JOEL FERNANDEZ DE OLIVEIRA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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  • article 37 Citação(ões) na Scopus
    Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis
    (2016) OLIVEIRA, J. F.; MOURA, E. G. H.; BERNARDO, W. M.; IDE, E.; CHENG, S.; SULBARAN, M.; SANTOS, C. M. L.; SAKAI, P.
    Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review. A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD. We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies, n = 85), the preventive therapy decreased the risk of stenosis (risk difference = -0.36, 95 % CI -0.55 to -0.18, P = 0.0001). Two studies (one randomized and one non-randomized, n = 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = -8.57, 95 % CI -13.88 to -3.25, P < 0.002). There were no significant differences in the three RCT studies (n = 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI -0.09 to 0.14, P = 0.68). The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.
  • article 2 Citação(ões) na Scopus
    Argon plasma coagulation and radiofrequency ablation in nonvariceal upper gastrointestinal bleeding
    (2016) MENDONCA, Ernesto Quaresma; OLIVEIRA, Joel Fernandezde; MALUF-FILHO, Fauze
    Upper 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.