LUIZ HENRIQUE MAZZONETTO MESTIERI
Índice h a partir de 2011
5
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
16 resultados
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- 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.
- Natural orifice transluminal endoscopic surgery to salvage a migrated stent during EUS-guided hepaticogastrostomy(2016) MOURA, Diogo Turiani Hourneaux De; MESTIERI, Luiz Henrique M.; CHENG, Spencer; RODELA, Gustavo Luis; MOURA, Eduardo Guimaraes Hourneaux De; SAKAI, Paulo; OLIVEIRA, Joel F.; ARTIFON, Everson L.
- Endoscopic pyloromyotomy via a gastric submucosal tunnel dissection for the treatment of gastroparesis after surgical vagal lesion(2014) CHAVES, Dalton M.; MOURA, Eduardo G. H. de; MESTIERI, Luiz H. M.; ARTIFON, Everson L.; SAKAI, Paulo
bookPart Endoscopia digestiva alta no estômago gastrectomizado(2014) TOMISHIGE, Toshiro; MESTIERI, Luiz Henrique Mazzonetto; CAMPOS, Mariana Iennaco de Siqueira- Improvement of Body Composition and Quality of Life Following Intragastric Balloon(2018) REIMAO, Silvia Mansur; SILVA, Maria Elizabeth Rossi da; NUNES, Gabriel Cairo; MESTIERI, Luiz Henrique Mazzonetto; SANTOS, Rosa Ferreira dos; MOURA, Eduardo Guimaraes Hourneaux deThe aim is to evaluate the effects of IGB in overweight or class I obese patients, by analyzing body composition and quality of life (QOL). Prospective study including patients with BMI 27-34.9 kg/m(2.)body composition analysis (BCA) was performed before IGB implantation and its removal, after 6 months of treatment. QOL was assessed by the Short Form 36 (SF-36) Health Survey at baseline and after treatment. Forty patients were included in this study, but four were excluded. The total weight decreased by 12.29 kg after 6 months of use of IGB, which corresponds to loss of 13.69% of the total weight. There was a significant reduction in body fat mass and fat area. QOL improved in all eight sections analyzed (p < 0.001 to 0.041): functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health. IGB induces not only weight loss but changes in body composition through the reduction of body fat mass and fat area. Furthermore, it improves QOL.
conferenceObject 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.- EUS-Guided Intragastric Injection of Botulinum Toxin A in the Preoperative Treatment of Super-Obese Patients: a Randomized Clinical Trial(2019) MOURA, Eduardo Guimaraes Hourneaux de; RIBEIRO, Igor Braga; FRAZAO, Mariana Souza Varela; MESTIERI, Luiz Henrique Mazzonetto; MOURA, Diogo Turiani Hourneaux de; BO, Creusa Maria Roveri Dal; BRUNALDI, Vitor Ottoboni; MOURA, Eduardo Turiani Hourneaux de; NUNES, Gabriel Cairo; BUSTAMANTE, Fabio Alberto Castillo; GALVAO NETO, Manoel dos Passos; MATUGUMA, Sergio Eiji; BERNARDO, Wanderley Marques; SANTO, Marco AurelioBackgroundObesity is a disease that is highly prevalent in Brazil, and the associated comorbidities represent a major global public health challenge. Botulinum toxin type A (BTX-A) is a potent neurotoxin and inhibitor of gastric smooth muscle activity. In theory, BTX-A administration should promote early satiety and weight loss because it delays gastric emptying by inhibiting acetylcholine-mediated peristalsis, which is primarily responsible for gastric motility. Because results in the literature are discrepant, the efficacy of intragastric injections of BTX-A as a primary treatment for obesity remains unknown. The objective of this prospective, double-blind, single-center randomized study was to evaluate the effects of endoscopic ultrasound-guided intragastric BTX-A injections, as a bridge to bariatric surgery, in super-obese patients.MethodsThirty-two super-obese patients were randomized to one of two groups: BTX-A, in which 200units of BTX-A were injected into the gastric antrum and body; and control, in which the same injections were performed with 0.9% saline. Weight, body mass index (BMI), and loss of excess weight were measured monthly over a 6-month period. Gastric emptying scintigraphy was performed before and after the procedure.ResultsThe patients in both groups showed significant weight loss over the course of the study (p<0.001). There were no statistically significant differences between the groups regarding weight loss, excess weight, total loss of excess weight, total weight loss, or change in BMI.ConclusionsIntragastric injection of BTX-A does not appear to be an effective method of achieving preoperative weight loss in super-obese patients.
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.- A New Technique for Performing Endoscopic Pyloromyotomy by Gastric Submucosal Tunnel Dissection(2014) CHAVES, Dalton M.; GUSMON, Carla C.; MESTIERI, Luiz H. M.; MOURA, Eduardo G. H. de; VERAS, Mariana M.; PESSORRUSSO, Fernanda C. S.; SAKAI, PauloAim:To investigate the feasibility of a new endoscopic pyloromyotomy technique. Materials and Methods:Endoscopic pyloromyotomy through a gastric submucosal tunnel was performed in 6 pigs. At the greater curvature, 2 cm proximal to the pylorus, we incised the mucosa and dissected the submucosal tunnel up to the pyloric ring. The pyloric muscular ring was sectioned, and then the gastric mucosal incision was closed with metallic clips. The pigs were then euthanized and necropsies were performed. Results:Section of the pyloric ring was successful in all 6 pigs. Small perforations occurred in 2 of the pigs, and there was limited bleeding in 1 pig. Necropsy and histologic evaluation confirmed the pyloric section. Conclusions:This technique is feasible, easy to perform, and maybe alternative to pyloroplasty in selected cases. Experimental comparative studies with other techniques still must be performed.
conferenceObject The Use of Stents for Treatment of Post-Bariatric Fistula: Systematic Review and Metanaysis(2017) OKAZAKI, Ossamu; BRUNALDI, Vitor O.; MOURA, Diogo T. de; SOUZA, Thiago F. de; MESTIERI, Luiz H.; SANTO, Marco Aurelio; MOURA, Eduardo G. de