PAULO SAKAI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
146 resultados
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- Narrow band imaging versus lugol chromoendoscopy to diagnose squamous cell carcinoma of the esophagus: a systematic review and meta-analysis(2017) MORITA, Flavio Hiroshi Ananias; BERNARDO, Wanderley Marques; IDE, Edson; ROCHA, Rodrigo Silva Paula; AQUINO, Julio Cesar Martins; MINATA, Mauricio Kazuyoshi; YAMAZAKI, Kendi; MARQUES, Sergio Barbosa; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux deBackground: In the early stage esophageal cancer, changes in the mucosa are subtle and pass unnoticed in endoscopic examinations using white light. To increase sensitivity, chromoscopy with Lugol's solution has been used. Technological advancements have led to the emergence of virtual methods of endoscopic chromoscopy, including narrow band imaging (NBI). NBI enhances the relief of the mucosa and the underlying vascular pattern, providing greater convenience without the risks inherent to the use of vital dye. The purpose of this systematic review and meta-analysis was to evaluate the ability of NBI to diagnose squamous cell carcinoma of the esophagus and to compare it to chromoscopy with Lugol's solution. Methods: This systematic review included all studies comparing the diagnostic accuracy of NBI and Lugol chromoendoscopy performed to identify high-grade dysplasia and/or squamous cell carcinoma in the esophagus. In the meta-analysis, we calculated and demonstrated sensitivity, specificity, and positive and negative likelihood values in forest plots. We also determined summary receiver operating characteristic (sROC) curves and estimates of the areas under the curves for both per-patient and per-lesion analysis. Results: The initial search identified 7079 articles. Of these, 18 studies were included in the systematic review and 12 were used in the meta-analysis, for a total of 1911 patients. In per-patient and per-lesion analysis, the sensitivity, specificity, and positive and negative likelihood values for Lugol chromoendoscopy were 92% and 98, 82 and 37%, 5.42 and 1.4, and 0.13 and 0.39, respectively, and for NBI were 88 and 94%, 88 and 65%, 8.32 and 2.62, and 0.16 and 0.12, respectively. There was a statistically significant difference in only specificity values, in which case NBI was superior to Lugol chromoendoscopy in both analyses. In the per-patient analysis, the area under the sROC curve for Lugol chromoendoscopy was 0.9559. In the case of NBI, this value was 0.9611; in the per-lesion analysis, this number was 0.9685 and 0.9587, respectively. Conclusions: NBI was adequate in evaluating the esophagus in order to diagnose high-grade dysplasia and squamous cell carcinoma. In the differentiation of those disorders from other esophageal mucosa alterations, the NBI was shown to be superior than Lugol.
- Endoscopic polymer injection and endoluminal plication in treatment of gastroesophageal reflux disease: evaluation of long-term results(2018) MOURA, Eduardo Guimaraes Hourneaux De; SAIIUM, Rubens A. A.; NASI, Ary; CORONEL, Martin; MOURA, Diogo Turiani Hourneaux De; MOURA, Eduardo Turiani Hourneaux De; MINATA, Mauricio Kazuyoshi; CURY, Marcelo; FALCAO, Angela; CECCONELLO, Ivan; SAKAI, PauloBackground and study aims Us of proton pump inhibitors (PPIs) has made endoscopic treatment of gastroesophageal reflux disease (GERD) more efficient, with reduction in morbidity and complications. However, some patients persist with symptoms despite medical treatment and some are not compliant with it or cannot afford it for financial reasons, and thus they require non-pharmacological therapeutic options such as surgical fundoplication. Surgery may be effective in the short term, but there is related morbidity and concern about its long-term efficacy. The possibility of minimally invasive endoluminal surgeries has resulted in interest in and development of newly endoscopic devices. Good short-term results with surgical fundoplication lack of studies of is with long follow-up justify our interest in this study. The aim of this study was to investigate the efficacy of endoscopic polymer injection and endoluminal full-thickness plication in the long-term control of GERD. Patients and methods Forty-seven patients with GERD who underwent an endoscopic procedure were followed up for 60 months and evaluated for total response (RT), partial response (RP) and no response (SR) to endoscopic treatment with reintroduction of PPIs. Results Twenty-one patients received polymer injection (G0) and 26 endoluminal plication (G1). The number of patients with no response to endoscopic treatment with reintroduction of PPIs increased in time for both techniques (G0 P = 0.006; G1 P < 0.001). There was symptomatic improvement up to 12 months, with progressive loss of this trending up to 60 months in G0 and G1 (P < 0.001). Health-related quality of life score (GERD-HRQL) demonstrated TR in G0 and G1 at 1, 3, 6 and 12 months. The 60-month analysis showed an increased number of patients with SR in both groups. The quality of life assessment (SF-36) showed benefit in G0 up to 3 months. G0 showed a higher rate of complications. There were no deaths. There was healing of esophagitis at 3 months in 45 % of patients in G0 and 40 % in G1. There was no improvement in manometric or pH findings. Conclusion Endoscopic therapies were ineffective in controlling GERD in the long term.
conferenceObject Traditional forward view versus wide view technology: polyp and adenoma detection rate in colonoscopy(2016) ROCHA, Rodrigo S.; KORKISCHKO, Nadia; SILVA, Gustavo L.; AQUINO, Julio Cesar M.; MORITA, Flavio H.; MOURA, Eduardo T. de; MOURA, Diogo T. de; OLIVEIRA, Joel; MENDONCA, Ernesto Q.; BRAVO, Jose G.; BARACAT, Felipe I.; SAKAI, Paulo; MOURA, Eduardo G. de- Comparison between Enteroscopy-Based and Laparoscopy-Assisted ERCP for Accessing the Biliary Tree in Patients with Roux-en-Y Gastric Bypass: Systematic Review and Meta-analysis(2018) PONTE-NETO, Alberto Machado da; BERNARDO, Wanderley M.; COUTINHO, Lara M. de A.; JOSINO, Iatagan Rocha; BRUNALDI, Vitor Ottoboni; MOURA, Diogo T. H.; SAKAI, Paulo; KUGA, Rogerio; MOURA, Eduardo G. H. deAlthough balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography (BAE-ERCP) is a well-described means of accessing the duodenal papilla in patients with Roux-en-Y gastric bypass (RYGB), it is associated with modest clinical success rates. Laparoscopy-assisted ERCP (LA-ERCP)performed by advancing a standard duodenoscope through a gastrostomy into the excluded stomach and duodenumhas emerged as a viable alternative to BAE-ERCP, with apparently higher success rates. In this systematic review, we compare LA-ERCP with enteroscopy-based techniques in post-RYGB patients, including 22 case series that provided data on papilla identification, papilla cannulation, and complications. We found that LA-ERCP was superior to the enteroscopy-based techniques in its capacity to reach the duodenal papilla, although complication rates were lower for the latter. Comparative studies are needed in order to corroborate our findings.
conferenceObject Reduced Transcobalamin I Gene Expression Following Roux-en-Y Gastric Bypass Surgery Can Contribute to B12 Deficiency(2015) SALA, Priscila; MACHADO, Natasha; BELARMINO, Giliane; ISHIDA, Robson; GUARDA, Ismael; GIANNELLA-NETO, Daniel; SANTO, Marco Aurelio; MOURA, Eduardo; SAKAI, Paulo; SILVA, Ismael; YE, Jianping; HEYMSFIELD, Steven; WAITZBERG, Dan- USEFULNESS OF GASTRIC SUBMUCOSAL DISSECTION DEPTH TO EVALUATE SKILL ACQUIREMENT IN SHORT TERM TRAINING COURSES IN ESD: AN EXPERIMENTAL STUDY(2018) YAMAZAKI, Kendi; MOURA, Eduardo Guimarães Hourneaux de; VERAS, Mariana Matera; MESTIERI, Luiz Henrique; SAKAI, PauloABSTRACT BACKGROUND: Endoscopic submucosal dissection (ESD) is a complex endoscopic procedure, with high rates of adverse events and technical difficulties. To overcome that problem, many training centers published the importance of animal models for skill acquirement in ESD. However, no study has used the submucosal dissection depth (DSUB) as a parameter to evaluate the learning curve in ESD, which might be a relevant factor since an optimal resection plane is important to achieve a curative resection and avoid intraoperative complications. OBJECTIVE: This study aimed to assess ESD skill acquirement after short-term training sessions by evaluating the submucosal dissection depth (DSUB) and the association with adverse events. METHODS: This experimental study included 25 experienced endoscopists in therapeuthic procedures (>5years) and 75 specimens resected by ESD (three resections / endoscopist). Learning parameters (resection time, size, en bloc resection rate, bleeding, perforation and submucosal dissection depth) were prospectively evaluated. The percentages of DSUB of all specimens resected were calculated. RESULTS: All specimens were resected from the gastric body (n=75). The mean size of the resected specimens was 23.97±7.2 mm. The number of adverse events, including bleeding, perforation, and death, were 17 (22.67%), 3 (4%), and 0 cases, respectively. The average mean time by the third dissection decreased from 28.44±9.73 to 18.72±8.81 min (P<0.001). The proportion of DSUB in the bleeding and non-bleeding group were respectively 37.97%±21.13% and 68.66%±23.99%, indicating a significant association between DSUB and bleeding incidence (P<0.001). The ROC curve analysis indicated a cut-off point of 61% (sensitivity, 64%; specificity, 94%) of submucosal dissection depth associated with bleeding. Therefore, when ESD was performed at a depth of >61% of the submucosal layer, the risk for bleeding during the procedure decreased (PPV, 0.97; 95% CI, 0.85-0.99). CONCLUSION: Improvement in the learning curve in ESD and a better cognitive ability were seen by the third dissection in these short term training courses. And a significant association between DSUB and the risk of bleeding.
- Metabolic Improvements in Obese Type 2 Diabetes Subjects Implanted for 1 Year with an Endoscopically Deployed Duodenal-Jejunal Bypass Liner(2012) MOURA, Eduardo G. H. de; MARTINS, Bruno C.; LOPES, Guilherme S.; ORSO, Ivan R.; OLIVEIRA, Suzana L. de; GALVAO NETO, Manoel P.; SANTO, Marco A.; SAKAI, Paulo; RAMOS, Almino C.; GARRIDO JUNIOR, Arthur B.; MANCINI, Marcio C.; HALPERN, Alfredo; CECCONELLO, IvanBackground: The purpose of this study was to evaluate the effect of the duodenal-jejunal bypass liner (DJBL), a 60-cm, impermeable fluoropolymer liner anchored in the duodenum to create a duodenal-jejunal bypass, on metabolic parameters in obese subjects with type 2 diabetes. Methods: Twenty-two subjects (mean age, 46.2 +/- 10.5 years) with type 2 diabetes and a body mass index between 40 and 60 kg/m(2) (mean body mass index, 44.8 +/- 7.4 kg/m(2)) were enrolled in this 52-week, prospective, open-label clinical trial. Endoscopic device implantation was performed with the patient under general anesthesia, and the subjects were examined periodically during the next 52 weeks. Primary end points included changes in fasting blood glucose and insulin levels and changes in hemoglobin A1c (HbA1c). The DJBL was removed endoscopically at the end of the study. Results: Thirteen subjects completed the 52-week study, and the mean duration of the implant period for all subjects was 41.9 +/- 3.2 weeks. Reasons for early removal of the device included device migration (n = 3), gastrointestinal bleeding (n = 1), abdominal pain (n = 2), principal investigator request (n = 2), and discovery of an unrelated malignancy (n = 1). Using last observation carried forward, statistically significant reductions in fasting blood glucose (-30.3 +/- 10.2 mg/dL), fasting insulin (-7.3 +/- 2.6 mu U/mL), and HbA1c (-2.1 +/- 0.3%) were observed. At the end of the study, 16 of the 22 subjects had an HbA1c < 7% compared with only one of 22 at baseline. Upper abdominal pain (n = 11), back pain (n = 5), nausea (n = 7), and vomiting (n = 7) were the most common device-related adverse events. Conclusions: The DJBL improves glycemic status in obese subjects with diabetes and therefore represents a nonsurgical, reversible alternative to bariatric surgery.
conferenceObject Results of Endoscopic Cyanoacrylate Injection for the Treatment of Esophageal Variceal Hemorrhage in Child-Pugh C Patients(2012) RIBEIRO, Joao Paulo A.; MALUF-FILHO, Fauze; MATUGUMA, Swrgio E.; HERMAN, Paulo; SAKAI, Paulo; D'ALBUQUERQUE, Luiz Augusto C.- EFTR, STER AND LAPAROSCOPIC ASSISTED RESECTION OF SUBMUCOSAL LESIONS OF THE UPPER GI TRACT: WHAT HAVE WE LEARNED ?(2019) KAHALEH, Michel; BHAGAT, Vicky; DELLATORE, Peter; TYBERG, Amy; SARKAR, Avik; SHAHID, Haroon M.; ANDALIB, Iman; ALKHIARI, Resheed; GAIDHANE, Monica; KEDIA, Prashant; NIETO, Jose; KUMTA, Nikhil A.; DIXON, Rebekah E.; SALAMEH, Habeeb; MAVROGENIS, Georgios; ABE, Seiichiro; MORITA, Flavio H.; SAKAI, Paulo; MOURA, Eduardo G. de