Myriam Moretto - Academia.edu (original) (raw)

Papers by Myriam Moretto

Background: Hepatic steatosis has a high prevalence among morbidly obese patients. Its relation t... more Background: Hepatic steatosis has a high prevalence among morbidly obese patients. Its relation to steatohepatitis and cirrhosis has been extensively studied among these patients. The aim of this study was to evaluate the behavior of hepatic steatosis with weight loss 1 year after bariatric surgery.

Surgery for Obesity and Related Diseases, 2008

Background: To demonstrate that bariatric procedures can be done with natural orifice visualizati... more Background: To demonstrate that bariatric procedures can be done with natural orifice visualization (NOTES) at 2 institutions (Nucleo Universitario de Estudos de Notes Centro de Cirurgia Experimental Vila do Conde-Junqueira, Vila do Conde, Portugal and Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS, Brasil). NOTES is a new surgical approach that is being developed. It consists of the use of a minimally invasive technique in which the surgical procedure is performed through natural orifices, thereby circumventing incisions through the skin. Methods: We performed vertical gastrectomy or laparoscopic sleeve gastrectomy in a porcine model using vaginal route visualization. Results: A laparoscopic vertical sleeve gastrectomy with NOTES visualization in a porcine model was performed with safety. Conclusion: Bariatric procedures can be done with NOTES with results as good as those using laparoscopic techniques. (Surg Obes Relat Dis 2008;4:773-776.)

Obesity Surgery, 2004

Background: Hepatic steatosis is prevalent in obese patients. Although it requires histology for ... more Background: Hepatic steatosis is prevalent in obese patients. Although it requires histology for diagnosis, ultrasound may indicate its presence. We evaluated the importance of ultrasound in the diagnosis of steatosis in morbidly obese patients, and considered its clinical relevance for patients with BMI of 35-40 kg/m 2 without co-morbidities.

Obesity Surgery, 2006

Background: Morbidly obese patients, despite normal laboratory tests and no clinical evidence of ... more Background: Morbidly obese patients, despite normal laboratory tests and no clinical evidence of liver disease, present a high prevalence of hepatic histological changes. Liver biopsy is able to provide the diagnosis, staging and assessment of follow-up of hepatic disease, thus helping to define clinical management. There is no agreement on which biopsy technique provides better material for analysis. Considering that subcapsular fibrosis is a common finding, sampling from deeper sites is necessary to achieve an adequate histological assessment.

Obesity Surgery, 2005

Background: Hepatic steatosis has a high prevalence among morbidly obese patients. Its relation t... more Background: Hepatic steatosis has a high prevalence among morbidly obese patients. Its relation to steatohepatitis and cirrhosis has been extensively studied among these patients. The aim of this study was to evaluate the behavior of hepatic steatosis with weight loss 1 year after bariatric surgery.

Obesity Surgery, 2008

Background Based on the reduced gastric volume and the malabsorption produced by Roux-en-Y gastri... more Background Based on the reduced gastric volume and the malabsorption produced by Roux-en-Y gastric bypass (RYGBP) and diet therapy, it is essential in the postoperative period to obtain and maintain an adequate nutritional state, with the aim of preventing malnutrition and seeking a healthy life. It is observed that patients have difficulty in understanding the new food choices that must considered, as they have eating habits that are very divergent from those currently proposed. There is often the need for vitamin and mineral replacement after laboratory tests. Methods This study calculated and evaluated the 24-h eating records of 210 patients, collected in the course of nutritional visits in follow-ups of the first, third, sixth, ninth, 12th, 18th, and 24th months postoperative. Results It was possible to observe an increase in the consumption of nutrients in the course of the study period, but it was not regular and significant for all the nutrients. Also, it is noted that the minimal requirements for vitamin A, vitamin C, calcium, iron and B-complex vitamins (except for cyanocobalamin and riboflavin) were not attained. The nutrients in which satisfactory results were obtained were total proteins of high biological value: cyanocobalamin and riboflavin. Conclusion This study demonstrated the concern for nutrient supplementation in the postoperative period of RYGBP. Thus, the routine use of multivitamins is deemed necessary after the first month postoperatively, with its maintenance preferably for the rest of the patient's life, without abandoning periodic clinical and laboratory follow-up.

Obesity Surgery, 2012

Although bariatric surgery has been shown to improve hepatic steatosis in morbidly obese patients... more Although bariatric surgery has been shown to improve hepatic steatosis in morbidly obese patients, the effect of weight loss on hepatic fibrosis has not been determined. Since the prognosis of patients with nonalcoholic fatty liver disease is closely related to the development of hepatic fibrosis, it is important to determine the hepatic histology of these patients after weight loss. We therefore evaluated the prevalence of hepatic fibrosis in morbidly obese patients undergoing bariatric surgery and assessed the correlation of histologic changes with weight loss. We retrospectively evaluated 78 morbidly obese patients who underwent gastric bypass. Liver biopsies were taken during surgery and after weight loss, and the correlations between histologic findings and hepatic fibrosis were determined. Of the 78 patients, 35 (44.8%) had fibrosis at first biopsy, and 24 (30.8%) had hepatic fibrosis after weight loss, including 19 of the 35 patients (54.3%) with fibrosis at first biopsy and 5 of the 43 (11.6%) without hepatic fibrosis at first biopsy (P = 0.027). Weight loss in morbidly obese patients was associated with a reduction in the prevalence of hepatic fibrosis.

Obesity Surgery, 2008

A 32-year-old female patient with morbid obesity (body mass index 44.4) was submitted to upper di... more A 32-year-old female patient with morbid obesity (body mass index 44.4) was submitted to upper digestive endoscopy performed routinely as a preoperative procedure in bariatric surgery. The examination identified multiple small polypoid lesions in the upper portion of the gastric body, some with small ulcerations. Anatomo-pathological findings were compatible with carcinoid tumor of the stomach. The patient was submitted to extended subtotal gastrectomy with loco-regional lymphadenectomy. Upper digestive endoscopy is performed routinely in some services for bariatric surgery, but its value has been questioned by some authors. In this case, endoscopic examination was of great importance, being responsible for a change in the surgical procedure. We did not find any report in the literature of a carcinoid tumor of the stomach in morbidly obese patients.

Obesity Surgery, 2003

Background: Although non-alcoholic hepatitis usually is asymptomatic and benign, this condition m... more Background: Although non-alcoholic hepatitis usually is asymptomatic and benign, this condition may progress to cirrhosis and hepatic failure. Some findings are similar to alcoholic hepatitis, but there is no history of excessive alcohol consumption. Among the factors associated with non-alcoholic hepatitis, obesity, diabetes and dyslipidemia are the most important.

Obesity Surgery, 2009

Background The duodenal-jejunal bypass sleeve (DJBS) has been shown to achieve a completely endos... more Background The duodenal-jejunal bypass sleeve (DJBS) has been shown to achieve a completely endoscopic duodenal exclusion without the need for stapling. This report is the first randomized controlled trial for weight loss. Methods In a 12-week, prospective, randomized study, subjects received either a low fat diet and the DJBS or a low fat diet control (no device). Twenty-five patients were implanted with the device and 14 received the control. The groups were demographically similar. Both groups received counseling at baseline only, which consisted of a low calorie diet, and exercise/behavior modification advice. No additional counseling occurred in either group. Measurements included starting and monthly body weight and serum blood tests. The device group also had a plain abdominal film post implant, a monthly KUB and a 4-week post explant EGD. Results Twenty device (80%) subjects maintained the DJBS without a significant adverse event for the 12-week duration. At 12 weeks, the mean excess weight loss was 22% and 5% for the device and control groups, respectively (p \ 0.001). Five subjects (20%) were endoscopically explanted early secondary to upper GI (UGI) bleeding (n = 3), anchor migration (n = 1) and sleeve obstruction (n = 1). The UGI bleeding occurred at a mean of 13.8 days post implant. EGD was performed in each of these cases with no distinct bleeding source identified. No blood transfusion was required. The migration occurred on day 47 and manifested as abdominal pain. The subject with the sleeve obstruction presented with abdominal pain and vomiting on day 30. Eight subjects (40%) underwent the 4 week post explant EGD at which time mild degrees of residual duodenal inflammation was noted. Conclusion The DJBS achieves noninvasive duodenal exclusion and short term weight loss efficacy. Longer term randomized controlled sham trials for weight loss and treatment of T2DM are underway.

Obesity Surgery, 2010

Background Morbid obesity may be associated with malnutrition. Because it is important to assess ... more Background Morbid obesity may be associated with malnutrition. Because it is important to assess the preoperative nutritional/metabolic status and bone mineral density of these patients, this study was designed aiming to evaluate bone metabolism/mineral density and nutritional profile in morbidly obese women. Methods Thirty-three morbidly obese women in preoperative care for obesity surgery were enrolled. Blood samples were drawn to determine nutritional and metabolic status, and dual-energy X-ray absorptiometry (DXA) was per-formed to evaluate bone mineral density; 24-h recall and food frequency questionnaire (FFQ) were also evaluated. Results Twenty-seven (81.8%) women were premenopausal and six (18.2%) were postmenopausal. The mean body mass index was 43.2±4.8 kg/m 2 , and 91% were Caucasian. Insulin-resistant subjects comprised 81.8% of the sample. The median (25-75 percentile) of the total intake of 24-h recall was 3,081 (2,718-3,737) and for FFQ 2,685 (2,284-4,400) calories. FFQ underestimated total energy value intake. The median of calcium was higher when evaluated by the FFQ as compared with the 24-h recall. Protein and lipid intakes were lower if evaluated by the FFQ as compared to the 24-h recall. Vitamin D levels were low in 18 (81.8%) patients. In one premenopausal woman, bone mineral density was low in the lumbar spine (L1-L4), and in one postmenopausal woman it was low in L1-L4, femoral neck and 1/3 proximal radius. Conclusions In this study, the nutritional status of morbidly obese women was good, except for markers of bone metabolism, with no detectable differences between preand postmenopausal women.

Background: Hepatic steatosis has a high prevalence among morbidly obese patients. Its relation t... more Background: Hepatic steatosis has a high prevalence among morbidly obese patients. Its relation to steatohepatitis and cirrhosis has been extensively studied among these patients. The aim of this study was to evaluate the behavior of hepatic steatosis with weight loss 1 year after bariatric surgery.

Surgery for Obesity and Related Diseases, 2008

Background: To demonstrate that bariatric procedures can be done with natural orifice visualizati... more Background: To demonstrate that bariatric procedures can be done with natural orifice visualization (NOTES) at 2 institutions (Nucleo Universitario de Estudos de Notes Centro de Cirurgia Experimental Vila do Conde-Junqueira, Vila do Conde, Portugal and Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS, Brasil). NOTES is a new surgical approach that is being developed. It consists of the use of a minimally invasive technique in which the surgical procedure is performed through natural orifices, thereby circumventing incisions through the skin. Methods: We performed vertical gastrectomy or laparoscopic sleeve gastrectomy in a porcine model using vaginal route visualization. Results: A laparoscopic vertical sleeve gastrectomy with NOTES visualization in a porcine model was performed with safety. Conclusion: Bariatric procedures can be done with NOTES with results as good as those using laparoscopic techniques. (Surg Obes Relat Dis 2008;4:773-776.)

Obesity Surgery, 2004

Background: Hepatic steatosis is prevalent in obese patients. Although it requires histology for ... more Background: Hepatic steatosis is prevalent in obese patients. Although it requires histology for diagnosis, ultrasound may indicate its presence. We evaluated the importance of ultrasound in the diagnosis of steatosis in morbidly obese patients, and considered its clinical relevance for patients with BMI of 35-40 kg/m 2 without co-morbidities.

Obesity Surgery, 2006

Background: Morbidly obese patients, despite normal laboratory tests and no clinical evidence of ... more Background: Morbidly obese patients, despite normal laboratory tests and no clinical evidence of liver disease, present a high prevalence of hepatic histological changes. Liver biopsy is able to provide the diagnosis, staging and assessment of follow-up of hepatic disease, thus helping to define clinical management. There is no agreement on which biopsy technique provides better material for analysis. Considering that subcapsular fibrosis is a common finding, sampling from deeper sites is necessary to achieve an adequate histological assessment.

Obesity Surgery, 2005

Background: Hepatic steatosis has a high prevalence among morbidly obese patients. Its relation t... more Background: Hepatic steatosis has a high prevalence among morbidly obese patients. Its relation to steatohepatitis and cirrhosis has been extensively studied among these patients. The aim of this study was to evaluate the behavior of hepatic steatosis with weight loss 1 year after bariatric surgery.

Obesity Surgery, 2008

Background Based on the reduced gastric volume and the malabsorption produced by Roux-en-Y gastri... more Background Based on the reduced gastric volume and the malabsorption produced by Roux-en-Y gastric bypass (RYGBP) and diet therapy, it is essential in the postoperative period to obtain and maintain an adequate nutritional state, with the aim of preventing malnutrition and seeking a healthy life. It is observed that patients have difficulty in understanding the new food choices that must considered, as they have eating habits that are very divergent from those currently proposed. There is often the need for vitamin and mineral replacement after laboratory tests. Methods This study calculated and evaluated the 24-h eating records of 210 patients, collected in the course of nutritional visits in follow-ups of the first, third, sixth, ninth, 12th, 18th, and 24th months postoperative. Results It was possible to observe an increase in the consumption of nutrients in the course of the study period, but it was not regular and significant for all the nutrients. Also, it is noted that the minimal requirements for vitamin A, vitamin C, calcium, iron and B-complex vitamins (except for cyanocobalamin and riboflavin) were not attained. The nutrients in which satisfactory results were obtained were total proteins of high biological value: cyanocobalamin and riboflavin. Conclusion This study demonstrated the concern for nutrient supplementation in the postoperative period of RYGBP. Thus, the routine use of multivitamins is deemed necessary after the first month postoperatively, with its maintenance preferably for the rest of the patient's life, without abandoning periodic clinical and laboratory follow-up.

Obesity Surgery, 2012

Although bariatric surgery has been shown to improve hepatic steatosis in morbidly obese patients... more Although bariatric surgery has been shown to improve hepatic steatosis in morbidly obese patients, the effect of weight loss on hepatic fibrosis has not been determined. Since the prognosis of patients with nonalcoholic fatty liver disease is closely related to the development of hepatic fibrosis, it is important to determine the hepatic histology of these patients after weight loss. We therefore evaluated the prevalence of hepatic fibrosis in morbidly obese patients undergoing bariatric surgery and assessed the correlation of histologic changes with weight loss. We retrospectively evaluated 78 morbidly obese patients who underwent gastric bypass. Liver biopsies were taken during surgery and after weight loss, and the correlations between histologic findings and hepatic fibrosis were determined. Of the 78 patients, 35 (44.8%) had fibrosis at first biopsy, and 24 (30.8%) had hepatic fibrosis after weight loss, including 19 of the 35 patients (54.3%) with fibrosis at first biopsy and 5 of the 43 (11.6%) without hepatic fibrosis at first biopsy (P = 0.027). Weight loss in morbidly obese patients was associated with a reduction in the prevalence of hepatic fibrosis.

Obesity Surgery, 2008

A 32-year-old female patient with morbid obesity (body mass index 44.4) was submitted to upper di... more A 32-year-old female patient with morbid obesity (body mass index 44.4) was submitted to upper digestive endoscopy performed routinely as a preoperative procedure in bariatric surgery. The examination identified multiple small polypoid lesions in the upper portion of the gastric body, some with small ulcerations. Anatomo-pathological findings were compatible with carcinoid tumor of the stomach. The patient was submitted to extended subtotal gastrectomy with loco-regional lymphadenectomy. Upper digestive endoscopy is performed routinely in some services for bariatric surgery, but its value has been questioned by some authors. In this case, endoscopic examination was of great importance, being responsible for a change in the surgical procedure. We did not find any report in the literature of a carcinoid tumor of the stomach in morbidly obese patients.

Obesity Surgery, 2003

Background: Although non-alcoholic hepatitis usually is asymptomatic and benign, this condition m... more Background: Although non-alcoholic hepatitis usually is asymptomatic and benign, this condition may progress to cirrhosis and hepatic failure. Some findings are similar to alcoholic hepatitis, but there is no history of excessive alcohol consumption. Among the factors associated with non-alcoholic hepatitis, obesity, diabetes and dyslipidemia are the most important.

Obesity Surgery, 2009

Background The duodenal-jejunal bypass sleeve (DJBS) has been shown to achieve a completely endos... more Background The duodenal-jejunal bypass sleeve (DJBS) has been shown to achieve a completely endoscopic duodenal exclusion without the need for stapling. This report is the first randomized controlled trial for weight loss. Methods In a 12-week, prospective, randomized study, subjects received either a low fat diet and the DJBS or a low fat diet control (no device). Twenty-five patients were implanted with the device and 14 received the control. The groups were demographically similar. Both groups received counseling at baseline only, which consisted of a low calorie diet, and exercise/behavior modification advice. No additional counseling occurred in either group. Measurements included starting and monthly body weight and serum blood tests. The device group also had a plain abdominal film post implant, a monthly KUB and a 4-week post explant EGD. Results Twenty device (80%) subjects maintained the DJBS without a significant adverse event for the 12-week duration. At 12 weeks, the mean excess weight loss was 22% and 5% for the device and control groups, respectively (p \ 0.001). Five subjects (20%) were endoscopically explanted early secondary to upper GI (UGI) bleeding (n = 3), anchor migration (n = 1) and sleeve obstruction (n = 1). The UGI bleeding occurred at a mean of 13.8 days post implant. EGD was performed in each of these cases with no distinct bleeding source identified. No blood transfusion was required. The migration occurred on day 47 and manifested as abdominal pain. The subject with the sleeve obstruction presented with abdominal pain and vomiting on day 30. Eight subjects (40%) underwent the 4 week post explant EGD at which time mild degrees of residual duodenal inflammation was noted. Conclusion The DJBS achieves noninvasive duodenal exclusion and short term weight loss efficacy. Longer term randomized controlled sham trials for weight loss and treatment of T2DM are underway.

Obesity Surgery, 2010

Background Morbid obesity may be associated with malnutrition. Because it is important to assess ... more Background Morbid obesity may be associated with malnutrition. Because it is important to assess the preoperative nutritional/metabolic status and bone mineral density of these patients, this study was designed aiming to evaluate bone metabolism/mineral density and nutritional profile in morbidly obese women. Methods Thirty-three morbidly obese women in preoperative care for obesity surgery were enrolled. Blood samples were drawn to determine nutritional and metabolic status, and dual-energy X-ray absorptiometry (DXA) was per-formed to evaluate bone mineral density; 24-h recall and food frequency questionnaire (FFQ) were also evaluated. Results Twenty-seven (81.8%) women were premenopausal and six (18.2%) were postmenopausal. The mean body mass index was 43.2±4.8 kg/m 2 , and 91% were Caucasian. Insulin-resistant subjects comprised 81.8% of the sample. The median (25-75 percentile) of the total intake of 24-h recall was 3,081 (2,718-3,737) and for FFQ 2,685 (2,284-4,400) calories. FFQ underestimated total energy value intake. The median of calcium was higher when evaluated by the FFQ as compared with the 24-h recall. Protein and lipid intakes were lower if evaluated by the FFQ as compared to the 24-h recall. Vitamin D levels were low in 18 (81.8%) patients. In one premenopausal woman, bone mineral density was low in the lumbar spine (L1-L4), and in one postmenopausal woman it was low in L1-L4, femoral neck and 1/3 proximal radius. Conclusions In this study, the nutritional status of morbidly obese women was good, except for markers of bone metabolism, with no detectable differences between preand postmenopausal women.