{"id":4574,"date":"2018-06-11T09:00:25","date_gmt":"2018-06-11T09:00:25","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/opcoes-endoscopicas-no-tratamento-das-complicacoes-do-anel-de-restricao-em-pacientes-pos-by-pass-gastrico-serie-endoscopia-bariatrica\/"},"modified":"2023-03-13T16:52:03","modified_gmt":"2023-03-13T16:52:03","slug":"opcoes-endoscopicas-no-tratamento-das-complicacoes-do-anel-de-restricao-em-pacientes-pos-by-pass-gastrico-serie-endoscopia-bariatrica","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/opcoes-endoscopicas-no-tratamento-das-complicacoes-do-anel-de-restricao-em-pacientes-pos-by-pass-gastrico-serie-endoscopia-bariatrica\/","title":{"rendered":"Op\u00e7\u00f5es endosc\u00f3picas no tratamento das complica\u00e7\u00f5es do anel de restri\u00e7\u00e3o em pacientes p\u00f3s by-pass g\u00e1strico.  S\u00e9rie Endoscopia Bari\u00e1trica"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"4574\" class=\"elementor elementor-4574\">\n\t\t\t\t\t\t<section class=\"penci-section penci-disSticky penci-structure-10 elementor-section elementor-top-section elementor-element elementor-element-4341fe14 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4341fe14\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"penci-ercol-100 penci-ercol-order-1 penci-sticky-ct    elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7e11c18c\" data-id=\"7e11c18c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3a7399d2 elementor-widget elementor-widget-text-editor\" data-id=\"3a7399d2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tO anel de conten\u00e7\u00e3o no by-pass g\u00e1strico (cirurgia de Fobi-Capella) foi muito utilizado no passado com o objetivo de evitar a dilata\u00e7\u00e3o da anastomose e perda do efeito restritivo da cirurgia, gerando assim, um melhor resultado na perda de peso a longo prazo.\n\nApesar das vantagens acima, as complica\u00e7\u00f5es do anel s\u00e3o relativamente frequentes. O seu uso est\u00e1 associado \u00e0 intoler\u00e2ncia alimentar (principalmente com carne), v\u00f4mitos, e em casos mais severos,\u00a0 desnutri\u00e7\u00e3o e defici\u00eancia de prote\u00ednas. Estas complica\u00e7\u00f5es costumam ocorrer tardiamente, e muitas vezes, v\u00e1rios anos ap\u00f3s a cirurgia.\n\nO tratamento destas complica\u00e7\u00f5es \u00e9 realizado atrav\u00e9s da remo\u00e7\u00e3o do anel, procedimento que por muito tempo foi realizado cirurgicamente. Esta cirurgia costuma ser trabalhosa devido \u00e0s ader\u00eancias na regi\u00e3o do\u00a0coto g\u00e1strico e com risco de complica\u00e7\u00f5es como sangramento e perfura\u00e7\u00e3o.\nAtualmente, uma op\u00e7\u00e3o menos invasiva tem se apresentado. V\u00e1rios estudos demonstraram sucesso e seguran\u00e7a no tratamento endosc\u00f3pico das complica\u00e7\u00f5es do anel.\n<h5><\/h5>\n<h5><strong>Tratamento endosc\u00f3pico da eros\u00e3o do anel com extrus\u00e3o parcial<\/strong><\/h5>\n&nbsp;\n\nA incid\u00eancia da eros\u00e3o do anel varia na literatura de 1 at\u00e9 7% dos casos de pacientes operados pela t\u00e9cnica de by-pass com anel. A eros\u00e3o pode ser assintom\u00e1tica ou estar associada a dor epig\u00e1strica, sangramento, n\u00e1useas e v\u00f4mitos.\n\nAp\u00f3s a ocorr\u00eancia da eros\u00e3o a remo\u00e7\u00e3o do anel deve ser considerada. O diagn\u00f3stico desta complica\u00e7\u00e3o \u00e9 f\u00e1cil, j\u00e1 que \u00e9 realizado atrav\u00e9s da identifica\u00e7\u00e3o de um segmento do anel vis\u00edvel na luz do coto g\u00e1strico durante a endoscopia digestiva alta.\n\n&nbsp;\n\n<div id=\"attachment_9004\" style=\"width: 1142px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/anel-extruso-bariatrica.png\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-9004\" class=\"wp-image-9004 size-full\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/anel-extruso-bariatrica.png\" alt=\"\" width=\"1132\" height=\"832\" \/><\/a><p id=\"caption-attachment-9004\" class=\"wp-caption-text\">Anel extruso na luz do coto g\u00e1strico<\/p><\/div>\n\n&nbsp;\n\nA remo\u00e7\u00e3o endosc\u00f3pica costuma ser r\u00e1pida e f\u00e1cil, desde que pelo menos 50% do anel esteja vis\u00edvel na luz g\u00e1strica. O procedimento \u00e9 realizado atrav\u00e9s da sec\u00e7\u00e3o do anel com tesoura endosc\u00f3pica e posterior tra\u00e7\u00e3o com pin\u00e7a de corpo estranho. Algumas vezes a sec\u00e7\u00e3o do silicone com a tesoura pode ser dif\u00edcil. A mobiliza\u00e7\u00e3o do anel at\u00e9 a exposi\u00e7\u00e3o do n\u00f3 e sec\u00e7\u00e3o direta do fio muitas vezes facilita o procedimento.\n\n&nbsp;\n\n<div style=\"position:relative;padding-top:56.20608899297424%;\"><iframe id=\"panda-d6d61d20-3f47-4531-a1ef-676241e6db06\" src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=d6d61d20-3f47-4531-a1ef-676241e6db06\" style=\"border:none;position:absolute;top:0;left:0;\" allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\" height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n<pre>Remo\u00e7\u00e3o endosc\u00f3pica de anel erodindo para a luz do coto g\u00e1strico.<\/pre>\n<h5><\/h5>\n<h5><strong>Tratamento endosc\u00f3pico do deslizamento ou obstru\u00e7\u00e3o pelo anel sem eros\u00e3o<\/strong><\/h5>\n&nbsp;\n\nNos casos em que o anel est\u00e1 parcialmente erodido e vis\u00edvel na luz g\u00e1strica ele pode ser facilmente removido com a t\u00e9cnica descrita previamente. O grande desafio para o endoscopista intervencionista ocorre nos casos onde o anel est\u00e1 causando obstru\u00e7\u00e3o e n\u00e3o existe eros\u00e3o da parede g\u00e1strica.\n\nOs sintomas de v\u00f4mitos frequentes, intoler\u00e2ncia alimentar e desnutri\u00e7\u00e3o podem ocorrer tanto em pacientes com an\u00e9is estreitos ou nos casos de deslizamento do anel com angula\u00e7\u00e3o e obstru\u00e7\u00e3o da sa\u00edda do coto g\u00e1strico.\n\n&nbsp;\n<h6><strong>Dilata\u00e7\u00e3o com bal\u00e3o de acalasia<\/strong><\/h6>\n&nbsp;\n\nNestes pacientes uma das op\u00e7\u00f5es \u00e9 a dilata\u00e7\u00e3o do anel com bal\u00e3o de acal\u00e1sia de 30 mm. Este procedimento \u00e9 realizado atrav\u00e9s da passagem de fio guia na al\u00e7a eferente e posicionamento do bal\u00e3o sobre o anel seguido de dilata\u00e7\u00e3o progressiva sob controle radiol\u00f3gico at\u00e9 a ruptura do anel. A dilata\u00e7\u00e3o da anastomose deve ser evitada mas muitas vezes isso acaba sendo imposs\u00edvel devido ao pequeno tamanho do coto g\u00e1strico e o grande tamanho do bal\u00e3o (10 cm de extens\u00e3o). Na maioria dos casos a transi\u00e7\u00e3o es\u00f4fago g\u00e1strica ou a anastomose v\u00e3o ser dilatados junto com o anel.\n\nUm estudo publicado em 2010 incluindo 39 pacientes obteve 66% de sucesso na ruptura completa do anel. Os outros e 34% obtiveram alargamento com melhora dos sintomas mas sem ruptura. Nenhuma complica\u00e7\u00e3o grave foi relatada.\n\nA ruptura do anel costuma ocorrer facilmente. Naqueles em que isso n\u00e3o ocorre, a press\u00e3o excessiva deve ser evitada. Outro cuidado muito importante \u00e9 que an\u00e9is deslizados e localizados sobre a al\u00e7a intestinal n\u00e3o devem ser dilatados. A al\u00e7a de intestino delgado n\u00e3o \u00e9 t\u00e3o resistente quanto o coto g\u00e1strico, podendo levar nesses casos \u00e0 perfura\u00e7\u00e3o.\n\n&nbsp;\n\n<div style=\"position:relative;padding-top:56.33802816901409%;\"><iframe id=\"panda-53ee7627-fccc-4869-9ada-4ec705b883e7\" src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=53ee7627-fccc-4869-9ada-4ec705b883e7\" style=\"border:none;position:absolute;top:0;left:0;\" allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\" height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n<pre>Dilata\u00e7\u00e3o do anel com bal\u00e3o de acal\u00e1sia.<\/pre>\n<h6><\/h6>\n<h6><strong>Remo\u00e7\u00e3o do anel com uso de pr\u00f3tese endosc\u00f3pica<\/strong><\/h6>\n&nbsp;\n\nAs pr\u00f3teses endosc\u00f3picas tamb\u00e9m podem ser utilizadas como primeira op\u00e7\u00e3o para o tratamento da obstru\u00e7\u00e3o por anel n\u00e3o erodido ou como salvamento nos pacientes em que a ruptura do anel n\u00e3o foi poss\u00edvel atrav\u00e9s da dilata\u00e7\u00e3o com bal\u00e3o de acal\u00e1sia.\n\nCampos\u00a0et al em 2016 publicaram um artigo com 41 pacientes onde obteve eros\u00e3o completa em 21 casos e eros\u00e3o incompleta permitindo a remo\u00e7\u00e3o em um segundo tempo em 17 casos. Em rela\u00e7\u00e3o \u00e0s complica\u00e7\u00f5es foram relatadas 3 migra\u00e7\u00f5es de pr\u00f3tese e 9 estenoses tratadas com dilata\u00e7\u00e3o. A melhora da disfagia ocorreu em 78% dos pacientes.\n\nO estudo acima utilizou pr\u00f3teses pl\u00e1sticas (Polyflex 25X21X90 mm). Por\u00e9m, estas pr\u00f3teses n\u00e3o existem mais no mercado. As pr\u00f3teses indicadas para esta t\u00e9cnica atualmente s\u00e3o as met\u00e1licas totalmente recobertas.\n\nA pr\u00f3tese deve ser colocada 2 cm acima do anel e abaixo da transi\u00e7\u00e3o es\u00f4fago-g\u00e1strica para evitar v\u00f4mitos. Ela \u00e9 mantida por 15 dias e ent\u00e3o removida. Se a eros\u00e3o for completa, o anel muitas vezes sai junto com a pr\u00f3tese. Nos casos de eros\u00e3o incompleta onde o anel est\u00e1 extruso, mas aparente na luz g\u00e1strica, ele deve ser removido ap\u00f3s 30 dias da retirada da pr\u00f3tese atrav\u00e9s de sec\u00e7\u00e3o e tra\u00e7\u00e3o com pin\u00e7a de corpo estranho.\n\n<div id=\"attachment_9003\" style=\"width: 496px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/protese-endoscopica.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" aria-describedby=\"caption-attachment-9003\" class=\"wp-image-9003 size-full\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/protese-endoscopica.png\" alt=\"\" width=\"486\" height=\"422\" \/><\/a><p id=\"caption-attachment-9003\" class=\"wp-caption-text\">Imagem adaptada de Campos et al 2016. Remo\u00e7\u00e3o do anel com aux\u00edlio de protese endosc\u00f3pica. Imagem radiol\u00f3gica da pr\u00f3tese posicionada. Imagens endosc\u00f3picas da remo\u00e7\u00e3o da pr\u00f3tese e do anel completamente liberado na luz do coto g\u00e1strico.<\/p><\/div>\n<h5><\/h5>\n<h5><strong>Conclus\u00e3o<\/strong><\/h5>\nO tratamento das complica\u00e7\u00f5es do anel de restri\u00e7\u00e3o em paciente p\u00f3s by pass g\u00e1strico atrav\u00e9s de t\u00e9cnicas endosc\u00f3picas aparenta ser seguro e efetivo. Na maioria das vezes \u00e9 realizado ambulatorialmente e com baixo \u00edndice de complica\u00e7\u00f5es.\n<h5><b>Confira tamb\u00e9m:\u00a0 <\/b><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/anatomia-endoscopica-pos-cirurgia-bariatrica\/\">Anatomia endosc\u00f3pica p\u00f3s cirurgia bari\u00e1trica<\/a><\/h5>\n&nbsp;\n<h5><strong>Refer\u00eancias<\/strong><\/h5>\nMoon Kyung Joo. Endoscopic Approach for Major Complications of Bariatric Surgery. Clin Endosc\u00a0 2017;50:31-41\n\nJosember Martins Campos, Luis Fernando Evangelista, Alvaro Antonio Ferraz et al. Treatment of ring slippage after gastric by-pass: long-term results after endoscopic dilation with na acalasia balloon. Gastrointestinal Endoscopy 2010;72(1).\n\nJosemberg Marins Campos, Rena C. Moon, Galeno E. J. Magalh\u00e3es Neto, Andre F. Teixeira, Muhammad A. Jawad, Lyz Bezerra Silva, Manoel Galv\u00e3o Neto, \u00c1lvaro Ant\u00f4nio B. Ferraz. Endoscopic treatment of food intolerance after a banded gastric bypass: inducing band erosion for removal using a plastic stent. Endoscopy DOI http:\/\/dx.doi.org\/ 10.1055\/s-0042-103418\n\n<hr \/>\n\nComo citar este artigo: Orso IRB. Op\u00e7\u00f5es endosc\u00f3picas no tratamento das complica\u00e7\u00f5es do anel de restri\u00e7\u00e3o em pacientes p\u00f3s by-pass g\u00e1strico; 2018. Dispon\u00edvel em www.endoscopiaterapeutica.net\/pt\n\n<hr \/>\n\n&nbsp;\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>O anel de conten\u00e7\u00e3o no by-pass g\u00e1strico (cirurgia de Fobi-Capella) foi muito utilizado no&hellip;<\/p>\n","protected":false},"author":2464,"featured_media":5270,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[270],"tipo":[158],"volume":[263],"class_list":["post-4574","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-270","tipo-endoscopia-bariatrica","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Op\u00e7\u00f5es endosc\u00f3picas no tratamento das complica\u00e7\u00f5es do anel de restri\u00e7\u00e3o em pacientes p\u00f3s by-pass g\u00e1strico. S\u00e9rie Endoscopia Bari\u00e1trica &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/opcoes-endoscopicas-no-tratamento-das-complicacoes-do-anel-de-restricao-em-pacientes-pos-by-pass-gastrico-serie-endoscopia-bariatrica\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Op\u00e7\u00f5es endosc\u00f3picas no tratamento das complica\u00e7\u00f5es do anel de restri\u00e7\u00e3o em pacientes p\u00f3s by-pass g\u00e1strico. 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