PAULO SAKAI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Reduced Transcobalamin I Gene Expression Following Roux-en-Y Gastric Bypass Surgery Can Contribute to B12 Deficiency(2015) SALA, Priscila; MACHADO, Natasha; BELARMINO, Giliane; ISHIDA, Robson; GUARDA, Ismael; GIANNELLA-NETO, Daniel; SANTO, Marco Aurelio; MOURA, Eduardo; SAKAI, Paulo; SILVA, Ismael; YE, Jianping; HEYMSFIELD, Steven; WAITZBERG, Dan- Endoscopy vs surgery in the treatment of early gastric cancer: Systematic review(2015) KONDO, Andre; MOURA, Eduardo Guimaraes Hourneaux de; BERNARDO, Wanderley Marques; YAGI, Osmar Kenji; MOURA, Diogo Turiani Hourneaux de; MOURA, Eduardo Turiani Hourneaux de; BRAVO, Jose Goncalves Pereira; YAMAZAKI, Kendi; SAKAI, PauloAIM: To report a systematic review, establishing the available data to an unpublished 2a strength of evidence, better handling clinical practice. METHODS: A systematic review was performed using MEDLINE, EMBASE, Cochrane, LILACS, Scopus and CINAHL databases. Information of the selected studies was extracted on characteristics of trial participants, inclusion and exclusion criteria, interventions (mainly, mucosal resection and submucosal dissection vs surgical approach) and outcomes (adverse events, different survival rates, mortality, recurrence and complete resection rates). To ascertain the validity of eligible studies, the risk of bias was measured using the Newcastle-Ottawa Quality Assessment Scale. The analysis of the absolute risk of the outcomes was performed using the software RevMan, by computing risk differences (RD) of dichotomous variables. Data on RD and 95% CIs for each outcome were calculated using the Mantel-Haenszel test and inconsistency was qualified and reported in. 2 and the Higgins method (I 2). Sensitivity analysis was performed when heterogeneity was higher than 50%, a subsequent assay was done and other findings were compiled. RESULTS: Eleven retrospective cohort studies were selected. The included records involved 2654 patients with early gastric cancer that filled the absolute or expanded indications for endoscopic resection. Three-year survival data were available for six studies (n = 1197). There were no risk differences (RD) after endoscopic and surgical treatment (RD = 0.01, 95% CI: -0.02-0.05, P = 0.51). Five-year survival data (n = 2310) showed no difference between the two groups (RD = 0.01, 95% CI: -0.01-0.03, P = 0.46). Recurrence data were analized in five studies (1331 patients) and there was no difference between the approaches (RD = 0.01, 95% CI: -0.00-0.02, P = 0.09). Adverse event data were identified in eight studies (n = 2439). A significant difference was detected (RD = -0.08, 95% CI: -0.10--0.05, P < 0.05), demonstrating better results with endoscopy. Mortality data were obtained in four studies (n = 1107). There was no difference between the groups (RD = -0.01, 95% CI: -0.02-0.00, P = 0.22). CONCLUSION: Three-, 5-year survival, recurrence and mortality are similar for both groups. Considering complication, endoscopy is better and, analyzing complete resection data, it is worse than surgery.
- Comparison of electrical current and ultrasonic device for incision of the septum of the pharyngoesophageal diverticulum in a pig model(2015) HONDO, Fabio Yuji; GIORDANO-NAPPI, Jose Humberto; PESSORRUSSO, Fernanda Cristina Simoes; FRANCO, Matheus Cavalcante; NEVES, Carla Zanelatto; CECCONELLO, Ivan; SAKAI, Paulo; MALUF-FILHO, FauzeComplications of endoscopic treatment of pharyngoesophageal diverticulum (PED) such as bleeding and perforation occur in up to 15 % of cases. Our objective was to compare incision of the PED septum using the ultrasonic device (group H) with incision using electrical current (group M) in a pig model. Twenty domestic pigs were divided into groups H and M. The incision of the PED septum was performed using the ultrasonic device or using electrical current, respectively. The procedural time, complication rate, length of the border of the incised septum, and thermal tissue damage were compared between groups. Mean time to divide the septum and total procedure time were significantly shorter in group H. Mean length of the border of the incised septum was significantly higher in group H. The lateral thermal spread caused by electrical current (group M) was more intense. Hemorrhage was exclusively observed in group M. Experimental endoscopic diverticulotomy using ultrasonic device was faster and caused less tissue damage when compared to electrical current.
- Results of treatment of esophageal variceal hemorrhage with endoscopic injection of n-butyl-2-cyanoacrylate in patients with Child-Pugh class C cirrhosis(2015) RIBEIRO, Joao Paulo; MATUGUMA, Sergio Eiji; CHENG, Spencer; HERMAN, Paulo; SAKAI, Paulo; D'ALBUQUERQUE, Luiz Augusto Carneiro; MALUF-FILHO, FauzeBackground and study aims: The results of endoscopic treatment with elastic band ligation for esophageal variceal bleeding in patients with Child-Pugh class C cirrhosis remain poor. In comparison with treatment with elastic band ligation, we have found lower rates of rebleeding and mortality with n-butyl-2-cyanoacrylate injections. Thus, the aim of the current study was to describe our unit's 10 years of experience with injection of n-butyl-2-cyanoacrylate to control esophageal variceal ruptures in patients with Child-Pugh class C cirrhosis. Patients and methods: A single-center, retrospective study was conducted. Sixty-three patients with Child-Pugh class C cirrhosis had been admitted to the center with an acute episode of esophageal variceal bleeding. All were treated with injection of n-butyl-2-cyanoacrylate. The patients were assigned to 1 of 2 groups according to their Child-Pugh class C cirrhosis scores: group I (score range, 10 through 13 points) and group II (score, 14 or 15 points). The 3 variables studied were rates of initial failure to control bleeding, failure to prevent rebleeding (secondary prophylaxis), and mortality. Patients in the 2 groups (group I, n=50; group II, n=13) had similar characteristics. Results: Bleeding was successfully controlled in almost 75% of the patients during the first 5 days after treatment, with no significant differences observed between groups I and II. There were no significant differences between the 2 groups with respect to mortality rate for the first 5 days after treatment. Thirty-four patients (54%) were free of bleeding at 6 weeks after treatment, with a significant difference noted between the groups: group I, 64%, versus group II, 15.4% (P<0.001). The overall mortality rate was 44.4%, with a significant difference noted between the groups: group I, 34%, versus group II, 84.6% (P<0.001). Conclusion: Endoscopic injection of n-butyl-2-cyanoacrylate is a valid treatment option to control esophageal variceal bleeding in patients with a Child-Pugh class C cirrhosis score in the range of 10 through 13 points.
- ENDOSCOPIC ULTRASOUND IN THE EVALUATION OF UPPER SUBEPITHELIAL LESIONS(2015) CHAVES, Dalton Marques; MEINE, Gilmara Coelho; MOURA, Diogo Turiani Hourneaux de; MATUGUMA, Sergio Eiji; LERA, Marcos Eduardo; ARTIFON, Everson Luiz de Almeida; MOURA, Eduardo Guimarães Hourneaux de; SAKAI, PauloBackgroundEndoscopic ultrasound is considered the best imaging test for the diagnosis and evaluation of subepithelial lesions of the gastrointestinal tract.ObjectiveThe present study aims to describe the endosonographic characteristics of upper gastric subepithelial lesions and our experience using endoscopic ultrasound for evaluation of such lesions.MethodsRetrospective data study of 342 patients who underwent endoscopic ultrasound evaluation of subepithelial lesions.ResultsLesions of the fourth layer were more common in the stomach (63.72%) than in the esophagus (44.68%) and duodenum (29.03%). In stomach, 81.1% of the lesions ≥2 cm, and 96.5% ≥3 cm, were from the fourth layer. Endosonographic signs that could be related to malignant behavior, such as irregular borders, echogenic foci, cystic spaces and/or size greater than 3 cm were identified in 34 (15.81%) lesions at the first endoscopic ultrasound evaluation. Endoscopic ultrasound-fine needle aspiration did the diagnosis in 21 (61.76%) patients who were submitted a puncture. Three (12.0%) lesions of 25 who were submitted to regular endoscopic ultrasound surveillance increased the size.ConclusionStomach is the organ most affected with subepithelial lesions of the gastrointestinal tract and the fourth layer was the most common layer of origin. More than 80% of gastric subepithelial lesions from the fourth layer are ≥2 cm. Endoscopic ultrasound evaluation of subepithelial lesions has been very important for stratification into risk groups and to determine the best management.
- Biliary stenosis extreme endoscopy treatment-very large balloon dilation: a new concept(2015) MOURA, Eduardo G. H. de; FURUYA JR., Carlos K.; MESTIERI, Luiz H. M.; MEDRADO, Bruno F.; CARNEIRO, Fred O.; ARTIFON, Everson L.; HERMAN, Paulo; SAKAI, Paulo
conferenceObject ENDOSCOPIC ASSISTED COLOSTOMY WITH PERCUTANEOUS COLOPEXY: AN EXPERIMENTAL STUDY.(2015) BUSTAMANTE-LOPEZ, L.; SULBARAN, M.; SAKAI, P.; MOURA, E.; NAHAS, C.; MARQUES, C.; SAKAI, C.; CECCONELLO, I.; PINTO, R.; NAHAS, S.- Strongyloides stercoralis hyperinfection: an unusual cause of gastrointestinal bleeding(2015) RIOS, Juliana Trazzi; FRANCO, Matheus Cavalcante; MARTINS, Bruno da Costa; BABA, Elisa Ryoka; SAFATLE-RIBEIRO, Adriana Vaz; SAKAI, Paulo; RETES, Felipe Alves; MALUF-FILHO, FauzeStrongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy.
- Effects of Duodenal-Jejunal Bypass Liner (EndoBarrierA (R)) on Gastric Emptying in Obese and Type 2 Diabetic Patients(2015) MOURA, Eduardo Guimaraes Hourneaux de; LOPES, Guilherme Sauniti; MARTINS, Bruno da Costa; ORSO, Ivan Roberto Bonotto; COUTINHO, Artur Martins Novaes; OLIVEIRA, Suzana Lopes de; SAKAI, Paulo; GALVAO-NETO, Manoel dos Passos; SANTO, Marco Aurelio; SAPIENZA, Marcelo Tatit; CECCONELLO, Ivan; BUCHPIGUEL, Carlos AlbertoThe duodenal-jejunal bypass liner (DJBL) is a promising technique for treating obesity and type 2 diabetes mellitus (T2DM). However, despite promising results, its mechanism of action has not been elucidated. It is thought to promote changes in gastric emptying owing to the neuro-endocrine axis. The aim of this paper was to study DJBL-induced changes in gastric emptying and the relationship of those changes with weight loss and T2DM. Twenty-five patients with obesity and T2DM met inclusion criteria. Scintigraphic gastric emptying testing was performed prior to implantation, 16 weeks after implantation, and 4 weeks after removal. The average gastric retention was compared between tests, to examine the relationship between gastric emptying and those who lost more than 10 % of total body weight. Similarly, we compared average gastric retention between those who achieved a glycated hemoglobin target lower than 7 %. Average gastric retention was greater after DJBL implantation compared with the baseline (first hour, 74 +/- 16.3 %, p = 0.001; second hour, 45 +/- 25 %, p < 0.001; fourth hour, 15.8 +/- 15 %, p < 0.001). There was no difference between the baseline and 4 weeks after device removal (fourth hour, p = 0.057). Gastric retention was similar between patients who achieved T2DM control and those who did not (p = 0.73). Additionally, no difference was seen between patients who lost more than 10 % of body weight and those who did not (p = 0.275). DJBL delays gastric emptying but is reversible after withdrawal. The changes in gastric emptying have no relationship to weight loss and T2DM control.
- IMPROVED EXPERIMENTAL MODEL TO EVALUATE SUBMUCOSAL INJECTION SOLUTIONS FOR ENDOSCOPIC SUBMUCOSAL DISSECTION(2015) YAMAZAKI, Kendi; MALUF-FILHO, Fauze; COSTA, Vitor Alves Pessoa da; PESSORRUSSO, Fernanda Cristina Simões; HONDO, Fabio Yuji; SAKAI, Paulo; FIGUEIREDO, Luis Francisco Poli deBackground: Endoscopic submucosal dissection carries an increased risk of bleeding and perforation. The creation of a long lasting submucosal cushion is essential for the safe and complete removal of the lesion. There is not a suitable experimental model for evaluation of the durability of the cushioning effect of different solutions. Aim: To describe an improved experimental model to evaluate submucosal injection solutions. Methods: A total of four domestic pigs were employed to evaluate two different submucosal fluid solutions in the gastric submucosa. After midline laparotomy, the anterior gastric wall was incised from the gastric body to the antrum and its mucosal surface was exposed by flipping inside out the incised gastric wall. Two different solutions (10% mannitol and normal saline) were injected in the submucosa of the anterior wall of the distal gastric body. All submucosal cushions were injected until they reach the same size, standardized as 1.0 cm in height and 2.0 cm in diameter. A caliper and a ruler were employed to guarantee accuracy of the measurements. Results: All four animal experiments were completed. All submucosal cushions had the exact same size measured with caliper and a ruler. By using the mannitol solution, the mean duration of the submucosal cushion was longer than the saline solution: 20 and 22 min (mean, 21 min) vs 5 and 6 min (mean, 5.5 min) Conclusions: This experimental model is simple and evaluate the duration, size, and effect of the submucosal cushion, making it more reliable than other models that employ resected porcine stomachs or endoscopic images in live porcine models.