EDUARDO TURIANI HOURNEAUX DE MOURA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
15 resultados
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- PREDICTORS OF GASTROESOPHAGEAL REFLUX AFTER POEM FOR ACHALASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS(2019) MOTA, Raquel Cristina L.; MOURA, Eduardo G. de; MOURA, Diogo T. de; MOURA, Eduardo T.; FARIAS, Galileu F.; BRUNALDI, Vitor O.; BERNARDO, Wanderlei M.; SAKAI, Paulo; THOMPSON, Christopher C.
- Peroral endoscopic myotomy (POEM): a comparative study between Chagasic and idiopathic achalasia(2020) FARIAS, Galileu F. A.; MOURA, Diogo T. H. de; MOURA, Eduardo T. H. de; REZENDE, Daniel T. de; HATHORN, Kelly E.; NASI, Ary; QUEIROZ, Natalia S. F.; MOURA, Eduardo G. H. deBackground and study aims Achalasia can be classified as either primary (idiopathic) achalasia or secondary achalasia, which is a consequence of another systemic disease. Peroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia. We evaluated the efficacy and safety of POEM in patients with Chagasic achalasia compared to idiopathic achalasia. Patients and methods We evaluated POEM procedures performed at a single institution from November 2016 to January 2018. Demographic data, Eckardt score, lower esophageal sphincter (LES) pressure, body mass index, post-operative erosive esophagitis, adverse events, length of hospital stay, and procedure-related parameters were analyzed. Results Fifty-one patients underwent POEM as a treatment for achalasia in this period (20 patients with Chagasic and 31 with Idiopathic etiology). The overall clinical success rate was 92.1 %, with no statistical difference between groups (90 % in the Chagasic group vs. 93.5 % in the Idiopathic group, P = 0.640). Both groups had significant reduction in Eckardt score and in LES pressure, and increase in bodey mass index (BMI) at 1-year follow-up. There was no statistical difference between groups regarding Eckardt score ( P = 0.439), LES pressure (p = 0.507), BMI ( P = 0.254), post erosive esophagitis (35 % vs. 38.7 %, P = 0.789), adverse events (30 % vs. 12 %, P = 0.163,) length of hospital stay (3.75 days vs. 3.58 days, P = 0.622), and operative time (101.3 min vs. 99.1 min, P = 0.840). Conclusion POEM is an effective and safe treatment for patients with achalasia. There is no difference in POEM outcomes for those patients with Chagasic or Idiopathic achalasia.
- Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial(2022) MOURA, Eduardo Turiani Hourneaux de; JUKEMURA, Jose; RIBEIRO, Igor Braga; FARIAS, Galileu Ferreira Ayala; DELGADO, Aureo Augusto de Almeida; COUTINHO, Lara Meireles Azeredo; MOURA, Diogo Turiani Hourneaux de; SALLUM, Rubens Antonio Aissar; NASI, Ary; SANCHEZ-LUNA, Sergio A.; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux deBACKGROUND Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy (POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy, has emerged as a promising minimally invasive technique for the management of this condition. AIM To compare POEM and laparoscopic myotomy and partial fundoplication (LM-PF) regarding their efficacy and outcomes for the treatment of achalasia. METHODS Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria (dysphagia score >= II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis (as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min (on a barium esophagogram), pressure at the LES, the occurrence of adverse events (AEs), length of stay (LOS), and quality of life (QoL). RESULTS There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up (P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group (P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group (185.00 +/- 56.89 and 95.70 +/- 30.47 min vs 296.75 +/- 56.13 and 218.75 +/- 50.88 min, respectively; P = 0.001 for both). In the POEM group, there were improvements in all domains of the QoL questionnaire, whereas there were improvements in only three domains in the LM-PF group. CONCLUSION POEM and LM-PF appear to be equally effective in controlling the symptoms of achalasia, shortening LOS, and minimizing AEs. Nevertheless, POEM has the advantage of improving all domains of QoL, and shortening anesthesia and procedure times but with a significantly higher rate of gastroesophageal reflux
- Risk factors for gastroesophageal reflux after POEM for achalasia: a systematic review and meta-analysis(2021) MOTA, Raquel Cristina Lins; MOURA, Eduardo Guimaraes Hourneaux de; MOURA, Diogo Turiani Hourneaux de; BERNARDO, Wanderlei Marques; MOURA, Eduardo Turiani Hourneaux de; BRUNALDI, Vitor O.; SAKAI, Paulo; THOMPSON, Christopher C.Introduction Peroral endoscopic myotomy (POEM) demonstrated similar efficacy to surgical myotomy in the management of achalasia. However, gastroesophageal reflux disease (GERD) is common after POEM. The aim of this study is to identify factors associated with GERD after POEM. Method After searching electronic databases, randomized trials and observational studies including patients with achalasia or other spastic esophageal disorders, treated by POEM, and providing GERD data were selected. GERD was evaluated by 3 methods: pH monitoring, endoscopic findings, and symptoms. For each method, an analysis was performed comparing the outcomes related to the following independent variables: full-thickness (FT) vs circular myotomy, anterior vs posterior, long myotomy vs short myotomy, naive vs previous treatment failure, previous Heller myotomy (HM) vs non-previous-HM, Type I vs II, Type I vs III, and Type II vs III. Results 2869 publications were identified, and 25 studies met criteria for inclusion in the qualitative analysis. Of these, 18 were included in the meta-analysis. According to the endoscopic findings, circular and anterior myotomy demonstrated a lower trend of GERD with borderline significance (p = 0.06; p = 0.07, respectively). In the pH monitoring and symptom analyses, circular myotomy, anterior myotomy, treatment naive, and non-HM patients were associated with a lower occurrence of GERD; however, no statistically significant difference was found. When comparing achalasia subtypes, no statistical difference was found in all analyses. Conclusion This systematic review and meta-analysis suggest that a circular anterior approach may limit post-POEM GERD and should be considered in appropriate patients.
conferenceObject HOW DOES PER ORAL ENDOSCOPIC MYOTOMY COMPARE TO HELLER MYOTOMY IN CHAGAS PATIENTS: THE LATIN AMERICAN SHIFT(2018) KAHALEH, Michel; TYBERG, Amy; SURESH, Supriya; LAMBROZA, Arnon; GAIDHANE, Monica; ZAMARRIPA, Felipe; MARTINEZ, Ma Guadalupe; CARAMES, Juan C.; MOURA, Eduardo T.; FARIAS, Galileu F.; MONDRAGON, Oscar V. Hernandez; PORFILIO, Maria G.; NIETO, Jose; REY, Mario; CASASRODRIGUEZ, Fernando; CASTILLO, Bismarck; LUKASHOK, Hannah P.; ROBLES-MEDRANDA, Carlos; MOURA, Eduardo G. deconferenceObject THE LEARNING CURVE OF PERORAL ENDOSCOPIC MYOTOMY IN LATIN AMERICA: A SLIDE TO THE RIGHT ?(2018) KAHALEH, Michel; TYBERG, Amy; SURESH, Supriya; LAMBROZA, Arnon; CASASRODRIGUEZ, Fernando; REY, Mario; NIETO, Jose; MARTINEZ, Ma Guadalupe; ZAMARRIPA, Felipe; ARANTES, Vitor N.; PORFILIO, Maria G.; GAIDHANE, Monica; FAMILIARI, Pietro; CARAMES, Juan C.; CASTILLO, Bismarck; MOURA, Eduardo T.; FARIAS, Galileu F.; LUKASHOK, Hannah P.; ROBLES-MEDRANDA, Carlos; MOURA, Eduardo G. de- VIDEO CAPSULE ENDOSCOPY VS DOUBLE-BALLOON ENTEROSCOPY IN THE DIAGNOSIS OF SMALL BOWEL BLEEDING: A SYSTEMATIC REVIEW AND META-ANALYSIS(2019) BRITO, Helcio P.; RIBEIRO, Igor B.; MOURA, Diogo T. de; BERNARDO, Wanderlei M.; CHAVES, Dalton; KUGA, Rogerio; MAAHS, Ethan D.; ISHIDA, Robson K.; MOURA, Eduardo T.; MOURA, Eduardo G. de
- POEM in Latin America The Rise of a New Standard(2019) KAHALEH, Michel; XU, Ming-ming; ZAMARRIPA, Felipe; MARTINEZ, Guadalupe; ARANTES, Vitor N.; RODRIGUEZ, Fernando Casas; CASTILLO, Bismarck; ANDALIB, Iman; TYBERG, Amy; LAMBROZA, Arnon; SAUMOY, Monica; CARAMES, Juan C.; BAPTISTA, Alberto; ROBLES-MEDRANDA, Carlos; LUKASHOK, Hanna; GAIDHANE, Monica; VALENCIA, Juan M. B.; MOURA, Eduardo T. H. d; MOURA, Eduardo G. H. dBackground: Per-oral endoscopic myotomy (POEM) has become the preferred alternative treatment to standard Heller myotomy for patients with esophageal achalasia, in Latin American countries. The aim of our study was to evaluate the efficacy and safety of a POEM in the management of achalasia with and without Chagas disease in patients receiving POEM. Methods: Patients who underwent POEM from tertiary centers in Latin America were included in a dedicated registry. Countries included Brazil, Colombia, Ecuador, Mexico, Nicaragua, and Venezuela. Patients enrolled needed to have a preoperative manometry and swallow contrast study confirming achalasia. Clinical success was defined as significant improvement in Eckardt score after therapy. Results: POEM was technically successful in 81/89 (91%) patients (mean age, 44 y). There was a significant decrease in preprocedure and postprocedure Eckardt score from 8.7 (range, 3 to 12) to 2.15 (0 to 10) (P<0.001), preprocedure and postprocedure barium swallow evaluation (98% vs. 89%; P=0.017), and preprocedure and postprocedure lower esophageal sphincter pressure measurement (from 35 to 13.8 mm Hg; P<0.001). Clinical success was achieved in 93% of patients. Patients with Chagas disease (n=58) were 9.5 times more likely to respond to POEM (P=0.0020; odds ratio, 9.5). Conclusions: POEM is an efficacious and safe therapeutic modality for treatment of achalasia in Latin America. Chagas disease-related achalasia seems to particularly respond better to POEM when it is performed by experienced endoscopists.
- Adverse Events and Complications with Intragastric Balloons: a Narrative Review (with Video)(2021) RIBEIRO, Igor Braga; KOTINDA, Ana Paula Samy Tanaka; SANCHEZ-LUNA, Sergio A.; MOURA, Diogo Turiani Hourneaux de; MANCINI, Fabio Catache; SOUZA, Thiago Ferreira de; MATUGUMA, Sergio Eiji; SAKAI, Christiano Makoto; ROCHA, Rodrigo Silva de Paula; LUZ, Gustavo de Oliveira; SANTOS, Marcos Eduardo Lera dos; CHAVES, Dalton Marques; FRANZINI, Tomazo Antonio Prince; MOURA, Eduardo Turiani Hourneaux de; MOURA, Eduardo Guimaraes Hourneaux deIntragastric balloon (IGB) is a minimally invasive and reversible therapy for weight loss with a good efficacy and safety profile. Introduced in the 1980s, IGBs have significantly evolved in the last couple of decades. They mechanically act by decreasing the volume of the stomach and its reservoir capacity, delaying gastric emptying, and increasing satiety leading to a subsequent weight loss. Despite the low rates of complications and mortality associated with IGBs, adverse events and complications still occur and can range from mild to fatal. This review aims to provide an update on the current scientific evidence in regard to complications and adverse effects of the use of the IGB and its treatment. This is the first comprehensive narrative review in the literature dedicated to this subject.
- The Learning Curve for Peroral Endoscopic Myotomy in Latin America: A Slide to the Right?(2021) KAHALEH, Michel; TYBERG, Amy; SURESH, Supriya; LAMBROZA, Arnon; CASAS, Fernando Rodriguez; REY, Mario; NIETO, Jose; MARTINEZ, Guadalupe Ma; ZAMARRIPA, Felipe; ARANTES, Vitor; PORFILIO, Maria G.; GAIDHANE, Monica; FAMILIARI, Pietro; CARAMES, Juan Carlos; VARGAS-RUBIO, Romulo; CANADAS, Raul; HANI, Albis; MUNOZ, Guillermo; CASTILLO, Bismarck; MOURA, Eduardo T.; GALILEU, Farias F.; LUKASHOK, Hannah P.; ROBLES-MEDRANDA, Carlos; MOURA, Eduardo G. deBackground/Aims: Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America. Methods: Patients undergoing POEM in Latin America with a single operator were included from a prospective registr y over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve. Results: A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients). The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressi v e l y decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01). Conclusions: Mastering POEM in Latin America requires approxima t e l y 61 procedures for both POEM efficiency and to accomplish the procedure within 97 minutes.