GUSTAVO ANDRADE DE PAULO
Índice h a partir de 2011
6
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
3 resultados
Resultados de Busca
Agora exibindo 1 - 3 de 3
- 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.
- Underwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trial(2023) LENZ, Luciano; MARTINS, Bruno; PAULO, Gustavo Andrade de; KAWAGUTI, Fabio Shiguehissa; BABA, Elisa Ryoka; UEMURA, Ricardo Sato; GUSMON, Carla Cristina; GEIGER, Sebastian Naschold; MOURA, Renata Nobre; PENNACCHI, Caterina; LIMA, Marcelo Simas de; SAFATLE-RIBEIRO, Adriana Vaz; HASHIMOTO, Claudio Lyoiti; RIBEIRO, Ulysses; MALUF-FILHO, FauzeBackground and aims: Conventional endoscopic mucosal resection (CEMR) is the standard modality for removing nonpedunculated colorectal lesions. Underwater endoscopic mucosal resection (UEMR) has emerged as an alternative method. There are few comparative studies between these techniques, especially evaluating recurrence. Therefore, the purpose of this trial was to compare CEMR and UEMR for the resection of colorectal lesions with respect to efficacy, safety, and recurrence rate. Methods: This was a randomized controlled trial of UEMR versus CEMR for naive and nonpedunculated lesions measuring between 10 and 40 mm. The primary outcome was adenoma recurrence at 6 months after the resec-tion. Secondary outcomes were rates of technical success, en bloc resection, and adverse events. Block random-ization was used to assign patients. Tattooing was performed to facilitate localization of the scars and eventual recurrences. Endoscopic follow-up was scheduled at 6 months after the procedure. The sites of resections were examined with white-light imaging, narrow-band imaging (NBI), and conventional chromoscopy with indigo carmine followed by biopsies. Results: One hundred five patients with 120 lesions were included, with a mean size of 17.5 +/- 7.1 (SD) mm. Sixty-one lesions were resected by UEMR and 59 by CEMR. The groups were similar at baseline regarding age, sex, average size, and histologic type. Lesions in the proximal colon in the CEMR group corresponded to 83% and in the UEMR group to 67.8% (P = .073). There was no difference between groups regarding success rate (1 failure in each group) and en bloc resection rate (60.6% UEMR vs 54.2% CEMR, P = .48). Intraprocedural bleeding was observed in 5 CEMRs (8.5%) and 2 UEMRs (3.3%) (P = .27). There was no perforation or delayed hemorrhage in either groups. Recurrence rate was higher in the CEMR arm (15%) than in the UEMR arm (2%) (P = .031). Therefore, the relative risk of 6-month recurrence rate in the CEMR group was 7.5-fold higher (95% CI, 0.98-58.20), with a number needed to treat of 7.7 (95% CI, 40.33-4.22). The higher recurrence rate in the CEMR group persisted only for lesions measuring 21 to 40 mm (35.7% vs 0%; P = .04). Conclusion: This study demonstrated that UEMR was associated with a lower adenoma recurrence rate than was CEMR. Both endoscopic techniques were effective and had similar rates of adverse events for the treatment of nonpedunculated colorectal lesions. (Gastrointest Endosc 2023;97:549-58.)
- The Role of Probe-Based Confocal Laser Endomicroscopy (pCLE) in the Diagnosis of Sustained Clinical Complete Response Under Watch-and-Wait Strategy After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Adenocarcinoma: a Score Validation(2023) SAFATLE-RIBEIRO, Adriana Vaz; JR, Ulysses Ribeiro; LATA, John; BABA, Elisa Ryoka; LENZ, Luciano; MARTINS, Bruno da Costa; KAWAGUTI, Fabio; MOURA, Renata Nobre; PENNACCHI, Caterina; GUSMON, Carla; LIMA, Marcelo Simas de; PAULO, Gustavo Andrade de; NAHAS, Caio Sergio; MARQUES, Carlos Frederico; IMPERIALE, Antonio Rocco; COTTI, Guilherme C. C.; MALUF-FILHO, Fauze; NAHAS, Sergio CarlosBackgroundWatch-and-wait strategy has been increasingly accepted for patients with clinical complete response (cCR) after multimodal treatment for locally advanced rectal adenocarcinoma. Close follow-up is essential to the early detection of local regrowth. It was previously demonstrated that probe-based confocal laser endomicroscopy (pCLE) scoring using the combination of epithelial and vascular features might improve the diagnostic accuracy of cCR.AimTo validate the pCLE scoring system in the assessment of patients with cCR after neoadjuvant chemoradiotherapy (nCRxt) for advanced rectal adenocarcinoma.MethodsDigital rectal examination, pelvic magnetic resonance imaging (MRI), and pCLE were performed in 43 patients with cCR, who presented either a scar (N = 33; 76.7%) or a small ulcer with no signs of tumor, and/or biopsy negative for malignancy (N = 10; 23.3%).ResultsTwenty-five (58.1%) patients were men, and the mean age was 58.4 years. During the follow-up, 12/43 (27.9%) patients presented local regrowth and underwent salvage surgery. There was an association between pCLE diagnostic scoring and final histological report (for patients who underwent surgical resection) or final diagnosis at the latest follow-up (p = 0.0001), while this association was not observed with MRI (p = 0.49). pCLE sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.7%, 93.5%, 80%, 88.9%, and 86%, respectively. MRI sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.7%, 48.4%, 66.7%, 78.9%, and 53.5%, respectively.ConclusionspCLE scoring system based on epithelial and vascular features improved the diagnosis of sustained cCR and might be recommended during follow-up. pCLE might add some valuable contribution for identifying local regrowth.Trial RegistrationThis protocol was registered at the Clinical Trials (ClinicalTrials.gov identifier NCT02284802).