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
66 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 66
- 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
- EFFICACY OF ENDOSCOPIC TOPICAL MITOMYCIN C APPLICATION IN CAUSTIC ESOPHAGEAL STRICTURES IN THE PEDIATRIC POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS(2021) FLOR, Marcelo Mochate; RIBEIRO, Igor Braga; DE MOURA, Diogo Turiani Hourneaux; MARQUES, Sérgio Barbosa; BERNARDO, Wanderley Marques; DE MOURA, Eduardo Guimarães HourneauxABSTRACT BACKGROUND: Caustic ingestion and development of esophageal strictures are recognized major public health problems in childhood. Different therapeutic methods have been proposed in the management of such strictures. OBJECTIVE: To evaluate efficacy and risk of endoscopic topical application of mitomycin C in the treatment of caustic esophageal strictures. METHODS: We searched MEDLINE, EMBASE, Central Cochrane, and LILACS databases. The outcomes evaluated were dysphagia resolution rate, number of dilations performed in resolved cases, and the number of dilations performed in all patients. RESULTS: Three randomized clinical trials were included for final analysis with a total of 190 patients. Topical mitomycin C application group showed a significant increase in dysphagia resolution rate, corresponding to a 42% higher dysphagia resolution as compared to endoscopic dilation alone, with statistical significance between the two groups (RD: 0.42 - [CI: 0.29-0.56]; P-value <0.00001). The mean number of dilations performed in resolved cases were significantly less in the topical mitomycin C application group, compared to endoscopic dilations alone, with statistical significance between the two groups (MD: 2.84 [CI: 1.98-3.69]; P-value <0.00001). When comparing the number of dilations in all patients, there was no statistical difference between the two groups (MD: 1.46 [CI: -1.53-4.44]; P-value =0.34). CONCLUSION: Application of topical mitomycin C with endoscopic dilations in caustic esophageal strictures was more effective in dysphagia resolution than endoscopic therapy alone in the pediatric population. Moreover, topical mitomycin C application also reduced the number of dilation sessions needed to alleviate dysphagia without rising morbidity.
- Propofolvsmidazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials(2020) GUACHO, John Alexander Lata; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; PONTE NETO, Alberto Machado da; SINGH, Shailendra; TUCCI, Marina Gammaro Baldavira; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBACKGROUND Patients with cirrhosis frequently require sedation for elective endoscopic procedures. Several sedation protocols are available, but choosing an appropriate sedative in patients with cirrhosis is challenging. AIM To conduct a systematic review and meta-analysis to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best approach. METHODS This systematic review and meta-analysis was conducted using the PRISMA guidelines. Electronic searches were performed using MEDLINE, EMBASE, Central Cochrane, LILACS databases. Only randomized control trials (RCTs) were included. The outcomes studied were procedure time, recovery time, discharge time, and adverse events (bradycardia, hypotension, and hypoxemia). The risk of bias assessment was performed using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB-2). Quality of evidence was evaluated by GRADEpro. The meta-analysis was performed using Review Manager. RESULTS The search yielded 3,576 records. Out of these, 8 RCTs with a total of 596 patients (302 in the propofol group and 294 in the midazolam group) were included for the final analysis. Procedure time was similar between midazolam and propofol groups (MD: 0.25, 95%CI: -0.64 to 1.13,P= 0.59). Recovery time (MD: -8.19, 95%CI: -10.59 to -5.79,P< 0.00001). and discharge time were significantly less in the propofol group (MD: -12.98, 95%CI: -18.46 to -7.50,P< 0.00001). Adverse events were similar in both groups (RD: 0.02, 95%CI: 0-0.04,P= 0.58). Moreover, no significant difference was found for bradycardia (RD: 0.03, 95%CI: -0.01 to 0.07,P= 0.16), hypotension (RD: 0.03, 95%CI: -0.01 to 0.07,P= 0.17), and hypoxemia (RD: 0.00, 95%CI: -0.04 to 0.04,P= 0.93). Five studies had low risk of bias, two demonstrated some concerns, and one presented high risk. The quality of the evidence was very low for procedure time, recovery time, and adverse events; while low for discharge time. CONCLUSION This systematic review and meta-analysis based on RCTs show that propofol has shorter recovery and patient discharge time as compared to midazolam with a similar rate of adverse events. These results suggest that propofol should be the preferred agent for sedation in patients with cirrhosis.
- 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.
- 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
- A rare non-oncological pancreatic mass: eosinophilic pancreatitis diagnosis through EUS-FNA(2019) MOURA, Diogo Turiani Hourneaux De; ROCHA, Rodrigo Silva de Paula; JUKEMURA, Jose; BRUNALDI, Vitor Ottoboni; GUEDES, Hugo Goncalo; TORREZ, Franz Robert Apodaca; RIBEIRO, Igor Braga; GELRUD, Andres; MOURA, Eduardo Guimaraes Hourneaux DeBackground and study aims Eosinophilic pancreatitis (EP) is a rare etiology of chronic pancreatitis, and few cases have been reported. It is characterized by eosinophilic infiltration of the pancreas and elevated IgE levels. EP is difficult to distinguish from pancreatic cancer based on clinical symptoms and auxiliary exams. We present a case of EP and debate the routine performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for resectable pancreatic mass.
- Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis(2019) SERRANO, Juan Pablo Roman; MOURA, Diogoturiani Hourneaux de; BERNARDO, Wanderley Marques; RIBEIRO, Igor Braga; FRANZINI, Tomazo Prince; MOURA, Eduardo Turiani Hourneaux de; BRUNALDI, Vitor Ottoboni; SALESSE, Marianne Torrezan; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux DeBackground and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic procedure for treatment of diseases that affect the biliary tree and pancreatic duct. While the therapeutic success rate of ERCP is high, the procedure can cause complications, such as acute pancreatitis (PEP), bleeding, and perforation. This meta-analysis aimed to assess the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing PEP following (ERCP). Materials and methods We searched databases, such as MEDLINE, Embase, and Cochrane Central Library. Only randomized controlled trials (RCTs) that compared the efficacy of NSAIDs and placebo for the prevention of PEP were included. Outcomes assessed included incidence of PEP, severity of pancreatitis, route of administration, and type of NSAIDs. Results Twenty-one RCTs were considered eligible with a total of 6854 patients analyzed. Overall, 3427 patients used NSAIDs before ERCP and 3427 did not use the drugs (control group). In the end, 250 cases of acute pancreatitis post-ERCP were diagnosed in the NSAIDs group and 407 cases in the placebo group. Risk for PEP was lower in the NSAID group (risk difference (RD): -0.05; 95% confidence interval (CI): -0.07 to -0.03; number need to treat (NNT), 20; P<0.05). Use of NSAIDs effectively prevented mild pancreatitis compared with use of placebo (2.5% vs. 4.1%; 95% CI, -0.05 to -0.01; NNT, 33; P<0.05), but the information on moderate and severe PEP could not be completely elucidated. Only rectal administration reduced incidence of PEP (6.8% vs. 13 %; 95% CI, -0.10 to -0.04; NNT, 20; P<0.05). Furthermore, only diclofenac or indomethacin use was effective in preventing PEP. Conclusions Rectal administration of diclofenac and indomethacin significantly reduced risk of developing mild PEP. Further RCTs are needed to compare efficacy between NSAID administration pathways in prevention of PEP after ERCP.
- 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