KENDI YAMAZAKI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject Results of Endoscopic Treatment of Gastrojejunal Anastomosis Strictures After Bariatric Surgery: Analyses of Risk Factors Related to Bad Prognosis(2012) MOURA, Eduardo G. H. De; MANOEL, Galvao Neto; CEREDA, Diamari C.; RAMOS, Almino C.; MOURA, Diogo T. H. De; OLIVEIRA, Suzana L. De; YAMAZAKI, Kendi; MOURA, Eduardo T. H. De; FERREIRA, Flavio C.; ARTIFON, Everson L.; SAKAI, Paulo; CAMPOS, JosembergBackground: One of the most popular techniques on bariatric surgery is gastric bypass with Roux-en-Y reconstruction which aims to create a narrow area with important restriction of stomach area thus leading to early repletion. Objective: To analyze the factors relevant to patient’s clinical response to the treatment by endoscopic dilation and the risk factors. Methods: 54 patients submitted to bariatric surgery by gastric bypass with Roux-en-Y reconstruction that developed anastomotic stricture. The parameters analyzes were age, gender, presence or not of silastic ring, extension of the gastric pouch, anastomosis diameter, number of dilation sessions, balloon diameter, association with other surgical complications, endoscopic complications and need of re-operation. Results: When silastic ring was found it was necessary to perform dilation with larger balloons (Rigiflex 30mm) (p = 0,02) and also higher post-surgical complication rates (p = 0,01). Among the analyzed factors relevant to technical success it was identified that the presence of an ischemic segment was related with higher complication rates (perforation and re-estenosis) and also technical failure. There was no significant correlation between the diameter of the anastomosis, total amount of dilation sessions, gender, age and post-surgical complications. Conclusion: Gastrojejunal anastomosis strictures after bariatric surgery are associated with a high success rate of treatment by endoscopic dilation. When performing dilation of patients with a silastic ring or an ischemic segment of the gastric pouch it is recommended to perform this procedure with extra care once this condition is associated with higher complication rates and technical failure.conferenceObject Learning Curve for ESD: Experience From a South American Center(2012) MOURA, Eduardo G. H. De; YAMAZAKI, Kendi; MESTIERI, Luiz H.; MIYAJIMA, Nelson T.; CHAVES, Dalton M.; SANTOS, Marcos E. Lera Dos; IDE, Edson; FRANZINI, Tomazo; PESSORRUSSO, Fernanda C.; SAKAI, PauloIntroduction: Endoscopic resection techniques such as endoscopic submucosal dissection (ESD) for early gastric cancer are gaining acceptance in many countries. However complication rates on this procedure reaches 20% on non-experienced hands. Experts recommend that ESD should first be carried out in animal models before starting to be performed in humans, in order to overcome the initial learning curve. Aims: To evaluate the learning curve during intensive ESD training on live porcine models under supervision of experts. Material and Methods: Forty endoscopists have performed ESD during an intensive training course on live porcine models, under experts’ supervision. This training had duration of two days. Simulation of a gastric lesion was obtained by aspirating the gastric mucosa with a cap on the tip of the endoscope. The following variables were analyzed: procedure time, resected specimen size, complete en bloc resection rate, circumferential incision time, submucosal solution injected volume, distance between the circumferential incision and the lesion (lateral margin) and complication rates as perforation, bleeding and death. And from the beginning to the end of the last procedure a questionnaire was given to the participants to see if they felt secure to perform ESD without supervision. Results: At the end of 2 days training, 125 gastric ESDs were achieved. Each participant performed at least 3 complete ESDs. The mean procedure time for the first cases were 32.69 min ± 15.89 (CI 95% 6.52 - 19.36) and at the end of the third case 19.7min ± 8.57 (CI 95% 6.52 - 19.36), p 0.001; the distance between the circumferential incision and the lesion (lateral margin) has increased from 2.54mm 1.75 (CI 95% 1.24 - 1.05) to 2.71mm ± 2.70(CI 95% 1.24 - 1.05), p=0.87 at the end of the third case. Bleeding rate has decreased from 18.75% to 15.63%. At the end of the training course 56.25% of the endoscopists felt secure to do ESD without supervision, a percentage that was 6.25% at the beginning of the course. Conclusion: Training ESD on live porcine models may help endoscopist overcome the learning curve but more training is needed to make it secure in humans.