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SOARD Category 1 CME Credit Featured Articles, Volume 9, September–October 2013
SOARD Category 1 CME Credit Featured Articles, Volume 9, September–October 2013 Mean fourteen-year, 100% follow-up of laparoscopic adjustable gastric banding for morbid obesity. Victorzon M, Tolonen P. Surg Obes Relat Dis 2013;9;753–7.
Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass. Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Surg Obes Relat Dis 2013;9;760–4.
Objectives: After reading the featured articles published in this issue of Surgery for Obesity and Related Diseases (SOARD) participants in the SOARD CME program should be able to demonstrate increased understanding of the material specific to the article featured and be able to apply relevant information to clinical practice. Objectives are stated at the beginning of each featured article; the questions follow with three to five response choices, and a critique discussing the objective. Disclosure Statement: It is the policy of the American Society for Metabolic and Bariatric Surgery that speakers and/or anyone in control of content of a CME Category 1 event must disclose any financial or other relationship with (1) any manufacturer(s) of commercial products that may be discussed in the speaker’s presentation and/or (2) commercial supporters of the event. All disclosures are included under the list of author names. There was no commercial support received for this activity. Accreditation Statement: The American Society for Metabolic and Bariatric Surgery (ASMBS) is accredited by the Accreditation Council for Continuing Medical
Education (ACCME) to provide continuing medical education for physicians. The American Society for Metabolic and Bariatric Surgery (ASMBS) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. SOARD CME Online provides two articles from each issue for 2 credits per month; 1 credit per article. The articles this month on SOARD CME Online are: Mean fourteen-year, 100% follow-up of laparoscopic adjustable gastric banding for morbid obesity. Victorzon M, Tolonen P. Surg Obes Relat Dis 2013;9;753–7. Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass. Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Surg Obes Relat Dis 2013;9;760–4.
1550-7289/13/$ – see front matter r 2013 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery. http://dx.doi.org/10.1016/j.soard.2013.08.013
834
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 833–836
VOLUME 9
NUMBER 5
SEPTEMBER/OCTOBER 2013
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 833–836
ARTICLE 1 Mean fourteen-year, 100% follow-up of laparoscopic adjustable gastric banding for morbid obesity. Victorzon M, Tolonen P. Surg Obes Relat Dis 2013;9;753–7.
Question 4 Gastric banding worldwide is: A. increasing. B. decreasing. C. unchanged.
Learning Objectives
ARTICLE 2
Excess weight loss (%EWL) among patients with their
Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass.
bands still in place after 14 years was fairly good, 49%. In the long run the need for reoperations rises up to 460% after 14 years. After 14 years nearly 50% of the bands had been removed. A strict follow-up program and continuous filling adjustments of the bands are mandatory for even moderate success in the long run. The long-term overall failure rate in this study was at least 58% at 14 years.
Question 1 How do you calculate excess weight? A. The weight in kilograms above the weight at BMI of 22 kg/m2 B. The weight in kilograms above the weight at BMI of 25 kg/m2 C. The weight in kilograms above the weight calculated by substracting 100 from the subject’s length in cm
835
Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Surg Obes Relat Dis 2013;9;760–4. Learning Objectives
Review and evaluate possible causes for marginal ulcer following RYGB.
Determine whether Helicobacter pylori status, either positive preoperatively or persistently positive after treatment, has an effect on the complication rates of marginal ulcer or stomal stenosis in patients undergoing RYGB. Review the existing literature regarding any possible link between Helicobacter pylori status and marginal ulcer.
Question 1 Which of the following is least likely to cause marginal ulceration following Roux-en-y gastric bypass?
Question 2 What is the difference between the “pars flaccida” and the “perigastric” techniques? A. The perigastric technique includes the fat along the lesser curvature into the band. B. The pars flaccida technique means dissection close to the gastric wall along the lesser curvature. C. The pars flaccida technique includes the fat along the lesser curvature into the band.
Question 3 Why is a broad, low pressure band preferred rather than a leaner high-pressure band? A. There is less risk for slippage. B. There is less risk for reflux disease. C. There is less risk for erosion.
A. B. C. D. E.
Smoking NSAIDs Absorbable suture Gastro-gastric fistula Ischemia
Question 2 Which of the following test(s) is/are able to differentiate between active and chronic Helicobacter pylori infection? A. B. C. D. E.
Serum antigen Endoscropic biopsy Stool antigen Both A. and C. Both B. and C.
836
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 833–836
Question 3 Based on the data presented in the article, which of the following conclusions can be drawn? A. Helicobacter pylori infection likely does not have a role in formation of marginal ulcers or stomal stenosis following gastric bypass. B. Patients who are persistently Helicobacter pylori–positive after treatment with triple therapy are at greater risk for complications. C. Preoperative screening and treatment of Helicobacter pylori significantly reduced the rates of marginal ulcer.
D. Female gender was associated with a higher rate of marginal ulcer.
Question 4 Helicobacter pylori infection can lead to all of the following conditions, EXCEPT: A. B. C. D. E.
gastritis peptic ulcer neoplasm gastrointestinal bleeding gastroparesis
Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass. Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Surg Obes Relat Dis 2013;9;760–4.
Objectives: After reading the featured articles published in this issue of Surgery for Obesity and Related Diseases (SOARD) participants in the SOARD CME program should be able to demonstrate increased understanding of the material specific to the article featured and be able to apply relevant information to clinical practice. Objectives are stated at the beginning of each featured article; the questions follow with three to five response choices, and a critique discussing the objective. Disclosure Statement: It is the policy of the American Society for Metabolic and Bariatric Surgery that speakers and/or anyone in control of content of a CME Category 1 event must disclose any financial or other relationship with (1) any manufacturer(s) of commercial products that may be discussed in the speaker’s presentation and/or (2) commercial supporters of the event. All disclosures are included under the list of author names. There was no commercial support received for this activity. Accreditation Statement: The American Society for Metabolic and Bariatric Surgery (ASMBS) is accredited by the Accreditation Council for Continuing Medical
Education (ACCME) to provide continuing medical education for physicians. The American Society for Metabolic and Bariatric Surgery (ASMBS) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. SOARD CME Online provides two articles from each issue for 2 credits per month; 1 credit per article. The articles this month on SOARD CME Online are: Mean fourteen-year, 100% follow-up of laparoscopic adjustable gastric banding for morbid obesity. Victorzon M, Tolonen P. Surg Obes Relat Dis 2013;9;753–7. Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass. Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Surg Obes Relat Dis 2013;9;760–4.
1550-7289/13/$ – see front matter r 2013 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery. http://dx.doi.org/10.1016/j.soard.2013.08.013
834
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 833–836
VOLUME 9
NUMBER 5
SEPTEMBER/OCTOBER 2013
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 833–836
ARTICLE 1 Mean fourteen-year, 100% follow-up of laparoscopic adjustable gastric banding for morbid obesity. Victorzon M, Tolonen P. Surg Obes Relat Dis 2013;9;753–7.
Question 4 Gastric banding worldwide is: A. increasing. B. decreasing. C. unchanged.
Learning Objectives
ARTICLE 2
Excess weight loss (%EWL) among patients with their
Effect of Helicobacter pylori on marginal ulcer and stomal stenosis after Roux-en-Y gastric bypass.
bands still in place after 14 years was fairly good, 49%. In the long run the need for reoperations rises up to 460% after 14 years. After 14 years nearly 50% of the bands had been removed. A strict follow-up program and continuous filling adjustments of the bands are mandatory for even moderate success in the long run. The long-term overall failure rate in this study was at least 58% at 14 years.
Question 1 How do you calculate excess weight? A. The weight in kilograms above the weight at BMI of 22 kg/m2 B. The weight in kilograms above the weight at BMI of 25 kg/m2 C. The weight in kilograms above the weight calculated by substracting 100 from the subject’s length in cm
835
Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Surg Obes Relat Dis 2013;9;760–4. Learning Objectives
Review and evaluate possible causes for marginal ulcer following RYGB.
Determine whether Helicobacter pylori status, either positive preoperatively or persistently positive after treatment, has an effect on the complication rates of marginal ulcer or stomal stenosis in patients undergoing RYGB. Review the existing literature regarding any possible link between Helicobacter pylori status and marginal ulcer.
Question 1 Which of the following is least likely to cause marginal ulceration following Roux-en-y gastric bypass?
Question 2 What is the difference between the “pars flaccida” and the “perigastric” techniques? A. The perigastric technique includes the fat along the lesser curvature into the band. B. The pars flaccida technique means dissection close to the gastric wall along the lesser curvature. C. The pars flaccida technique includes the fat along the lesser curvature into the band.
Question 3 Why is a broad, low pressure band preferred rather than a leaner high-pressure band? A. There is less risk for slippage. B. There is less risk for reflux disease. C. There is less risk for erosion.
A. B. C. D. E.
Smoking NSAIDs Absorbable suture Gastro-gastric fistula Ischemia
Question 2 Which of the following test(s) is/are able to differentiate between active and chronic Helicobacter pylori infection? A. B. C. D. E.
Serum antigen Endoscropic biopsy Stool antigen Both A. and C. Both B. and C.
836
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 833–836
Question 3 Based on the data presented in the article, which of the following conclusions can be drawn? A. Helicobacter pylori infection likely does not have a role in formation of marginal ulcers or stomal stenosis following gastric bypass. B. Patients who are persistently Helicobacter pylori–positive after treatment with triple therapy are at greater risk for complications. C. Preoperative screening and treatment of Helicobacter pylori significantly reduced the rates of marginal ulcer.
D. Female gender was associated with a higher rate of marginal ulcer.
Question 4 Helicobacter pylori infection can lead to all of the following conditions, EXCEPT: A. B. C. D. E.
gastritis peptic ulcer neoplasm gastrointestinal bleeding gastroparesis