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
7 resultados
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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.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.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. deconferenceObject Learning Curve for ESD: Experience From a South American Center(2012) MOURA, Eduardo G. H. De; YAMAZAKI, Kendi; MESTIERI, Luiz H.; MIYAJIMA, Nelson T.; CHAVES, Dalton M.; SANTOS, Marcos E. Lera Dos; IDE, Edson; FRANZINI, Tomazo; PESSORRUSSO, Fernanda C.; SAKAI, PauloIntroduction: Endoscopic resection techniques such as endoscopic submucosal dissection (ESD) for early gastric cancer are gaining acceptance in many countries. However complication rates on this procedure reaches 20% on non-experienced hands. Experts recommend that ESD should first be carried out in animal models before starting to be performed in humans, in order to overcome the initial learning curve. Aims: To evaluate the learning curve during intensive ESD training on live porcine models under supervision of experts. Material and Methods: Forty endoscopists have performed ESD during an intensive training course on live porcine models, under experts’ supervision. This training had duration of two days. Simulation of a gastric lesion was obtained by aspirating the gastric mucosa with a cap on the tip of the endoscope. The following variables were analyzed: procedure time, resected specimen size, complete en bloc resection rate, circumferential incision time, submucosal solution injected volume, distance between the circumferential incision and the lesion (lateral margin) and complication rates as perforation, bleeding and death. And from the beginning to the end of the last procedure a questionnaire was given to the participants to see if they felt secure to perform ESD without supervision. Results: At the end of 2 days training, 125 gastric ESDs were achieved. Each participant performed at least 3 complete ESDs. The mean procedure time for the first cases were 32.69 min ± 15.89 (CI 95% 6.52 - 19.36) and at the end of the third case 19.7min ± 8.57 (CI 95% 6.52 - 19.36), p 0.001; the distance between the circumferential incision and the lesion (lateral margin) has increased from 2.54mm 1.75 (CI 95% 1.24 - 1.05) to 2.71mm ± 2.70(CI 95% 1.24 - 1.05), p=0.87 at the end of the third case. Bleeding rate has decreased from 18.75% to 15.63%. At the end of the training course 56.25% of the endoscopists felt secure to do ESD without supervision, a percentage that was 6.25% at the beginning of the course. Conclusion: Training ESD on live porcine models may help endoscopist overcome the learning curve but more training is needed to make it secure in humans.conferenceObject The Usefulness of Reaching the Appropriate Submucosal Dissection Depth in Gastric ESD: A Prospective Experimental Study in Live Porcine Models(2016) YAMAZAKI, Kendi; MOURA, Eduardo G. de; SAKAI, Paulo; MESTIERI, Luiz H.; VERAS, Mariana M.; MIYAJIMA, Nelson T.; CECCONELLO, IvanconferenceObject Effectiveness of Intragastric Balloon Associated with Diet on Treatment of Patients with Type 2 Diabetes (T2DM)(2017) REIMAO, Silvia M.; SILVA, Maria Elizabeth R.; MESTIERI, Luiz Henrique M.; NUNES, Gabriel C.; SOUZA, Thiago F.; SANTO, Marco Aurelio; SANTOS, Rosa F.; MOURA, Eduardo G. H.- IMPACT OF THE INTRAGASTRIC BALLOON ASSOCIATED WITH DIET ON THE TREATMENT OF DIABETIC PATIENTS WITH OVERWEIGHT OR GRADE I OBESITY AND ITS INFLUENCE ON THE PRODUCTION OF ENTEROHORMONES(2019) REIMAO, Silvia M.; SILVA, Maria Elizabeth R. da; NUNES, Gabriel C.; MESTIERI, Luiz H.; SANTOS, Rosa F. dos; MOURA, Eduardo G. de