JOEL FERNANDEZ DE OLIVEIRA
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
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- II Brazilian consensus statement on endoscopic ultrasonography(2017) MALUF-FILHO, Fauze; OLIVEIRA, Joel Fernandez de; MENDONCA, Ernesto Quaresma; CARBONARI, Augusto; MACIENTE, Bruno Antonio; SALOMAO, Bruno Chaves; MEDRADO, Bruno Frederico; DOTTI, Carlos Marcelo; LOPES, Cesar Vivian; BRAGA, Claudia Utsch; DUTRA, Daniel Alencar M.; RETES, Felipe; NAKAO, Frank; SOUSA, Giovana Biasia de; PAULO, Gustavo Andrade de; ARDENGH, Jose Celso; SANTOS, Juliana Bonfim dos; SAMPAIO, Luciana Moura; OKAWA, Luciano; ROSSINI, Lucio; CARDOSO, Manoel Carlos de Brito; CAMUNHA, Marco Antonio Ribeiro; CLARENCIO, Marcos; SANTOS, Marcos Eduardo Lera dos; FRANCO, Matheus; SCHNEIDER, Nutianne Camargo; MASCARENHAS, Ramiro; RODA, Rodrigo; MATUGUMA, Sergio; GUARALDI, Simone; FIGUEIREDO, VivianeBackground and Objectives: At the time of its introduction in the early 80s, endoscopic ultrasonography (EUS) was indicated for diagnostic purposes. Recently, EUS has been employed to assist or to be the main platform of complex therapeutic interventions. Methods: From a series of relevant new topics in the literature and based on the need to complement the I Brazilian consensus on EUS, twenty experienced endosonographers identified and reviewed the pertinent literature in databases. The quality of evidence, strength of recommendations, and level of consensus were graded and voted on. Results: Consensus was reached for eight relevant topics: treatment of gastric varices, staging of nonsmall cell lung cancer, biliary drainage, tissue sampling of subepithelial lesions (SELs), treatment of pancreatic fluid collections, tissue sampling of pancreatic solid lesions, celiac neurolysis, and evaluation of the incidental pancreatic cysts. Conclusions: There is a high level of evidence for staging of nonsmall cell lung cancer; biopsy of SELs as the safest method; unilateral and bilateral injection techniques are equivalent for EUS-guided celiac neurolysis, and in patients with visible ganglia, celiac ganglia neurolysis appears to lead to better results. There is a moderate level of evidence for: yield of tissue sampling of pancreatic solid lesions is not influenced by the needle shape, gauge, or employed aspiration technique; EUS-guided and percutaneous biliary drainage present similar clinical success and adverse event rates; plastic and metallic stents are equivalent in the EUS-guided treatment of pancreatic pseudocyst. There is a low level of evidence in the routine use of EUS-guided treatment of gastric varices.
- Reality named endoscopic ultrasound biliary drainage(2015) GUEDES, Hugo Goncalo; LOPES, Roberto Iglesias; OLIVEIRA, Joel Fernandez de; ARTIFON, Everson Luiz de AlmeidaEndoscopic ultrasound (EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangiography, but nowadays it emerges as a powerful therapeutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage (EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retrograde cholangiopancreatography (ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or transpapillary, which, again, can be antegrade or retrograde [rendezvous (EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology.
- Validation of classic and expanded criteria for endo-scopic submucosal dissection of early gastric cancer: 7 years of experience in a Western tertiary cancer center(2018) MENDONCA, Ernesto Quaresma; PESSORRUSSO, Fernanda Cristina Simoes; RAMOS, Marcus Fernando Kodama Pertille; JACOB, Carlos Eduardo; OLIVEIRA, Joel Fernandez de; RIBEIRO, Maria Sylvia; SAFATLE-RIBEIRO, Adriana; ZILBERSTEIN, Bruno; RIBEIRO JUNIOR, Ulysses; MALUF-FILHO, FauzeOBJECTIVE: Our aim was to evaluate the Japan Gastroenterological Endoscopy Society criteria for endoscopic submucosal resection of early gastric cancer (EGC) based on the experience in a Brazilian cancer center. METHODS: We included all patients who underwent endoscopic submucosal resection for gastric lesions between February 2009 and October 2016. Demographic data and information regarding the endoscopic resection, pathological report and follow-up were obtained. Statistical calculations were performed with Fisher's exact test and chi-square tests, with 95% confidence intervals. RESULTS: In total, 76% of the 51 lesions were adenocarcinomas, 16% were adenomas, and 8% had other diagnoses. The average size was 19.9 mm (+/- 11.7). The average procedure length was 113.9 minutes (+/- 71.4). The complication rate was 21.3%, with only one patient who needed surgical treatment (transmural perforation). Among the adenocarcinomas, 39.5% met the classic criteria for curability, 31.6% met the expanded criteria and 28.9% met the criteria for noncurative resection. Analysis of the indication criteria and curability revealed differences among cases with ""only-by-size"" expanded criteria (64.28%), other expanded criteria (40%) and classic criteria (89.47%), with a p-value of 0.049. During follow-up (15.8 months; +/- 14.3), 86.1% of the EGC patients had no recurrence. When well-differentiated and poorly differentiated lesions or lesions included in the classic and expanded criteria were compared, there were no differences in recurrence. The noncurative group presented a higher recurrence rate than the classic group (p=0.014). CONCLUSION: These results suggest that the Japanese endoscopic submucosal resection criteria might be useful for endoscopic treatment of EGC in Western countries.
- Argon plasma coagulation and radiofrequency ablation in nonvariceal upper gastrointestinal bleeding(2016) MENDONCA, Ernesto Quaresma; OLIVEIRA, Joel Fernandezde; MALUF-FILHO, FauzeUpper gastrointestinal bleeding (UGIB) is one of the most common causes of emergency department visits worldwide and represents a significant public health problem in many countries. Endoscopy plays a major role in the diagnosis and treatment of UGIB. Endoscopic hemostasis of peptic ulcer bleeding is preferably achieved by the combination of injection with contact thermal methods or mechanical methods. Argon plasma coagulation (APC) is a noncontact thermal method of hemostasis that has been employed to treat bleeding angioectasia. The use of APC in this situation presents satisfactory results with a low adverse event rate. APC presents the possibility to treat large bleeding areas in a single session. There is also a limited experience with the use of APC for peptic ulcer bleeding and bleeding from gastrointestinal neoplasia. More recently, radiofrequency ablation has been employed for the treatment of diffuse UGIB caused by angioectasias with promising results.