IGOR BRAGA RIBEIRO
Projetos de Pesquisa
Unidades Organizacionais
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
49 resultados
Resultados de Busca
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- Managing adverse events after endoscopic ultrasound-guided drainage of the biliary tract and pancreatic fluid collections: Narrative review (with video)(2022) FUNARI, Mateus Pereira; RIBEIRO, Igor Braga; SANTOS, Marcos Eduardo Lera dos; MATUGUMA, Sergio Eiji; MOURA, Eduardo Guimaraes Hourneaux deEndoscopic ultrasound (EUS)-guided therapeutic procedures have become increasingly common in clinical practice. The development of EUS-guided fine needle aspiration cytology led to the concept of interventional EUS. However, it carries a considerable risk of adverse events (AEs), which occur in approximately 23% of the procedures performed for the drainage of pancreatic fluid collections and 2.5-37.0% of those performed for drainage of the biliary tract. Although the vast majority of AEs occurring after EUS-guided drainage are mild, a deep understanding of such events is necessary for their appropriate management. Because EUS-guided drainage is a novel procedure, there have been few studies of the topic. To our knowledge, this is the first narrative review that focuses on the management and resolution of AEs occurring after EUS-guided drainage of pancreatic fluid collections or the biliary tract. We also include an explanatory video.
- Perspectives toward minimizing the adverse events of endoscopic sleeve gastroplasty(2020) MOURA, Diogo Turiani Hourneaux de; BADURDEEN, Dilhana S.; RIBEIRO, Igor Braga; LEITE, Eduardo Filipe Marques Silva Dantas; THOMPSON, Christopher C.; KUMBHARI, VivekEndoscopic sleeve gastroplasty (ESG) transforms the saccular stomach into a tubular structure along the lesser curvature, thereby reducing gastric functional volume.(1-4) Current medical literature demonstrates that ESG achieves greater than 25% excess weight loss at 12 months with a less than 5% rate of severe adverse events (AEs), which is considered satisfactory according to the Preservation and Incorporation of Valuable endoscopic Innovations document created by a task force assembled by the American Society for Gastrointestinal Endoscopy and the American Society for Metabolic and Bariatric Surgery.(5) Despite widespread adoption of the procedure,(6-8) no peer-reviewed resource exists to guide the physician on how to optimally perform the procedure. The aim of this article is to help physicians currently performing or those contemplating performing ESG by providing technical in-sights to facilitate durable tubularization of the stomach while simultaneously minimizing the rate of AEs.
- Acute esophageal necrosis (black esophagus) with active upper gastrointestinal bleeding: What to do?(2021) RIBEIRO, Igor Braga; LUZ, Gustavo de Oliveira; SOUZA, Gabriel Mayo Vieira de; BOGHOSSIAN, Mateus Bond; MONTE JUNIOR, Epifanio Silvino do; SANTOS, Marcos Eduardo Lera dos; MOURA, Eduardo Guimaraes Hourneaux de
- The Effectiveness and Safety of the Duodenal-Jejunal Bypass Liner (DJBL) for the Management of Obesity and Glycaemic Control: a Systematic Review and Meta-Analysis of Randomized Controlled Trials(2023) YVAMOTO, Erika Yuki; MOURA, Diogo Turiani Hourneaux de; PROENCA, Igor Mendonca; MONTE JUNIOR, Epifanio Silvino do; RIBEIRO, Igor Braga; RIBAS, Pedro Henrique Boraschi Vieira; HEMERLY, Matheus Candido; OLIVEIRA, Victor Lira de; SANCHEZ-LUNA, Sergio A.; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deIntroduction The duodenal-jejunal bypass liner (DJBL) is a less-invasive treatment of obesity and type 2 diabetes mellitus (T2DM). Methods This is a systematic review and meta-analysis including randomized clinical trials (RCTs) comparing DJBL versus sham or pharmacotherapies aiming to evaluate the effectiveness and safety of DJBL. Results Ten RCTs (681 patients) were included. The DJBL group showed superior excess weight loss (+ 11.4% [+ 7.75 to + 15.03%], p < 0.00001) and higher decrease in HbA1c compared to the control group (- 2.73 +/- 0.5 vs. - 1.73 +/- 0.4, p = 0.0001). Severe adverse events (SAEs) occurred in 19.7%. Conclusion The DJBL did not reach the ASGE/ASMBS thresholds for the treatment of obesity. However, it is important to state that many SAEs were not really severe. Therefore, we believe this therapy plays an important role in the management obesity and T2DM.
- Is Endoscopic Balloon Dilation Still Associated With Higher Rates of Pancreatitis? A Systematic Review and Meta-Analysis(2020) MATSUBAYASHI, Carolina Ogawa; RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; BRUNALDI, Vitor Ottoboni; BERNARDO, Wanderley Marques; HATHORN, Kelly E.; MOURA, Eduardo Guimaraes Hourneaux deThe objective of this study was to compare the efficacy and safety of endoscopic papillary balloon dilation (EPBD), endoscopic sphincterotomy (ES), and the combination of large balloon dilation and ES (ES + EPLBD) in the treatment of common bile duct stones, with a special focus on postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials (RCTs) which evaluated at least one of the following outcomes: PEP, complete stone removal in the first ERCP, need for mechanical lithotripsy, recurrence of common bile duct stones, bleeding, and cholangitis. Twenty-five RCTs were selected for analysis. Pancreatitis rates were higher for EPBD than for ES (P = 0.003), as were severe pancreatitis rates (P = 0.04). However, in the 10-mm or greater balloon subgroup analysis, this difference was not shown (P = 0.82). Rates of PEP were higher in the subgroup of non-Asian subjects (P = 0.02), and the results were not robust when RCTs that used endoscopic nasobiliary drainage were omitted. The incidence of pancreatitis was comparable between EPLBD and ES + EPLBD. All 3 approaches were equally efficacious. Nevertheless, the results should be interpreted with caution, because pancreatitis is a multifactorial pathology, and RCTs can have limited generalizability.
- Sodium picosulphate or polyethylene glycol before elective colonoscopy in outpatients? A systematic review and meta-analysis(2018) ROCHA, Rodrigo Silva de Paula; RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; BERNARDO, Wanderley Marques; MINATA, Mauricio Kazuyoshi; MORITA, Flavio Hiroshi Ananias; AQUINO, Julio Cesar Martins; BABA, Elisa Ryoka; MIYAJIMA, Nelson Tomio; MOURA, Eduardo Guimaraes Hourneaux deAIM To determine the best option for bowel preparation [sodium picosulphate or polyethylene glycol (PEG)] for elective colonoscopy in adult outpatients. METHODS A systematic review of the literature following the PRISMA guidelines was performed using Medline, Scopus, EMBASE, Central, Cinahl and Lilacs. No restrictions were placed for country, year of publication or language. The last search in the literature was performed on November 20th, 2017. Only randomized clinical trials with full texts published were included. The subjects included were adult outpatients who underwent bowel cleansing for elective colonoscopy. The included studies compared sodium picosulphate with magnesium citrate (SPMC) and PEG for bowel preparation. Exclusion criteria were the inclusion of inpatients or groups with specific conditions, failure to mention patient status (outpatient or inpatient) or dietary restrictions, and permission to have unrestricted diet on the day prior to the exam. Primary outcomes were bowel cleaning success and/or tolerability of colon preparation. Secondary outcomes were adverse events, polyp and adenoma detection rates. Data on intention-totreat were extracted by two independent authors and risk of bias assessed through the Jadad scale. Funnel plots, Egger's test, Higgins' test (I2) and sensitivity analyses were used to assess reporting bias and heterogeneity. The meta-analysis was performed by computing risk difference (RD) using Mantel-Haenszel (MH) method with fixed-effects (FE) and random-effects (RE) models. Review Manager 5 (RevMan 5) version 6.1 (The Cochrane Collaboration) was the software chosen to perform the meta-analysis. RESULTS 662 records were identified but only 16 trials with 6200 subjects were included for the meta-analysis. High heterogeneity among studies was found and sensitivity analysis was needed and performed to interpret data. In the pooled analysis, SPMC was better for bowel cleaning [MH FE, RD 0.03, IC (0.01, 0.05), P = 0.003, I-2 = 33%, NNT 34], for tolerability [MH RE, RD 0.08, IC (0.03, 0.13), P = 0.002, I-2 = 88%, NNT 13] and for adverse events [MH RE, RD 0.13, IC (0.05, 0.22), P = 0.002, I-2 = 88%, NNT 7]. There was no difference in regard to polyp and adenoma detection rates. Additional analyses were made by subgroups (type of regimen, volume of PEG solution and dietary recommendations). SPMC demonstrated better tolerability levels when compared to PEG in the following subgroups: ""day-before preparation"" [MH FE, RD 0.17, IC (0.13, 0.21), P < 0.0001, I-2 = 0%, NNT 6], "" preparation in accordance with time interval for colonoscopy"" [MH RE, RD 0.08, IC (0.01, 0.15), P = 0.02, I-2 = 54%, NNT 13], when compared to ""high-volume PEG solutions"" [MH RE, RD 0.08, IC (0.01, 0.14), I-2 = 89%, P = 0.02, NNT 13] and in the subgroup "" liquid diet on day before"" [MH RE, RD 0.14, IC (0.06,0.22), P = 0.0006, I-2 = 81%, NNT 8]. SPMC was also found to cause fewer adverse events than PEG in the "" high-volume PEG solutions"" [MH RE, RD -0.18, IC (-0.30, -0.07), P = 0.002, I-2 = 79%, NNT 6] and PEG in the "" low-residue diet"" subgroup [MH RE, RD -0.17, IC (-0.27, 0.07), P = 0.0008, I-2 = 86%, NNT 6]. CONCLUSION SPMC seems to be better than PEG for bowel preparation, with a similar bowel cleaning success rate, better tolerability and lower prevalence of adverse events.
- Stent as a bridge to surgery for colonic obstruction: Do we really need more systematic reviews with meta-analysis of the same articles?(2019) RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; SACHDEV, Amit H.; MOURA, Eduardo Guimaraes Hourneaux de
- Efficacy and Safety of Endoscopic Sleeve Gastroplasty at Mid Term in the Management of Overweight and Obese Patients: a Systematic Review and Meta-Analysis(2020) MIRANDA NETO, Antonio Afonso de; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; KHAN, Ahmad; SINGH, Shailendra; PONTE NETO, Alberto Machado da; MADRUGA NETO, Antonio Coutinho; MONTE JUNIOR, Epifanio Silvino do; TUSTUMI, Francisco; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBackground Endoscopic sleeve gastroplasty (ESG) has emerged as a promising technique in endoscopic bariatric and metabolic therapies (EBMTs). We aimed to perform a systematic review and meta-analysis to provide an update on its efficacy and safety. Methods This is a systematic review and meta-analysis was performed following the PRISMA guidelines. MEDLINE, Cochrane, EMBASE, and LILACS were searched to identify the studies related to ESG. Results Eleven studies with a total of 2170 patients were included. The average BMI pre-ESG was 35.78 kg/m(2). Pooled mean %TWL observed at 6, 12, and 18 months was 15.3%, 16.1%, and 16.8% respectively. Pooled mean %EWL at 6, 12, and 18 months was 55.8%, 60%, and 73% respectively. No procedure-related mortality was reported. Conclusion ESG is a safe and effective procedure for primary obesity therapy with promising short- and mid-term results.
- The feared postdilation complication in caustic esophageal stenosis: combined endoscopic and surgical treatment(2021) SAGAE, Vitor Massaro Takamatsu; RIBEIRO, Igor Braga; PONTE NETO, Alberto Machado da; MATUGUMA, Sergio Eiji; CHENG, Spencer; SANTOS, Marcos Eduardo Lera dos; MOURA, Eduardo Guimaraes Hourneaux de
- Pain relief in chronic pancreatitis: endoscopic or surgical treatment? a systematic review with meta-analysis(2021) MENDIETA, Pastor Joaquin Ortiz; SAGAE, Vitor Massaro Takamatsu; RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; SCATIMBURGO, Maria Vitoria Cury Vieira; HIRSCH, Bruno Salomao; ROCHA, Rodrigo Silva de Paula; VISCONTI, Thiago Arantes de Carvalho; SANCHEZ-LUNA, Sergio A.; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBackground and aims Pain is one of the consequences of chronic pancreatitis (CP) that has the greatest impact on the quality of life of patients. Endoscopic and surgical interventions, by producing a decrease in intraductal pancreatic pressure, can provide pain relief. This is the first systematic review that includes only randomized clinical trials (RTCs) comparing outcomes in the short-term (less than 2 years) and long-term (more than 2 years) between these two types of interventions. Material and methods A comprehensive search of multiple electronic databases to identify RTCs comparing short and long-term pain relief, procedural complications, and days of hospitalization between endoscopic and surgical interventions was performed following the PRISMA guidelines. Results Three RCTs evaluating a total of 199 patients (99 in the endoscopy group and 100 in the surgery group) were included in this study. Surgical interventions provided complete pain relief, with statistical difference, in the long-term (16,4% vs 35.7%; RD 0.19; 95% CI 0.03-0.35; p = 0.02; I2 = 0%), without significant difference in short-term (17.5% vs 31.2%; RD 0.14; 95% CI -0.01-0.28; p = 0.07; I2 = 0%) when compared to endoscopy. There was no statistical difference in short-term (17.5% vs 28.1%; RD 0.11; 95% CI -0.04-0.25; p = 0.15; I2 = 0%) and long-term (34% vs 41.1%; RD 0.07; 95% CI -0.10-0.24; p = 0.42; I2 0%) in partial relief of pain between both interventions. In the short-term, both complications (34.9% vs 29.7%; RD 0.05; 95% CI -0.10-0.21; p = 0.50; I2 = 48%) and days of hospitalization (MD -1.02; 95% CI -2.61-0.58; p = 0.21; I2 = 0%) showed no significant differences. Conclusion Surgical interventions showed superior results when compared to endoscopy in terms of complete long-term pain relief. The number of complications and length of hospitalization in both groups were similar.