EVERSON LUIZ DE ALMEIDA ARTIFON
Projetos de Pesquisa
Unidades Organizacionais
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina - Líder
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- EUS-Guided Biliary Drainage Versus ERCP in Malignant Biliary Obstruction Before Hepatobiliary Surgery(2023) TYBERG, Amy; SARKAR, Avik; SHAHID, Haroon M.; SHAH-KHAN, Sardar M.; GAIDHANE, Monica; SIMON, Alexa; EISENBERG, Ian A.; LAJIN, Michael; KARAGYOZOV, Petko; LIAO, Kelvin; PATEL, Roohi; ZHAO, Eric; MARTINEZ, Ma Guadalupe; ARTIFON, Everson L.; LINO, Andre D.; VANELLA, Giuseppe; ARCIDIACONO, Paolo G.; KAHALEH, MichelIntroduction:Endoscopic ultrasound-guided biliary drainage (EUS-BD) is the procedure of choice for patients who cannot undergo endoscopic retrograde cholangiopancreatography (ERCP). The outcomes of patients undergoing surgery after EUS-BD for malignancy are unknown.Methods:We conducted an international, multicenter retrospective comparative study of patients who underwent hepatobiliary surgery after having undergone EUS-BD or ERCP from 6 tertiary care centers. Patient demographics, procedural data, and follow-up care were collected in a registry.Results:One hundred forty-five patients were included: EUS-BD n=58 (mean age 66, 45% male), ERCP n=87 (mean age 68, 53% male). The majority of patients had pancreatic cancer, cholangiocarcinoma, or gallbladder malignancy. In the EUS-BD group, 29 patients had hepaticogastrostomy, 24 had choledochoduodenostomy, and 5 had rendezvous technique done. The most common surgery was Whipple in both groups (n=41 EUS-BD, n=56 ERCP) followed by partial hepatectomy (n=7 EUS-BD, n=14 ERCP) and cholecystectomy (n=2 EUS-BD, n=2 ERCP). Endoscopy clinical success was comparable in both groups (98% EUS-BD, 94% ERCP). Adverse event rates were similar in both groups: EUS-BD (n=10, 17%) and ERCP (n=23, 26%). Surgery technical success and clinical success were significantly higher in the EUS-BD group compared with the ERCP group (97% vs. 83%, 97% vs. 75%). Total Hospital stay from surgery to discharge was significantly higher in the ERCP group (19 d vs. 10 d, P=0.0082).Discussion:Undergoing EUS-BD versus ERCP before hepatobiliary surgery is associated with fewer repeat endoscopic interventions, shorter duration between endoscopy and surgical intervention, higher rates of surgical clinical success, and shorter length of hospital stay after surgery.
- Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography(2016) KHASHAB, Mouen A.; MERWE, Schalk Van der; KUNDA, Rastislav; ZEIN, Mohamad H. El; TEOH, Anthony Y.; MARSON, Fernando P.; FABBRI, Carlo; TARANTINO, Ilaria; VARADARAJULU, Shyam; MODAYIL, Rani J.; STAVROPOULOS, Stavros N.; PENAS, Irene; NGAMRUENGPHONG, Saowanee; KUMBHARI, Vivek; ROMAGNUOLO, Joseph; SHAH, Raj; KALLOO, Anthony N.; PEREZ-MIRANDA, Manuel; ARTIFON, Everson L.Background and aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. Patients and methods: Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50% at 2 weeks or to below 3mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon's severity grading system. Overall survival and duration of stent patency were calculated using Kaplan-Meier analysis. Results: A total of 96 patients (mean age 66 years, female 45%, pancreatic cancer 55%) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8%) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5%) patients. A total of 10 (10.5%) adverse events occurred: pneumoperitoneum (n=2), sheared wire (n=1), bleeding (n=1), bile leak (n=3), cholangitis (n=2), and unintentional perforation (n=1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44%) patients died of disease progression during the study period. The median patient survival was 167 days (95%CI 112-221) days. The 6-month stent patency rate was 95% (95%CI 94.94-95.06%) and the 1-year stent patency was 86% (95%CI 85.74-86.26%). Conclusion: This study on EUS-BD demonstrates excellent efficacy and safety of EUS-BD when performed by experts. Study registration: NCT01889953
- A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction(2018) GUO, Jintao; GIOVANNINI, Marc; V, Anand Sahai; SAFTOIU, Adrian; DIETRICH, Christoph F.; SANTO, Erwin; FUSAROLI, Pietro; SIDDIQUI, Ali A.; BHUTANI, Manoop S.; TEOH, Anthony Yuen Bun; IRISAWA, Atsushi; ARIAS, Brenda Lucia Arturo; ACHANTA, Chalapathi Rao; JENSSEN, Christian; SEO, Dong-Wan; ADLER, Douglas G.; KALAITZAKIS, Evangelos; ARTIFON, Everson; ITOKAWA, Fumihide; POLEY, Jan Werner; MISHRA, Girish; HO, Khek Yu; WANG, Hsiu-Po; OKASHA, Hussein Hassan; LACHTER, Jesse; VILA, Juan J.; IGLESIAS-GARCIA, Julio; YAMAO, Kenji; YASUDA, Kenjiro; KUBOTA, Kensuke; PALAZZO, Laurent; SABBAGH, Luis Carlos; SHARMA, Malay; KIDA, Mitsuhiro; EL-NADY, Mohamed; NGUYEN, Nam Q.; VILMANN, Peter; GARG, Pramod Kumar; RAI, Praveer; MUKAI, Shuntaro; CARRARA, Silvia; PARUPUDI, Sreeram; SRIDHAR, Subbaramiah; LAKHTAKIA, Sundeep; RANA, Surinder S.; OGURA, Takeshi; BARON, Todd H.; DHIR, Vinay; SUN, SiyuBackground and Objectives: EUS-guided biliary drainage (EUS-BD) w as shown to be useful for malignant bill obstruction (MBO). However. there is lack of consensus on how EUS-BD should be performed. Methods: This was a worldivide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD. Results; Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stewing technique should be the first choice. Self-expandable metal steins (SEMSs) mere recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach. longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach. 6-cm SEMS was recommended. During the intrahepatic (IH) approach. the IH segment 3 eras recommended. Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice. and randomized studies arc urgently needed to establish the best approach for the management of this condition.
- Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019 A Systematic Review and Meta-analysis(2020) PARASA, Sravanthi; DESAI, Madhav; CHANDRASEKAR, Viveksandeep Thoguluva; PATEL, Harsh K.; KENNEDY, Kevin F.; ROESCH, Thomas; SPADACCINI, Marco; COLOMBO, Matteo; GABBIADINI, Roberto; ARTIFON, Everson L. A.; REPICI, Alessandro; SHARMA, PrateekImportance Coronavirus disease 2019 (COVID-19) is a global pandemic and can involve the gastrointestinal (GI) tract, including symptoms like diarrhea and shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces. Objective To provide a pooled estimate of GI symptoms, liver enzyme levels outside reference ranges, and fecal tests positive for SARS-CoV-2 among patients with COVID-19. Data Sources An electronic literature search was performed for published (using MEDLINE/PubMed and Embase) and preprint (using bioRxiv and medRxiv) studies of interest conducted from November 1, 2019, to March 30, 2020. Search terms included ""COVID-19,"" ""SARS-Cov-2,"" and/or ""novel coronavirus."" Study Selection Eligible studies were those including patients with SARS-CoV-2 infection who reported GI symptoms. Data Extraction and Synthesis Data on patients with GI symptoms (ie, diarrhea, nausea, or vomiting), liver enzyme level changes, and fecal shedding of virus were extracted. Quality of studies was examined using methodological index for nonrandomized studies. Pooled estimates (%) were reported with 95% CIs with level of heterogeneity (I-2). Main Outcomes and Measures Study and patient characteristics with pooled detection rates for diarrhea, nausea or vomiting, liver enzyme levels outside reference ranges, and SARS-CoV-2 positivity in feces tests were analyzed. Results Of 1484 records reviewed, 23 published and 6 preprint studies were included in the analysis, with a total of 4805 patients (mean [SD] age, 52.2 [14.8] years; 1598 [33.2%] women) with COVID-19. The pooled rates were 7.4% (95% CI, 4.3%-12.2%) of patients reporting diarrhea and 4.6% (95% CI, 2.6%-8.0%) of patients reporting nausea or vomiting. The pooled rate for aspartate aminotransferase levels outside reference ranges was 20% (95% CI, 15.3%-25.6%) of patients, and the pooled rate for alanine aminotransferase levels outside reference ranges was 14.6% (95% CI, 12.8%-16.6%) of patients. Fecal tests that were positive for SARS-CoV-2 were reported in 8 studies, and viral RNA shedding was detected in feces in 40.5% (95% CI, 27.4%-55.1%) of patients. There was high level of heterogeneity (I-2 = 94%), but no statistically significant publication bias noted. Conclusions and Relevance These findings suggest that that 12% of patients with COVID-19 will manifest GI symptoms; however, SAR-CoV-2 shedding was observed in 40.5% of patients with confirmed SARS-CoV-2 infection. This highlights the need to better understand what measures are needed to prevent further spread of this highly contagious pathogen. Question What are the incidence rates of gastrointestinal symptoms among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection? Findings This systematic review and meta-analysis of 23 published and 6 preprint studies found that approximately 12% of patients with SARS-CoV-2 infection reported gastrointestinal symptoms, including diarrhea, nausea, and vomiting. Liver enzyme levels outside reference ranges were observed in 15% to 20% of patients, and SARS-CoV-2 RNA shedding in stool was detected in up to 41% of patients. Meaning These findings suggest that patients with SARS-CoV-2 infection can present with gastrointestinal symptoms with possible fecal-oral route of transmission due to the presence of viral RNA in stool. This systematic review and meta-analysis examines the prevalence of reported gastrointestinal symptoms in patients with coronavirus disease 2019 and of viral RNA shedding detected in these patients' stool.