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Saúde e Qualidade de Vida | SUGESTÃO DE PAUTA

Plasma de Argônio Endoscópico – Nova opção para pacientes que reganham peso após cirurgia bariátrica

  1. Dr. Giorgio Baretta

Dr. Giorgio Baretta

No mundo, de acordo Organização Mundial de Saúde (OMS), há mais de um bilhão de adultos com sobrepeso e 300 milhões com obesidade. A obesidade é uma doença crônica que afeta cerca de 18% das mulheres e 13% dos homens no Brasil. Isso representa cerca de 19 milhões de habitantes, sem contar os mais de 50% de brasileiros com sobrepeso, segundo pesquisa encaminhada pela Sociedade Brasileira de Cirurgia Bariátrica e Metabólica (SBCBM) em 2007.

Nos Estados Unidos, cerca de dois terços dos indivíduos são obesos ou têm excesso de peso , um em cada três norte-americanos é considerado obeso, e a outra terça parte sofre de excesso de peso crônico. Em geral 31% dos homens e 35% das mulheres sofrem de obesidade e apenas 1% destes têm acesso à cirurgia bariátrica. O Brasil, por sua vez, realiza em média 60 mil cirurgias bariátricas por ano. Sabidamente 10% destes pacientes reganham peso ao passar dos anos. Então, ao ano, são dois a seis mil obesos que voltam a engordar e a apresentar toda a gama de doenças associadas à obesidade como diabetes, hipertensão arterial, dislipidemia (aumento do colesterol e triglicerídeos), apneia do sono, artropatias (doença das articulações) e sem contar a baixa auto-estima e problemas psicológicos ou psiquiátricos.

De volta à obesidade - Devemos levar em consideração os motivos pelos quais os pacientes reganham peso. Os maus hábitos dietéticos como a ingesta abusiva de doces e álcool, o sedentarismo, a escolha inadequada da técnica cirúrgica e o rápido esvaziamento dos alimentos do novo estômago pela dilatação ou confecção maior da anastomose gastrointestinal (costura entre o estômago novo e o intestino desviado) devem ser investigados. Uma boa conversa com o paciente, avaliação nutricional e psicológica ou psiquiátrica no pré-operatório, bem como o incentivo à atividade física e aos retornos com a equipe multidisciplinar são de fundamental importância para evitar o insucesso da cirurgia bariátrica. Com relação à anastomose gastrointestinal (junção cirúrgica entre segmentos do intestino), várias técnicas para redução do seu calibre vêm sendo tentadas, porém sem muitos resultados animadores. Quanto maior o calibre desta anastomose, mais rápido o esvaziamento gástrico e consequentemente maior a ingesta alimentar. O contrário é verdadeiro, ou seja, quanto menor o diâmetro desta “saída” do novo estômago operado, mais lento será o esvaziamento gástrico e mais precoce será a saciedade alimentar do paciente.

Uma nova modalidade de procedimento endoscópico que visa reduzir o diâmetro da saída do estômago operado em pacientes já submetidos à cirurgia bariátrica e que estão reganhando peso, vem sendo desenvolvido pelo Serviço de Endoscopia do Hospital VITA Batel – Endobatel. Trata-se da fulguração (coagulação) com plasma de argônio. O plasma de argônio ganhou importância no campo da endoscopia digestiva desde a década passada. Esta técnica promove uma termocoagulação da mucosa da anastomose gastrointestinal e consequentemente uma redução do seu calibre. Com isso, o esvaziamento gástrico é retardado e a saciedade alimentar do paciente torna-se mais precoce.

O procedimento é ambulatorial, ou seja, o paciente recebe alta logo após despertar da sedação que é realizada sob a supervisão de um médico anestesiologista. São realizadas no mínimo três sessões com intervalo de seis a oito semanas entre cada uma delas. Os resultados iniciais são animadores, porém o paciente deve ser encorajado a realizar atividade física e acompanhamento psicológico.

A vantagem de tudo isso é que o procedimento é minimamente invasivo, não necessitando de outra cirurgia; praticamente isento de riscos e completamente bem tolerado pelos pacientes. A ideia é que isto se torne mais uma arma no vasto arsenal terapêutico disponível no auxílio do número cada vez maior de obesos em todo mundo.

Dr. Giorgio Baretta, cirurgião bariátrico e endoscopista do Hospital VITA Batel

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