Ten years after undergoing sleeve gastrectomy, a 39‐year‐old man developed pancreatitis and, after recovery, presented with severe diarrhea. An image study showed barium contrast passing from the ...stomach to the colon. Before surgery, initial treatment consisted of parenteral nutrition and antibiotics. The patient then underwent robot‐assisted resection of a gastrocolic fistula and omentoplasty. However, 72 h after surgery, the amount of suction drainage suggested that the fistulous track repair was leaking. Therefore, we decided to perform endoscopy to place a self‐expanding covered stent at the gastroesophageal junction as well as a nasojejunal tube to continue nutritional supplementation. After the patient had fasted for 2 weeks, there was no evidence of leakage in the image studies. The patient was discharged after he had clinically improved, and the stent was removed at the end of 8 weeks. The combination of robot‐assisted surgery and endoscopic management is effective for treating gastrocolic fistula.
Background
Atherosclerosis represents a cardiovascular risk. Chronic inflammation is a key factor for atherogenic progression. Neutrophil‐to‐lymphocyte ratio (NLR) has been proposed as a novel ...biomarker for cardiovascular risks. We aimed to explore whether NLR was related to surrogate pro‐atherogenic promoters driving atherogenic progression, as measured by carotid intima‐media thickness (CIMT).
Study Design
Thirty‐one patients with obesity candidates for bariatric surgery were recruited from Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City. The results are part of the “CROP” study (NCT03561987). NLR was calculated from routine complete blood count, and its relation with plasma pro‐inflammatory mediators (hsCRP, TNF‐α and IL‐1β), adipokines (adiponectin and leptin), adiposity markers (visceral adipose tissue VAT determined from CT scan image and VAT individual adipocyte area at histological sample) and CIMT were determined.
Results
Neutrophil‐to‐lymphocyte ratio correlated with hsCRP (Spearman's r = 0.70 95% CI 0.46 to 0.85, P < 0.01), TNF‐α (r = 0.69 0.44 to 0.84, P < 0.0001) and adiponectin (r = −0.69 −0.84 to −0.45, P < 0.03), as well as with VAT individual adipocyte area (r = 0.64 0.37 to 0.81, P < 0.0001) and with VAT area (r = 0.43; 0.07 to 0.68, P < 0.01). Leptin and adiponectin showed further independent association with higher NLR (multivariate regression analysis OR 7.9 95% CI 1.1 to 56.2 P = 0.03 and 0.1 0.01 to 1.0 P = 0.05, respectively). Moreover, NLR distribution significantly varied between subgroups divided according to progressive CIMT (P = 0.05); whereas adiponectin and VAT adipocyte area associated with CIMT > 0.9 mm (univariate analysis OR 0.1 0.01 to 1.0 P = 0.05 and 13.1 1.4 to 126.3 P = 0.03, respectively).
Conclusion
Neutrophil‐to‐lymphocyte ratio was related to pro‐inflammatory, adiposity biomarkers and progressive subclinical atherogenesis.
