Alba Zevallos

Background: Hypoalbuminemia is associated with worse postoperative outcomes, but data is limited in the bariatric population. Patients with BMI ≥50 may represent a higher-risk group for malnutrition. Methods: We analyzed MBSAQIP data (2015-2022) for patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Propensity score matching was used to control for 22 preoperative variables. We compared 30-day outcomes and bariatric-specific complications in patients with albumin P = 0.011; RYGB 0.3% vs 0.1%, P < 0.001), unplanned ICU admission (SG 1.0% vs 0.7%, P = 0.020; RYGB 1.6% vs 1.2%, P = 0.034), and non-home discharge (SG 0.8% vs 0.5%, P < 0.001; RYGB 0.9% vs 0.6%, P = 0.009). These mortality differences were not observed in patients with BMI <50. Conclusion: Hypoalbuminemia is associated with higher complications rates after bariatric surgery and increased mortality in patients with BMI ≥50. Preoperative nutritional optimization is strongly recommended in this high-risk group.

Background The Endoluminal Functional Lumen Imaging Probe (EndoFLIP™) is increasingly utilized in the diagnostic evaluation of gastroesophageal reflux disease (GERD). At our Center, EndoFLIP™ is routinely performed before Bravo™ pH monitoring during preoperative esophagogastroduodenoscopy to exclude major motility disorders in patients being considered for antireflux surgery. According to Lyon Consensus 2.0, the presence of Los Angeles (LA) grade B or higher esophagitis is diagnostic for GERD, obviating the need for pH testing. In select cases, bypassing pH monitoring reduces costs, improves workflow efficiency, and expedites symptom management. This study aimed to evaluate whether EndoFLIP™ measurements independently predict Bravo™ pH positivity and to assess the diagnostic accuracy of distensibility index (DI) thresholds. Methods We conducted a single-center retrospective review of adults with native anatomy who underwent 96-h Bravo™ pH monitoring and concomitant EndoFLIP™ at index EGD between October 2022 and August 2024. Patients with positive (Bravo +) and negative (Bravo–) studies were compared. Diagnostic accuracy of DI values (DI50, DI60, DI70) was assessed using receiver operating characteristic (ROC) curves, with area under the curve (AUC) and 95% confidence intervals (CI). Results A total of 171 patients were included (64 Bravo + , 107 Bravo–). LA grade B esophagitis was more common among Bravo + patients (7.8% vs. 0%, p = 0.007). Median DI60 was significantly higher in Bravo + patients (4.0 vs. 3.4 mm²/mmHg, p = 0.016). ROC analysis showed DI50 and DI60 yielded good discrimination for Bravo + (AUC 0.67 and 0.65) with high specificity (94%). In males, DI50 and DI60 both performed well (AUC 0.69), whereas in females, DI70 provided the strongest diagnostic value (AUC 0.69, 95% CI 0.49–0.89). The cut‐off points for DI50, DI60, and DI70 in the overall sample were 4.2 (95% CI: 3.8–4.6), 4.7 (95% CI: 4.3–5.1), and 3.8 (95% CI: 3.5–4.3), respectively. Conclusion DI60 values are significantly associated with Bravo + testing. Across the overall cohort and male sex, DI50 and DI60 demonstrated a strong diagnostic performance, while DI70 showed better performance in females.

Background Bariatric surgery is the most effective treatment for obesity and related comorbidities, but a substantial proportion of patients develop chronic abdominal pain (CAP), defined as persistent or recurrent pain lasting more than three months. CAP significantly impairs quality of life, is reported in 30–50% of patients, and represents one of the leading causes of emergency visits and readmissions. This systematic review aims to summarize the multifactorial etiologies of CAP following bariatric surgery, highlight diagnostic challenges, and propose a multidisciplinary framework for effective management. Methods A comprehensive literature search (PubMed and Scopus) was conducted from inception to March 15, 2025. Eligible studies included original research, case series, case reports, observational studies, and clinical trials evaluating CAP in adult patients after primary bariatric surgery. Data on prevalence, etiology, diagnostic modalities, and therapeutic interventions were extracted and synthesized. Results Of the 2,111 identified articles, 51 studies met the inclusion criteria. CAP was found to have diverse etiologies, including anatomical, functional, nutritional deficiencies, biliary disorders, abdominal wall conditions, and psychological contributors. Diagnostic strategies emphasized a stepwise approach integrating history, physical examination, targeted imaging, endoscopy, laboratory studies, and psychological screening. Treatment requires etiology-specific management combining surgical, endoscopic, medical, dietary, behavioral, and psychological interventions. Conclusion CAP after bariatric surgery is common, multifactorial, and underrecognized, leading to significant patient morbidity and healthcare burden. A systematic, multidisciplinary diagnostic and treatment approach is essential to optimize patient outcomes, reduce readmissions, and enhance the long-term success of metabolic surgery.