ALEXANDRE MORAES BESTETTI

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PAHC, Hospital das Clínicas, Faculdade de Medicina - Médico

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Agora exibindo 1 - 10 de 13
  • article 0 Citação(ões) na Scopus
    Endoscopic Approaches for Post Roux-en-Y Gastric Bypass Leaks: How to Choose the Best Tool for Each Task
    (2023) BESTETTI, Alexandre Moraes; OLIVEIRA, Victor Lira de; SILVEIRA, Saullo Queiros; MOURA, Eduardo Guimaraes Hourneaux de; MOURA, Diogo Turiani Hourneaux de
  • article 2 Citação(ões) na Scopus
    Sequential Endoscopic Therapies for Treatment of Complex Gastrointestinal Transmural Leak Following Bariatric Surgery
    (2022) BESTETTI, Alexandre Moraes; SANTO, Marco Aurelio; TRASOLINI, Roberto Paolo; FREITAS JUNIOR, Joao Remi de; HIRSCH, Bruno Salomao; MOURA, Eduardo Guimaraes Hourneaux de; MOURA, Diogo Turiani Hourneaux de
  • article
    Anti-reflux versus conventional self-expanding metal stents in the palliation of esophageal cancer: A systematic review and meta-analysis
    (2022) SASSO, Joao Guilherme Ribeiro Jordao; MOURA, Diogo Turiani Hourneaux de; PROENCA, Igor Mendonca; MONTE JUNIOR, Epifanio Silvino do; RIBEIRO, Igor Braga; SANCHEZ-LUNA, Sergio A.; CHENG, Spencer; BESTETTI, Alexandre Moraes; KUM, Angelo So Taa; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
    Background and study aims Self-expanding metal stents (SEMS) are an effective palliative endoscopic therapy to reduce dysphagia in esophageal cancer. Gastroesophageal reflux disease (GERD) is a relatively common complaint after non-valved conventional SEMS placement. Therefore, valved self-expanding metal stents (SEMS-V) were designed to reduce the rate of GERD symptoms. We aimed to perform a systematic review and meta-analysis comparing the two stents. Material and methods This was a systematic review and meta-analysis including only randomized clinical trials (RCT) comparing the outcomes between SEMS-V and non-valved self-expanding metal stents (SEMS-NV) following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were analyzed with Review Manager Software. Quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation guidelines. Results Ten randomized clinical trials including a total of 467 patients, 234 in the SEMS-V group and 233 in the SEMS-NV group, were included. There were no statistically significant differences regarding GERD qualitative analysis (RD -0.17; 95% CI -0.67, 0.33; P= 0.5) and quantitative analysis (SMD -0.22; 95% CI -0.53, 0.08; P=0.15) technical success (RD -0.03; 95% CI -0.07, 0.01; P= 0.16), dysphagia improvement (RD -0.07; 95% CI -0.19, 0.06; P=0.30), and adverse events (RD 0.07; 95% CI -0.07, 0.20; P= 0.32). Conclusions Both SEMS-V and SEMS-NV are safe and effective in the palliation of esophageal cancer with similar rates of GERD, dysphagia relief, technical success, adverse events, stent migration, stent obstruction, bleeding, and improvement of the quality of life.
  • article 5 Citação(ões) na Scopus
    Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations
    (2023) OLIVEIRA, Victor Lira de; BESTETTI, Alexandre Moraes; TRASOLINI, Roberto Paolo; MOURA, Eduardo Guimaraes Hourneaux de; MOURA, Diogo Turiani Hourneaux de
    Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.
  • article
    Endoscopic Treatment of Complex Walled-Off Necrosis in Necrotizing Pancreatitis With Two Simultaneous Lumen-Apposing Metal Stents: A Case Report
    (2022) SANTOS, Marcos Eduardo Lera dos; PROENCA, Igor Mendonca; SASSO, Joao Guilherme Ribeiro Jordao; OLIVEIRA, Victor Lira de; RIBAS, Pedro Henrique Boraschi Vieira; BESTETTI, Alexandre Moraes; RIBEIRO, Igor Braga; ANNA, Raoni Salomao Sant; OLIVEIRA, Guilherme Henrique Peixoto de; MOURA, Eduardo Guimaraes Hourneaux de
    Organized pancreatic and peripancreatic collections are complications of pancreatitis and should be treated when symptomatic or complicated. When feasible, the endoscopic ultrasound approach presents high efficacy and low morbidity and mortality, making it the first likely option. Among the available accessories for endoscopic drainage, the lumen-apposing metal stent can be a better option, with a low migration rate; furthermore, it allows endoscopic necrosectomy. Here, we present the case of complex walled-off necrosis treated with two lumen-apposing metal stents in the same procedure. A 41-year-old male patient with walled-off necrosis presented with delayed gastric emptying and obstruction of the main biliary duct. Magnetic resonance imaging and endoscopic ultrasound revealed two non-communicating collections. We opted for endoscopic ultrasound-guided drainage with the deployment of two simultaneous lumen-apposing metal stents: one transduodenal and the other transgastric, with clinical improvement. After three weeks, endoscopic retrograde cholangiopancreatography showed a biliary fistula communicating with the periduodenal collection, which was treated with a biliary plastic stent. An endoscopic necrosectomy was performed, and the metal stents were removed. Control magnetic resonance imaging demonstrated improvement. The patient was asymptomatic at the six-month follow-up. The treatment of symptomatic complex walled-off necrosis remains a challenge and may require multiple endoscopic approaches; moreover, surgical treatment may be necessary in case of failure. In the present report, we demonstrate that the deployment of two lumen-apposing metal stents in the same procedure is feasible when necessary as it was associated with technical success and short-term clinical success.
  • article
    Gastroesophageal Reflux Waning Over Time in Endoscopic Versus Surgical Myotomy for the Treatment of Achalasia: A Systematic Review and Meta-Analysis
    (2022) KUM, Angelo So Taa; MOURA, Diogo Turiani De; PROENCA, Igor Mendonca; AIKAWA, Masanori; SANCHEZ-LUNA, Sergio A.; RIBEIRO, Igor Braga; SASSO, Joao Guilherme Ribeiro Jordao; BESTETTI, Alexandre Moraes; BERNARDO, Wanderley Marques; MOURA, Eduardo G. Hourneaux de
    Peroral endoscopic myotomy (POEM) and Heller myotomy with fundoplication (HMF) effectively treat achalasia, an esophageal motor disease. Although a significant number of meta-analyses have compared POEM and HMF, these studies showed discrepant postoperative gastroesophageal reflux disease (GERD) conclusions. This review aimed to objectively compare GERD over time, as well as the efficiency, safety, and adverse events in POEM versus HMF for treating achalasia.We performed a systematic review and meta-analysis by searching Medline, Embase, Cochrane Library, Scopus, and Clinicaltrials.gov. The evaluated outcomes included early (within 12 months) and late (beyond 12 months) endoscopic assessment of GERD using the Lyon Consensus, clinical success, operative duration (OD), length of stay (LOS), and major adverse events (MAE).A total of 29 observational studies and two randomized clinical trials (RCTs) with 13,914 patients were included. GERD was 28% higher among RCTs discussing POEM at early assessment (95%CI 0.02, 0.54) and was not different at late evaluation (95% confidence interval (CI) = 0.00, 0.22). No difference in reflux was observed among observational studies in both periods. The clinical success was 9% higher (95% CI = 0.05, 0.12), and the OD was 37.74 minutes shorter (95% CI =-55.44,-20.04) in POEM among observational studies, whereas it was not different among RCTs. The LOS and MAE were similar in the groups.Comparisons among studies yielded divergent results. RCTs revealed that POEM had a higher incidence of GERD in the early assessment, whereas observational studies showed higher clinical success and a shorter OD in POEM. Ultimately, the between-group difference waned over time in GERD in all comparisons, resulting in no difference among RCTs in the late evaluation. Our meta-analysis demonstrated a non -preferential treatment of achalasia between endoscopic or surgical cardiomyotomy, prioritizing an individualized approach in the long term.
  • article 4 Citação(ões) na Scopus
    Multiple Endoscopic Therapies for Treatment of Chronic Post-bariatric Surgery Gastropleural Fistula
    (2022) BESTETTI, Alexandre Moraes; BOGHOSSIAN, Mateus Bond; HIRSCH, Bruno Salomao; MCCARTY, Thomas R.; SANTO, Marco Aurelio; MOURA, Eduardo Guimaraes Hourneaux de; MOURA, Diogo Turiani Hourneaux de
  • article 3 Citação(ões) na Scopus
    Cholangioscopy in a post-Covid-19 cholangiopathy patient
    (2022) FRANZINI, T. A. P.; GUEDES, M. M. F.; ROCHA, H. L. O. G.; FLEURY, C. A.; BESTETTI, A. M.; MOURA, E. G. H. de
  • article
    Pseudotumoral Amyloidosis Presentation With Upper Digestive Bleeding
    (2023) GOMES, Igor Logetto Caetite; CARLOS, Alexandre de Sousa; KUM, Angelo So Taa; BESTETTI, Alexandre Moraes; MOURA, Eduardo Guimaraes Hourneaux de
    Amyloidosis is a condition related to the extracellular deposition of abnormal fibrillar proteins. Gastric involvement may present as a systemic or localized form of the disease. The endoscopic presentation can vary from nodular, ulcerated, or infiltrative lesions. Clinical manifestations are nonspecific, including hyporexia, nausea, vomiting, weight loss, epigastralgia, and abdominal discomfort. Thus, amyloidosis can clinically and endoscopically mimic other diseases, such as neoplasms, syphilis, tuberculosis, and Crohn's disease, requiring a high suspicion. When it manifests with gastrointestinal bleeding, it most commonly occurs as intermittent melena. This report aims to present an unusual case of a patient with upper gastrointestinal bleeding exteriorized through melena secondary to amyloidosis with gastric involvement.
  • conferenceObject
    HOT VERSUS COLD SNARE FOR COLORECTAL POLYPECTOMIES SIZED UP TO 10MM. A SYSTEMATIC REVIEW AND META-ANALYSIS
    (2023) CAVASSOLA, Paulo; HIRSCH, Bruno Salomao; BESTETTI, Alexandre; OLIVEIRA, Guilherme Henrique Peixoto de; GOMES, Romulo; VERAS, Matheus; BERNARDO, Wanderley; MOURA, Diogo De; MOURA, Eduardo De