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
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- 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.bookPart Procedimentos endoscópicos na DRGE(2012) SAKAI, Paulo; MOURA, Eduardo Guimarães Hourneaux deconferenceObject Endoscopic Papillary Large Balloon Dilation Associated With Sphincterotomy for Extraction of Large Bile Duct Stones(2012) LUZ, Gustavo O.; MOURA, Eduardo G. De; MEINE, Gilmara C.; CARNEIRO, Fred O.; MEDRADO, Bruno F.; ALMEIDA, Maira R.; MALUF-FILHO, Fauze; LERA, Marcos; IDE, Edson; FURUYA, Carlos K.; CHAVES, Dalton M.; CHENG, Spencer; MATUGUMA, Sergio E.; TOMISHIGE, Toshiro; HONDO, Fabio Y.; BARACAT, Renato; ARTIFON, Everson L.; FRANZINI, Tomazo; SAKAI, PauloCommon bile duct stones larger than 15mm are related to a higher rate of failure of endoscopic ductal clearance and need for mechanical lithotripsy. Recently, endoscopic papillary large balloon dilation (EPLBD) associated with endoscopic sphyncterotomy (ES) has been advocated for the management of difficult bile duct stones. Objective: Evaluate the efficacy and safety of EPLBD associated with ES for removal of large bile duct stones. Patients and methods: retrospective review of prospectively collected data in an academic tertiary referral center, from November 2009 to August 2011. Ampullary dilation was performed with a wire guided hydrostatic balloon (CRE/Boston Scientific) which size ranged from 12 to 20mm. The stone size and the duct diameter directed the choice of the balloon diameter. Balloon was inflated with diluted contrast medium under endoscopic and fluoroscopic control until waist disappearance and/or maximal balloon pressure. After dilation stones were extracted with the aid of standard accessories and techniques. Outcomes and adverse events were recorded. Results: A total of 730 patients with common bile duct stones were admitted for ERCP in our institution. 123 (16,8%) patients were submitted to EPLBD after sphincterotomy. The mean age was 56 years (22-98) and 77 were female (63%). The size of the stones ranged from 13 to 30mm. Initial procedure success rate without mechanical lithitripsy was 83% (102/123). In further 4 patients (3,2%) mechanical lithotripsy was used with 75% success rate (3/4). For the remaining 17 patients, mechanical litotripsy was not available and a 10Fr biliary stent was introduced to prevent obstruction and cholangitis. The total adverse events rate was 3,2%. There were 2 cases of perforation with 20mm balloon (1,6%), both treated conservatively, and two cases of mild acute pancreatitis (1,6%). None of the patients presented bleeding that required transfusion or hospitalization. Conclusion: EPLBD after sphincterotomy is a safe and effective technique for the management of large bile duct stones and it avoids mechanical lithotripsy in the majority of cases.conferenceObject Balloon Assisted Enteroscopy Is Advised in the Long Term Follow-Up of Patients With On-Going Obscure Gastrointestinal Bleeding(2012) SAFATLE-RIBEIRO, Adriana V.; ARRAES, Livia R.; RIBEIRO, Ulysses; REIMAO, Silvia M.; MEDRADO, Bruno F.; SANTOS, Thiago N.; KAWAGUTI, Fabio S.; MOURA, Eduardo G. De; SAKAI, Paulo; CECCONELLO, IvanconferenceObject Evaluation of the Small Intestine by Video Capsule Endoscopy in Patients Candidates for Liver Transplantation(2012) FYLYK, Sonia N.; TOBARU, Andre; MESTIERI, Luiz H.; FARIAS, Alberto Q.; CARRILHO, Flair J.; D'ALBUQUERQUE, Luiz Augusto C.; MOURA, Eduardo G. De; SAKAI, PauloIntroduction: Recent studies suggest that in cirrhotic patients the small intestine can be affected by the consequences of a system of portal hypertension (PTH). This segment of the gastrointestinal tract, however, is hardly accessible for study. The video capsule endoscopy (VCE) is considered the gold standard exam for the investigation of small bowel diseases, especially vascular diseases of the intestinal mucosa. Objective: Evaluation of the findings of PTH in the mucosa of the small bowel of cirrhotic patients, candidates for liver transplantation (LT). Patients and Methods: Prospective, single-center, controlled study. All patients signed informed consent and the study was approved by the ethics committee. 21 patients were submitted to VCE and esophagogastroduodenoscopy (14 patients with liver cirrhosis candidates to LT and 7 control cases, with normal liver function and no evidence of PTH). Inclusion criteria: - Patients with liver cirrhosis of viral and/or alcoholic etiology and with indication for LT (Child-Pugh score A, B or C and MELD < 20). Patients submitted or not to endoscopic treatment of esophagogastric varices or GAVE. - Patients over 18 years. - Patients who agree to participate in the study. Exclusion criteria: - Patients with history of abdominal surgery and intestinal transit abnormalities. - Intestinal sub-occlusion or suspected gastroparesis. - Patients with congestive heart disease. - Patients with potentially hemorrhagic lesions that can contribute to anemia (ulcers, polyps) and not related to PTH. Results: The mucosal lesions of the small intestine secondary to portal hypertension were more common in cirrhotic patients than in control patients: 13/14 (92.8%) vs. 1/7 (14.2%). The reticular pattern of the mucosa (hypertensive enteropathy) was the most important finding of the cases (10/14 -71.4%), followed by vascular ectasia-like and varices of the jejunum and ileum (7/14 - 50%). Conclusion: This group of patients has significant changes in the mucosa of the small intestine secondary to PTH and this segment of the gastrointestinal tract may represent a site of bleeding, often classified as obscure. The VCE is an important tool for the identification of these lesions, contributing to a more accurate etiologic diagnosis.conferenceObject Deep Sedation Events During Diagnostic Upper Gastrointestinal Endoscopy: A Randomized Study of the Regimens Propofol-Fentanyl and Midazolam-Fentanyl(2012) SANTOS, Marcos E. Lera Dos; MOURA, Eduardo G. De; SAKAI, Paulo; MATUGUMA, Sergio E.; IDE, Edson; CHAVES, Dalton M.; LUZ, Gustavo; SOUZA, Thiago F.; PESSORRUSSO, Fernanda C.; MESTIERI, Luiz H.; MALUF-FILHO, FauzeGastrointestinal Endoscopy Unit - Gastroenterology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil Background and Study Aims: For upper gastrointestinal endoscopy (UGIE), the use of sedation is nearly universal. The objective of this study was to compare two drug combinations in terms of the frequency of deep sedation events during UGIE. Patients and Methods: We evaluated 200 patients referred for UGIE. Patients were randomized to receive propofol-fentanyl or midazolam-fentanyl (n = 100/group). We assessed the level of sedation with the Observer’s Assessment of Alertness/Sedation (OAA/S) and the bispectral index (BIS). We evaluated patient and physician satisfaction, as well as recovery time and complication rates. Results: The times to induction sedation, recovery, and discharge were shorter in the propofol-fentanyl group than in the midazolam-fentanyl group. According to the OAA/S, deep sedation events occurred in 25% of the propofol-fentanyl group patients and 11% of the midazolam-fentanyl group patients (p = 0.014), compared with 19% and 7%, respectively, for the BIS (p = 0.039). There was good concordance between the OAA/S and the BIS for both groups (k = 0.71 and k = 0.63, respectively). Oxygen supplementation was required in 42% of the propofol-fentanyl group patients and in 26% of the midazolam-fentanyl group patients (p = 0.025). The mean time to recovery was 28.82 and 44.13 min in the propofol-fentanyl and midazolam-fentanyl groups, respectively (p < 0.001). There were no severe complications in either group. Although patients were equally satisfied with both drug combinations, physicians were more satisfied with the propofol-fentanyl combination. Conclusions: Despite the greater risk of deep sedation, propofol is preferable to midazolam.- EUS-guided fistulization of postoperative colorectal stenosis in an infant with Hirschsprung's disease: a new technique(2012) ARTIFON, Everson L. A.; FERREIRA, Flavio; BARACAT, Renato; OKAWA, Luciano; GUPTA, Kapil; SAKAI, Paulo; BHUTANI, Manoop S.
conferenceObject Endoscopic Suturing Devices and Injection Teraphy on GERD: Prospective Study With Late Follow-Up (60 Months)(2012) MOURA, Eduardo G. H. De; FERREIRA, Flavio C.; SALLUM, Rubens A.; NASI, Ary; OLIVEIRA, Suzana L. De; MOURA, Eduardo T. H. De; MOURA, Diogo T. H. De; SAKAI, Paulo; CECCONELLO, IvanBackground: Several studies regarding endoscopic treatment of GERD were published on the 90’s with the intention to reduce gastro-esophageal reflux and diminish the use of acid-suppressing drugs. The appealing immediate results of these therapies that are also minimally invasive characteristics determined our goal to assess the long-term follow up of these patients. Objective: Assess the effectiveness of injection therapy with an inert polymer (G0) and endoscopic plication (G1) on GERD treatment on long-term follow-up (60months). Material: 47 patients with GERD, without complications, with good clinical response to proton pump inhibitors, fit to surgical procedure. Results: Most patients were male on both groups, with median age of 39 y (G0) and 48 y (G1). All patients completed follow-up until 6 months but the analyzes of patients that failed to attend follow-up on 12months and 60 months showed losses of 9,6% and 47,7% for group (G0); 6,9% and 58,7% for group (G1), respectively. It was seen increase over time of patients that had no response (UN) to proton pump inhibitors after 12months on both groups (p<0.001). EAV analyzes showed full response on both groups until 12 months but this was not seen on 60 months follow-up (p=0.013). On 1,3, 6 and 12 months there is a full response of clinical improvement on both groups however on 60 months follow-up it was clear that the number of patients with no response to proton pump inhibitors greatly increased (G0, p=0.019 ; G1 p=0.003). There was no improvement on endoscopic erosive esophagitis score, manometric PRM, total time of acid exposure and DeMeester score. Conclusion: Efficacy of endoscopic plication and injection therapy with inert polimer on GERD was limited on long-term follow-up. There was no sustained clinical response, reduction of proton pump inhibitors, QVSR response, improvement of quality of life, after 12 months. Immediate complications were limited and there was no mortality. There was no improvement of esophagitis score nor esophageal (pH) manometry tests.conferenceObject Results of Endoscopic Treatment of Gastrojejunal Anastomosis Strictures After Bariatric Surgery: Analyses of Risk Factors Related to Bad Prognosis(2012) MOURA, Eduardo G. H. De; MANOEL, Galvao Neto; CEREDA, Diamari C.; RAMOS, Almino C.; MOURA, Diogo T. H. De; OLIVEIRA, Suzana L. De; YAMAZAKI, Kendi; MOURA, Eduardo T. H. De; FERREIRA, Flavio C.; ARTIFON, Everson L.; SAKAI, Paulo; CAMPOS, JosembergBackground: One of the most popular techniques on bariatric surgery is gastric bypass with Roux-en-Y reconstruction which aims to create a narrow area with important restriction of stomach area thus leading to early repletion. Objective: To analyze the factors relevant to patient’s clinical response to the treatment by endoscopic dilation and the risk factors. Methods: 54 patients submitted to bariatric surgery by gastric bypass with Roux-en-Y reconstruction that developed anastomotic stricture. The parameters analyzes were age, gender, presence or not of silastic ring, extension of the gastric pouch, anastomosis diameter, number of dilation sessions, balloon diameter, association with other surgical complications, endoscopic complications and need of re-operation. Results: When silastic ring was found it was necessary to perform dilation with larger balloons (Rigiflex 30mm) (p = 0,02) and also higher post-surgical complication rates (p = 0,01). Among the analyzed factors relevant to technical success it was identified that the presence of an ischemic segment was related with higher complication rates (perforation and re-estenosis) and also technical failure. There was no significant correlation between the diameter of the anastomosis, total amount of dilation sessions, gender, age and post-surgical complications. Conclusion: Gastrojejunal anastomosis strictures after bariatric surgery are associated with a high success rate of treatment by endoscopic dilation. When performing dilation of patients with a silastic ring or an ischemic segment of the gastric pouch it is recommended to perform this procedure with extra care once this condition is associated with higher complication rates and technical failure.