EVERSON LUIZ DE ALMEIDA ARTIFON
Projetos de Pesquisa
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LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina - Líder
163 resultados
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- EUS-Guided Biliary Drainage Versus ERCP in Malignant Biliary Obstruction Before Hepatobiliary Surgery(2023) TYBERG, Amy; SARKAR, Avik; SHAHID, Haroon M.; SHAH-KHAN, Sardar M.; GAIDHANE, Monica; SIMON, Alexa; EISENBERG, Ian A.; LAJIN, Michael; KARAGYOZOV, Petko; LIAO, Kelvin; PATEL, Roohi; ZHAO, Eric; MARTINEZ, Ma Guadalupe; ARTIFON, Everson L.; LINO, Andre D.; VANELLA, Giuseppe; ARCIDIACONO, Paolo G.; KAHALEH, MichelIntroduction:Endoscopic ultrasound-guided biliary drainage (EUS-BD) is the procedure of choice for patients who cannot undergo endoscopic retrograde cholangiopancreatography (ERCP). The outcomes of patients undergoing surgery after EUS-BD for malignancy are unknown.Methods:We conducted an international, multicenter retrospective comparative study of patients who underwent hepatobiliary surgery after having undergone EUS-BD or ERCP from 6 tertiary care centers. Patient demographics, procedural data, and follow-up care were collected in a registry.Results:One hundred forty-five patients were included: EUS-BD n=58 (mean age 66, 45% male), ERCP n=87 (mean age 68, 53% male). The majority of patients had pancreatic cancer, cholangiocarcinoma, or gallbladder malignancy. In the EUS-BD group, 29 patients had hepaticogastrostomy, 24 had choledochoduodenostomy, and 5 had rendezvous technique done. The most common surgery was Whipple in both groups (n=41 EUS-BD, n=56 ERCP) followed by partial hepatectomy (n=7 EUS-BD, n=14 ERCP) and cholecystectomy (n=2 EUS-BD, n=2 ERCP). Endoscopy clinical success was comparable in both groups (98% EUS-BD, 94% ERCP). Adverse event rates were similar in both groups: EUS-BD (n=10, 17%) and ERCP (n=23, 26%). Surgery technical success and clinical success were significantly higher in the EUS-BD group compared with the ERCP group (97% vs. 83%, 97% vs. 75%). Total Hospital stay from surgery to discharge was significantly higher in the ERCP group (19 d vs. 10 d, P=0.0082).Discussion:Undergoing EUS-BD versus ERCP before hepatobiliary surgery is associated with fewer repeat endoscopic interventions, shorter duration between endoscopy and surgical intervention, higher rates of surgical clinical success, and shorter length of hospital stay after surgery.
- Endoscopic Ultrasonography–Guided Hemostasis Techniques(2017) ARTIFON, E. L. D. A.; MARSON, F. P.; KHAN, M. A.Endoscopic ultrasonography (EUS)–guided hemostasis is an evolving technique that has the potential to improve the care of patients with refractory variceal and nonvariceal gastrointestinal bleeding. EUS-guided treatment of fundal varices with coil and/or cyanoacrylate seems to be highly effective in active bleeding, as well as for primary and secondary bleeding prophylaxis. Reports of EUS-guided treatment of refractory nonvariceal sources of bleeding are more scarce, but show high success rates. The procedures involve a medium to high technical difficulty level, and this has been replicated worldwide. © 2017 Elsevier Inc.
conferenceObject EUS-FNA OF PANCREATIC SOLID MASSES: A PROSPECTIVE RANDOMIZED TRIAL COMPARING SUCTION WITH SLOW PULL(2018) CHENG, Spencer; DANIELLE, Chacon A.; ARTIFON, Everson L.; MATUGUMA, Sergio E.; SANTOS, Marcos E. dos; SAKAI, Christiano M.; CHAVES, Dalton; MOURA, Diogo T. De; MOURA, Eduardo T.- Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography(2016) KHASHAB, Mouen A.; MERWE, Schalk Van der; KUNDA, Rastislav; ZEIN, Mohamad H. El; TEOH, Anthony Y.; MARSON, Fernando P.; FABBRI, Carlo; TARANTINO, Ilaria; VARADARAJULU, Shyam; MODAYIL, Rani J.; STAVROPOULOS, Stavros N.; PENAS, Irene; NGAMRUENGPHONG, Saowanee; KUMBHARI, Vivek; ROMAGNUOLO, Joseph; SHAH, Raj; KALLOO, Anthony N.; PEREZ-MIRANDA, Manuel; ARTIFON, Everson L.Background and aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. Patients and methods: Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50% at 2 weeks or to below 3mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon's severity grading system. Overall survival and duration of stent patency were calculated using Kaplan-Meier analysis. Results: A total of 96 patients (mean age 66 years, female 45%, pancreatic cancer 55%) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8%) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5%) patients. A total of 10 (10.5%) adverse events occurred: pneumoperitoneum (n=2), sheared wire (n=1), bleeding (n=1), bile leak (n=3), cholangitis (n=2), and unintentional perforation (n=1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44%) patients died of disease progression during the study period. The median patient survival was 167 days (95%CI 112-221) days. The 6-month stent patency rate was 95% (95%CI 94.94-95.06%) and the 1-year stent patency was 86% (95%CI 85.74-86.26%). Conclusion: This study on EUS-BD demonstrates excellent efficacy and safety of EUS-BD when performed by experts. Study registration: NCT01889953
bookPart Balões intragástricos na obesidade(2014) SOUZA, Thiago Ferreira de; ALBERS, Débora da Costa Vieira; MOURA, Eduardo Guimarães Hourneaux de; ARTIFON, Everson Luiz de Almeida- Robotic endoscopy. A review of the literature(2020) VISCONTI, Thiago Arantes de Carvalho; OTOCH, Jose Pinhata; ARTIFON, Everson Luiz de AlmeidaPurpose: To present new endoscopic robotic devices in the context of minimally invasive procedures with high precision and automation. Methods: Review of the literature by December 2018 on robotic endoscopy. Results: We present the studies and investments for robotic implementation and flexible endoscopy evolution. We divided them into forceps manipulation platforms, active endoscopy and endoscopic capsule. They try to improve forceps handling and stability and to promote active movement. Conclusion: The implementation and propagation of robotic models depend on doing what the endoscopist is unable to. The new devices are moving forward in this direction.
bookPart Drenagem biliar e pancreática ecoguiada(2014) ARTIFON, Everson Luiz de Almeida; CHENG, Spencer; UEMURA, Ricardo SatobookPart Endoscopia de Alta Tecnologia de Imagem(2015) CASTAñO, Rodrigo; CABARCAS, Edilberto Nuñez; FAVARO, Gabriel; OTOCH, José Pinhata; ARTIFON, Everson L. A.bookPart Coledocolitíase(2014) ARTIFON, Everson Luiz de Almeida; BARACAT, Renato; KUGA, Rogério; FRANZINI, Tomazo A. Prince- Virtual reality simulator versus box-trainer to teach minimally invasive procedures: A meta-analysis(2019) GUEDES, Hugo Goncalo; FERREIRA, Zemia Maria Camara Costa; LEAO, Layra Ribeiro de Sousa; MONTERO, Edna Frasson Souza; OTOCH, Jose Pinhata; ARTIFON, Everson Luiz de AlmeidaBackground: To evaluate the effectiveness of virtual reality simulator (VRS) training compared to box-trainer training (BT) for learning outcomes in minimally invasive surgery (MIS) techniques. Materials and Methods: A systematic review of the literature was performed using CENTRAL, MEDLINE, EMBASE, Scopus, CINAHL, LILACS. The primary outcomes were time to perform MIS and performance score in MIS. After being selected, the articles were evaluated for methodological quality and risk of bias. The results were evaluated for quality of evidence and meta-analysis was performed. Results: 20 randomized clinical trials were included in the qualitative analysis and 14 were used in the meta-analysis. VRS training was more efficient than BT training (P < 0.00001, 95% CI: 35.08 to -25.01) when evaluating participant time needed to complete the peg task. In descriptive analysis, VRS training was better than BT training in participant performance score to perform MIS. There was no statistical difference in the meta-analysis in the time needed to perform surgery, time to complete basic or advanced tasks and performance score for basic or advanced tasks. Conclusions: VRS training was better than BT training in participant performance scores when performing MIS and in the time needed to complete the basic task of peg transfer. In all other outcomes, regardless of the student's level of experience or type of activity, the two forms of training were equivalent.