RICARDO SATO UEMURA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina
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- Comparison of the pull and introducer percutaneous endoscopic gastrostomy techniques in patients with head and neck cancer(2017) RETES, Felipe A.; KAWAGUTI, Fabio S.; LIMA, Marcelo S. de; MARTINS, Bruno da Costa; UEMURA, Ricardo S.; PAULO, Gustavo A. de; PENNACCHI, Caterina M. P.; GUSMON, Carla; RIBEIRO, Adriana V. S.; BABA, Elisa R.; GEIGER, Sebastian N.; SORBELLO, Mauricio P.; KULCSAR, Marco A.; RIBEIRO JR., Ulysses; MALUF-FILHO, FauzeBackground and study aims: Percutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients is associated with higher complication and mortality rates when compared to a general patient population. The pull technique is still the preferred technique worldwide but it has some limitations. The aim of this study is to compare the pull and introducer PEG techniques in patients with HNC. Patients and methods: This study is based on a retrospective analysis of a prospectively collected database of 309 patients with HNC who underwent PEG in the Cancer Institute of SAo Paulo. Results: The procedure was performed with the standard endoscope in 205 patients and the introducer technique was used in 137 patients. There was one procedure-related mortality. Age, sex and albumin level were similar in both groups. However in the introducer technique group, patients had a higher tumor stage, a lower Karnofsky status, and presented more frequently with tracheostomy and trismus. Overall, major, minor, immediate and late complications and 30-day mortality rates were similar but the introducer technique group presented more minor bleeding and tube dysfunctions. Conclusion: The push and introducer PEG techniques seem to be both safe and effective but present different complication profiles. The choice of PEG technique in patients with HNC should be made individually.
article Pancreatic Metastasis from Papillary Thyroid Carcinoma: A Case Report(2020) MACHADO, Andressa A.; LENZ, Luciano; DOMINGUES, Regina B.; LIMA, Gustavo R. A.; JOSINO, Iatagan R.; CORDERO, Martin A. C.; V, Adriana Safatle-Ribeiro; MARTINS, Bruno C.; PENNACCHI, Caterina M. P. S.; GUSMON, Carla C.; PAULO, Gustavo A.; LIMA, Marcelo S.; BABA, Elisa R.; KAWAGUTI, Fabio S.; UEMURA, Ricardo S.; MALUF-FILHO, FauzeIntroduction differentiated thyroid carcinoma presents with distant metastasis in 4% of cases, usually occurring in the lungs, bones and thoracic lymph nodes. Pancreatic involvement is extremely rare, with few cases reported in the literature. Case report A 47-years-old female patient presented abdominal pain. She had a history of papillary thyroid carcinoma surgically resected in 2009. After 10 years, computed tomography revealed hepatic lesions suggestive of secondary involvement and a solid mass in the pancreatic head. Endoscopic ultrasound fine-needle aspiration was performed in a heterogeneous hypoechoic mass located at pancreatic head. Cell block with immunohistochemistry was positive for thyroglobulin, suggesting papillary thyroid carcinoma metastasis. The patient still survives at present, treating metastasis with Cabozantinib. Conclusion endoscopic ultrasound fine-needle aspiration is a minimally invasive and accurate method of sampling lesions of the pancreas. In combination with clinical history and immunohistochemistry, can confirm diagnosis and define management.- Endoscopic Injection of Mitomycin C for the Treatment of Pharyngoesophageal Stenosis Refractory to Endoscopic Treatment with Dilatation in Patients Treated for Head and Neck Cancer(2018) GUSMON-OLIVEIRA, Carla Cristina; KUBOKI, Yeda Mayumi; PAULO, Gustavo Andrade de; LIMA, Marcelo Simas de; UEMURA, Ricardo Sato; MARTINS, Bruno Costa; TOLENTINO, Luciano Lenz; SAFATLE-RIBEIRO, Adriana Vaz; KULCSAR, Marco Aurelio; RIBEIRO JR., Ulysses; MALUF-FILHO, FauzeBackground. Management of pharyngoesophageal stenosis (PES) in patients after head and neck cancer (HNC) treatment remains a challenge. It is not uncommon that PES is refractory to dilation sessions. This study aimed at evaluating the efficacy of Mitomycin C (MMC) endoscopic injection for the treatment of refractory pharyngoesophageal stenosis. Patients and methods. This is a prospective study in patients with dysphagia following head and neck cancer treatment, without evidence suggestive of tumor recurrence, and refractory to endoscopic treatment. These patients were submitted to endoscopic dilation of the stenotic segment with thermoplastic bougies, followed by injection of MMC. We repeated the endoscopic sessions every three weeks. Results. From January 2015 to May 2015, we treated 13 patients with PES. Three patients were initially enrolled in the study for refractory stricture. We observed adverse events in all of them, with intense neck pain and ulcer development, justifying the interruption of the trial. Conclusion. The repeated injection in the short interval of MMC in refractory PES is not recommended, because it resulted in serious adverse events.
conferenceObject COMPARISON OF PLASTIC STENTS AND SELF-EXPANDING METAL STENTS IN THE ENDOSCOPIC DRAINAGE OF MALIGNANT HILAR BILIARY OBSTRUCTION(2023) MENDIETA, Pastor Joaquin Ortiz; MARTINS, Bruno; CENTENO, Deborah; GREGORIO, Julia; SUETA, Rafael; SAFATLE-RIBEIRO, Adriana; PENNACCHI, Caterina; GUSMON, Carla; KAWAGUTI, Fabio; PAULO, Gustavo De; LENZ, Luciano; LIMA, Marcelo; UEMURA, Ricardo; NOBRE, Renata; GEIGER, Sebastian; MALUF-FILHO, FauzeconferenceObject COMPARISON OF PLASTIC STENTS AND SELFEXPANDING METAL STENTS IN THE ENDOSCOPIC DRAINAGE OF MALIGNANT HILAR BILIARY OBSTRUCTION(2023) MENDIETA, Pastor Joaquin Ortiz; MARTINS, Bruno; CENTENO, Deborah; GREGORIO, Julia; SUETA, Rafael; SAFATLE-RIBEIRO, Adriana; PENNACCHI, Caterina; GUSMON, Carla; KAWAGUTI, Fabio; PAULO, Gustavo De; LENZ, Luciano; LIMA, Marcelo; UEMURA, Ricardo; NOBRE, Renata; GEIGER, Sebastian; MALUF, FauzeconferenceObject THE ROLE OF PROBE-BASED CONFOCAL ENDOMICROSCOPY (PCLE) IN THE DIAGNOSIS OF SUSTAINED CLINICAL COMPLETE RESPONSE UNDER WATCH-AND-WAIT STRATEGY AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR LOCALLY ADVANCED RECTAL ADENOCARCINOMA(2022) SAFATLE-RIBEIRO, Adriana V.; LATA, John; FERREIRA, Marina Tucci Gammaro Baldavira; FLOR, Marcelo M.; PEREZ, Caio; BABA, Elisa R.; LENZ, Luciano H.; MARTINS, Bruno Da Costa; KAWAGUTI, Fabio S.; PAULO, Gustavo A. De; LIMA, Marcelo S. De; MOURA, Renata N.; PENNACCHI, Caterina; GUSMON, Carla; GEIGER, Sebastian; UEMURA, Ricardo; NAHAS, Caio Sergio R.; MARQUES, Carlos F.; IMPERIALE, Antonio R.; COTTI, Guilherme C.; RIBEIRO, Ulysses; MALUF-FILHO, Fauze; NAHAS, Sergio C.- Results of endoscopic biliary drainage in patients with malignant hilar stricture(2023) MARTINS, Bruno Costa; PEREZ, Caio A.; RUAS, Jennifer N.; BENTO, Luiza H.; MENDONCA, Ernesto Q.; PAULO, Gustavo A. de; UEMURA, Ricardo S.; GEIGER, Sebastian N.; LIMA, Marcelo Simas de; JUKEMURA, Jose; JR, Ulysses Ribeiro; MALUF-FILHO, FauzeIn Malignant Hilar Biliary Stricture (MHBS) palliative biliary drainage is a frequent strategy, improving the qual-ity of life, reducing pruritus, loss of appetite and relieving cholangitis. The endoscopic approach is an effective, although challenging procedure. This study aimed to evaluate technical and clinical success rates of biliary drain-age by ERCP. This is a retrospective study including all patients with MHBS referred to Instituto do Cancer do Hos-pital de Sao Paulo (ICESP) submitted to biliary drainage by ERCP, between January 2010 and December 2017. Multivariable logistic regression was performed to evaluate predictors of clinical failure, as total bilirubin levels, Bismuth classification, number of hepatic sectors drained and presence of cholangitis. In total, 82 patients pre-senting unresectable MHBS were included in this study. 58.5% female and 41.5% male, with a mean age of 60 +/- 13 years. Bismuth classification grades II, IIIA, IIIB and IV were noted in 23.2%, 15.9%, 14.6% and 46.3%, respectively. Technical and clinical success was achieved in 92.7% and 53.7% respectively. At multivariable logis-tic-regression analyses, Bismuth IV strictures were related to higher clinical failure rates when compared to other strictures levels, with an Odds Ratio of 5.8 (95% CI 1.28-20.88). In conclusion, endoscopic biliary drainage for malignant hilar biliary stricture had a high technical success but suboptimal clinical success rate. Proximal stric-tures (Bismuth IV) were associated with poor drainage outcomes.
conferenceObject COMPARISON OF PLASTIC STENTS AND SELF-EXPANDING METAL STENTS IN THE ENDOSCOPIC DRAINAGE OF MALIGNANT HILAR BILIARY OBSTRUCTION(2023) MENDIETA, Pastor Joaquin Ortiz; MARTINS, Bruno; CENTENO, Deborah; GREGORIO, Julia; SUETA, Rafael; SAFATLE-RIBEIRO, Adriana; PENNACCHI, Caterina; GUSMON, Carla; KAWAGUTI, Fabio; PAULO, Gustavo De; LENZ, Luciano; LIMA, Marcelo; UEMURA, Ricardo; NOBRE, Renata; GEIGER, Sebastian; MALUF-FILHO, Fauze- Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer(2023) MACHADO, Andressa A.; MARTINS, Bruno C.; JOSINO, Iatagan R.; CHEN, Andre T. C.; HONG, Carlos B. C.; SANTOS, Alisson L. D. R.; LIMA, Gustavo R. A.; CORDERO, Martin A. C.; V, Adriana Safatle-Ribeiro; PENNACCHI, Caterina; GUSMON, Carla C.; PAULO, Gustavo A.; LENZ, Luciano; LIMA, Marcelo S.; BABA, Elisa R.; KAWAGUTI, Fabio S.; UEMURA, Ricardo S.; SALLUM, Rubens A. A.; JR, Ulysses Ribeiro; MALUF-FILHO, FauzeSelf-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.
conferenceObject NEAR FOCUS HIGH-DEFINITION ENDOSCOPY FOR THE DETECTION OF GASTRIC INFECTION BY HELICOBACTER PYLORI(2021) FIUZA, Felipe; MALUF-FILHO, Fauze; MARTINS, Bruno; ARAUJO, Gabriela A.; STABACH, Luciana; RUAS, Jennifer N.; IDE, Edson; FURUYA, Carlos K.; FYLYK, Sonia N.; MATUGUMA, Sergio E.; UEMURA, Ricardo S.; YAMAZAKI, Kendi; SAKAI, Christiano M.; SAKAI, Paulo; UEDA, Sergio S.