DENIS PAJECKI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
15 resultados
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Agora exibindo 1 - 10 de 15
- Comment on: Sleeve gastrectomy versus Roux-En-Y gastric bypass in patients aged >= 65 years: a comparison of short-term outcomes(2021) DANTAS, Anna Carolina Batista; PAJECKI, Denis; SANTO, Marco Aurelio
conferenceObject ROBOTIC-ASSISTED REVISIONAL ROUX-EN-Y GASTRIC BYPASS FOR LARGE HIATAL HERNIA AND MASSIVE INTRATHORACIC SLEEVE MIGRATION(2023) SANTO FILHO, Marco Aurelio; DANTAS, Anna Carolina Batista; ARABI, Arthur Youssif Mota; PAJECKI, Denis; SANTO, Marco AurelioconferenceObject LIVER FUNCTION IMPROVEMENT AFTER BARIATRIC SURGERY: USING THE INDOCYANINE GREEN TEST IN THE FOLLOW-UP OF OBESE PATIENTS NASH and bariatric surgery(2019) SILVA, M. B. D. B. E.; MESQUITA, G. H. A. D.; DANTAS, A. C. B.; MOTA, F. C.; KAWAMOTO, F. M.; PAJECKI, D.; RICCIOPPO, D.; CLEVA, R. D.; ANDRAUS, W.; SANTO, M. A.; CECCONELLO, I.- OBESITY AND SEVERE STEATOSIS: THE IMPORTANCE OF BIOCHEMICAL EXAMS AND SCORES(2021) SILVA, Miller Barreto de Brito e; TUSTUMI, Francisco; DANTAS, Anna Carolina Batista; MIRANDA, Barbara Cristina Jardim; PAJECKI, Denis; DE-CLEVA, Roberto; SANTO, Marco Aurelio; NAHAS, Sergio CarlosINTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is considered a public health problem, mainly in severely obese patients. OBJECTIVE: The aim of the present study was to investigate different biochemical-based scores available and determine which one could best serve as an NAFLD predicting tool in a severely obese population. METHODS: This was a cross-sectional study involving severely obese patients. All patients were evaluated with serum laboratory parameters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery. RESULTS: A total of 143 severely obese patients were included. The median body mass index (BMI) was 48 kg/m(2) (35-65). Diabetes mellitus was present in 36%, and steatosis was present in 93% (severe steatosis in 20%). Only aspartate transaminase (AST) to platelet ratio index (APRI=0.65 (95% CI: 0.55-0.8) and homeostatic model assessment for insulin resistance (HOMA-IR=0.7 (95% CI: 0.58-0.82) showed significant capacity for the prediction of severe steatosis. Hepatic steatosis index (HSI), NAFLD fibrosis score (NAFLDS), alanine aminotransferase (ALT)/AST, and fibrosis-4 (FIB-4) were not able to correctly predict severe steatosis on liver biopsy. APRI showed high specificity of 82% and low sensitivity of 54%. In contrast, HOMA-IR showed high sensitivity of 84% and low specificity of 48%. CONCLUSIONS: NAFLDS, FIB-4, AST/ALT, and HSI have no utility for the evaluation of severe steatosis in severely obese patients. Diabetes and insulin-resistance-related biochemical assessments, such as HOMA-IR, can be used as good screening tools for severe steatosis in these patients. APRI score is the most specific biochemical diagnostic tool for steatosis in severely obese patients and can help clinicians to decide the need for bariatric or metabolic surgery.
- Reply to comment on Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in the Elderly: 1-Year Preliminary Outcomes in a Randomized Trial (BASE Trial)(2022) PAJECKI, Denis; DANTAS, Anna Carolina Batista
- FOOD TOLERANCE AND NUTRITIONAL RISK AFTER SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS IN ELDERLY PATIENTS WITH SEVERE OBESITY: A PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL(2022) MEDEIROS, Veronica Garcia de; PAJECKI, Denis; DIAS, Maria Carolina Gonçalves; DANTAS, Anna Carolina Batista; CLEVA, Roberto de; SANTO, Marco AurelioABSTRACT Background: Bariatric surgery is still controversial in elderly patients with severe obesity. Most publications focus on safety and early clinical outcomes. Food tolerance and nutritional postoperative risk is unknown for this population. Methods: Thirty-six elderly patients with severe obesity were recruited for an open-label randomized trial from September 2017 to May 2019 comparing laparoscopic sleeve gastrectomy (LSG) to Roux-en-Y Gastric Bypass (LRYGB). Food tolerance was accessed by Quality of Alimentation (QoA) questionnaire and data on weight loss, body composition, and nutritional risk were collected between 6 and 24 months after surgery. Results: Comparing LSG to LRYGB patients, the latter had higher total weight loss (22% vs 31%, P=0.01) and excess weight loss (53% vs 68%, P=0.01). Food tolerance to eight food groups was similar between groups (14 vs 15 points, P=0.270), as Suter score (23 vs 25, P=0.238). Daily protein intake was below recommendation in both groups (40 vs 51 g/d, P=0.105). Nutritional risk, evaluated through Standardized Phase Angle (-1.48 vs -1.99, P=0.027), was worse for LRYGB group. Conclusion: Food tolerance and adequacy of food consumption were similar in both groups. LRYGB patients had higher nutritional risk.
- One-Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass as Revisional Surgery After Sleeve Gastrectomy: a Systematic Review and Meta-analysis(2022) DANTAS, Anna Carolina Batista; BRANCO, Leonardo Torres; TUSTUMI, Francisco; OLIVEIRA, Daniel Riccioppo Cerqueira Ferreira de; PAJECKI, Denis; SANTO, Marco AurelioThe demand for revisional bariatric surgery after sleeve gastrectomy (SG) has increased, but the ideal procedure remains unclear. A systematic review and meta-analysis were performed to compare the outcomes of weight loss and safety of one-anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) as revisional procedures for failed SG. Four retrospective comparative studies were included, comprising 499 individuals. Patients submitted to OAGB had a more significant total weight loss (TWL) (MD = - 5.89%; 95% CI - 6.80 to - 4.97) after revisional surgery. Overall early complication rate was similar between procedures (RD = 0.04; 95% CI: - 0.05 to 0.12). Limited and heterogeneous data prevent meaningful conclusions, but the present analysis suggests that OAGB has a better TWL after revisional surgery.
- Bariatric surgery in the elderly: a randomized prospective study comparing safety of sleeve gastrectomy and Roux-en-Y gastric bypass (BASE Trial)(2020) PAJECKI, Denis; DANTAS, Anna Carolina Batista; KANAJI, Ana Lumi; OLIVEIRA, Daniel Riccioppo Cerqueira Ferreira de; CLEVA, Roberto de; SANTO, Marco AurelioBackground: The aging population along with the obesity epidemic has increased the number of older patients undergoing bariatric surgery. Nevertheless, there is still conflicting data regarding surgical safety in this population. Objectives: The aim of this study was to compare the surgical morbidity of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for older patients. Setting: University hospital, Sao Paulo, Brazil. Methods: We performed a prospective randomized clinical trial from September 2017 to May 2019. Obese patients aged >= 65 years were randomized to LSG or LRYGB. Data collection included demographic information, body mass index (BMI), and co-morbidities. We assessed readmission, postoperative complications, and mortality. Complications were scored according to Clavien-Dindo classification. Results: A total of 36 patients, with a BMI between 35.5 and 52.8 kg/m(2) were randomized to either LSG (18 patients) or LRYGB (18 patients). The overall complication rate was similar between LSG and LRYGB (3 versus 7, P=.13). Severe complication was more prevalent in LRYGB patients but had no statistically significant difference (0 versus 3, P=.07). Each group had 1 readmission and there was no mortality in 90-day follow-up. Conclusions: Morbidity and mortality rates of bariatric surgery are low in elderly obese patients. Despite not statistically significant, LSG had a lower rate of severe complications compared with LRYGBin this population setting.
bookPart Cuidados pré e pós-operatórios do paciente bariátrico(2023) PAJECKI, Denis; DANTAS, Anna Carolina Batista; RICCIOPPO, Daniel; MARQUES, Fábio Israel Lima Castelo Branco; SANTO, Marco Aurelio- IMPACT OF HELICOBACTER PYLORI ON EARLY POSTOPERATIVE COMPLICATIONS AFTER SLEEVE GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS(2023) DANTAS, Anna Carolina Batista; JAYME, Vitoria Ramos; FILARDI, Kaique Flavio Xavier Cardoso; PAJECKI, Denis; SANTO, Marco AurelioThe impact of Helicobacter pylori (HP) on postoperative outcomes after sleeve gastrectomy (SG) is still controversial. A systematic review and meta-analysis were performed to compare the incidence of early complications after SG between HP-positive and HP-negative patients. Eight retrospective comparative studies were included, comprising 4,877 individuals. The prevalence of HP infection in gastric resected specimens ranged from 7.77 to 43.20%. There were no statistically significant differences between groups for overall complications (OR 1.46; 95%CI 0.95-2.23; p=0.08), bleeding (OR 1.35; 95%CI 0.70-2.60; p=0.38), and leak (OR 1.74; 95%CI 0.80-3.81; p=0.17) rates. The need for routine screening and treatment of HP infection before SG remains ambiguous.