance.-
