Docimo, Salvatore

Abstract Introduction Conversion of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) is performed for gastroesophageal reflux disease (GERD), recurrent weight gain, and suboptimal clinical response. We compared early safety, weight loss, and healthcare utilization across indications. Methods We retrospectively analyzed adults undergoing SG-to-RYGB conversion in the 2023 MBSAQIP Participant Use File linked to the Long-Term Follow-Up file. Patients were grouped by indication as GERD, recurrent weight gain, suboptimal clinical response, or other. Baseline, operative, 30-day, and 6-month outcomes were compared using unadjusted analyses. Results Among 12,350 patients, indications were GERD in 59.2%, recurrent weight gain in 24.7%, suboptimal clinical response in 10.5%, and other in 5.6%. Patients with weight-related indications had higher baseline BMI. Major 30-day complications were uncommon and did not differ significantly across groups. Among 8,797 patients with 6-month weight data, mean percent total weight loss (%TWL) was 14.2% for recurrent weight gain, 13.3% for suboptimal clinical response, and 12.7% for both GERD and other indications (P < 0.001). The maximum absolute difference was 1.5 percentage points. Six-month intervention rates were 6.4% for GERD and 6.8% for other indications, compared with 4.2% for recurrent weight gain and 2.8% for suboptimal clinical response (P < 0.001); mortality remained uncommon. Conclusion SG-to-RYGB conversion was associated with low short-term complication rates across indications. Six-month weight loss and healthcare utilization differed in unadjusted comparisons, but weight-loss differences were modest and may reflect baseline case-mix differences.

Objective: Review the current literature for available treatments for acute cholecystitis (AC) in nonsurgical candidates and provide guidelines for the management of these patients. Background: Cholecystectomy is the gold-standard treatment modality for AC. A considerable number of patients who are not eligible for surgery are managed by percutaneous and endoscopic techniques. There is recent data regarding endoscopic ultrasound-guided gallbladder drainage and emerging percutaneous approaches to address cholelithiasis and remove drains. Methods: An expert panel of surgeons, gastroenterologists, and interventional radiologists reviewed the current literature and provided recommendations for AC management in nonsurgical candidates. Recommendations were based on relevant evidence, with quality and strength assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: Percutaneous cholecystostomy is advised for patients ineligible for lumen-apposing metal stent (LAMS) or with reversible conditions, aiming to bridge to cholecystectomy. The optimal timing of cholecystectomy after percutaneous cholecystostomy remains unclear. In cases where surgery is not feasible, potential definitive treatments such as percutaneous cholecystolithotripsy/lithectomy and cholecystoduodenal stenting should be considered. For calculous AC, endoscopic ultrasound-guided gallbladder drainage with LAMS is recommended as a therapy for never-surgical candidates if they are eligible for monitored anesthesia care or general anesthesia and there is institutional expertise and minimal intervening ascites. Conclusions: The management of AC in nonsurgical candidates remains a challenge, with institutional protocols varying based on physician preferences and expertise. The proposed protocol integrates percutaneous and endoscopic approaches and emphasizes the need for multidisciplinary collaboration. Further research is required to evaluate these evolving management techniques, as the current literature is limited.