CLAUDIO LYOITI HASHIMOTO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
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- Bowel preparation for performing a colonoscopy: prospective randomized comparison study between a low-volume solution of polyethylene glycol and bisacodyl versus bisacodyl and a mannitol solution(2012) VIEIRA, Manoel Carlos; HASHIMOTO, Claudio Lyoiti; CARRILHO, Flair JoséCONTEXT: Colonoscopy is currently the gold standard method to examine the colon, the rectum and the terminal ileum. In order to perform the colonoscopy, it is necessary to clean the bowel and use medications that are generally poorly tolerated by the patients. OBJECTIVE: Compare the tolerability, acceptability, safety and efficacy of two solutions used for intestinal preparation for a colonoscopy. METHODS: One hundred patients matched for sex and age were prospective randomized into two groups. Polyethylene glycol group received bisacodyl 10 mg plus 1 L of polyethylene glycol the night before and 1 L on the day of the exam. Mannitol group received bisacodyl 20 mg the day before and 1 L of a 10% mannitol solution on the day of the exam. The diet was the same for both groups. Tolerability and acceptability were measured using previously validated questionnaires. In terms of safety, variations in vital signs before and after the preparation were recorded, in addition to any complications. The quality of the preparation was graded based on the Boston and Ottawa scales. RESULTS: Ninety-six percent (96%) completed the study. As for tolerability, the mannitol preparation group exhibited a significantly higher frequency of nausea, vomiting, abdominal pain, and abdominal distension than polyethylene glycol group (P < 0.05). Acceptability was significantly better in polyethylene glycol group. The polyethylene glycol solution has also previously been shown to be safer than mannitol. No difference was observed in the quality of the preparation between the two preparation methods. CONCLUSIONS: The following conclusions can be made: polyethylene glycol solution had higher tolerability, acceptability, and safety than the mannitol and should be used instead of mannitol. Both preparation solutions have similar efficacy.
- Endoscopic findings in uninvestigated dyspepsia(2014) FAINTUCH, Jacob Jehuda; SILVA, Fernando Marcuz; NAVARRO-RODRIGUEZ, Tomas; BARBUTI, Ricardo Correa; HASHIMOTO, Claudio Lyoiti; ROSSINI, Alessandra Rita Asayama Lopes; DINIZ, Marcio Augusto; EISIG, Jaime NatanBackground: It is important to know the causes of dyspepsia to establish the therapeutic approach. Dyspepsia is a frequent syndrome in our country, where there are restrictions to endoscopy and high prevalence of Helicobacter pylori (H. pylori) infection. This study aimed to assess the endoscopic findings of the syndrome, in an outpatient screening clinic of a tertiary hospital in Sao Paulo. Methods: Outpatients with uninvestigated dyspepsia, according to Rome III criteria, answered a dyspepsia questionnaire and underwent esophagogastroduodenoscopy. The Rapid Urease Test was applied to fragments of the antral mucosa and epidemiological data were collected from the studied population. Organic dyspepsia findings were analyzed with different variables to verify statistically significant associations. Results: Three hundred and six patients were included and 282 were analyzed in the study. The mean age was 44 years and women comprised 65% of the sample. Forty-five percent of the patients reported alarm symptoms. Functional dyspepsia was found in 66% of the patients (20% with normal endoscopy results and 46% with gastritis), 18% had GERD and 13% had ulcers (duodenal in 9% and gastric in 4%). Four cases of gastric adenocarcinoma were identified (1.4%), one without alarm characteristics, 1 case of adenocarcinoma of the distal esophagus and 1 case of gastric lymphoma. The prevalence of H. pylori was 54% and infection, age and smoking status were associated with organic dyspepsia. The age of 48 years was indicative of alarm signs. Conclusions: The endoscopic diagnosis of uninvestigated dyspepsia in our setting showed a predominance of functional disease, whereas cancer was an uncommon finding, despite the high prevalence of H. pylori. Organic dyspepsia was associated with infection, age and smoking status.
bookPart Esôfago de Barrett(2014) HASHIMOTO, Claudio Lyoiti; CARNEIRO, Fred Olavo Aragão Andrade; MACEDO, George Fred Soares de; MARQUES, Sergio B.; SAKAI, Paulo- COLONOSCOPY COMPLICATIONS IN THE ELDERLY: the impact of age and multimorbidity(2013) STEIN, Francine de Cristo; HOJAIJ, Naira Hossepian Salles de Lima; SILVA, Jose Guilherme Nogueira da; BORGES, Luana Vilarinho; JACOB-FILHO, Wilson; HASHIMOTO, Claudio LyoitiContext Age has been considered an independent risk factor for colonoscopy complications, especially when associated with multimorbidity. Objectives The primary objective was to verify the relationships between age, multimorbidity and colonoscopy complications in the elderly. Methods A retrospective cohort including patients of 60 years or older who had undergone a colonoscopy. Data relating to age, multimorbidities according to the cumulative illness scale for geriatrics and the Charlson index and complications related to bowel preparation and procedure (sedation and exam) were collected. Results Of the 207 patients (mean age 70.47 ± 7.04) with appropriate indication for colonoscopy according to the American Society for Gastrointestinal Endoscopy, 43 (20.77%) patients had some colonoscopy complications: 1 (0.48%) with the sedation (apnea), 4 (1.93%) with the procedure (abdominal pain and bacteremia) and 38 (18.35%) with the bowel preparation (acute renal failure, hypotension). Individuals ≥80 years had an RR = 3.4 (1.2-10.1), P = 0.025, and those with a Charlson index 3 had an RR = 5.2 (1.6-16.8), P = 0.006, for complications. The cumulative illness rating scale for geriatrics was not associated with complications (P = 0.45). Conclusion There was a significant risk of complications in ≥80 years and in the group with a Charlson index 3. The cumulative illness rating scale for geriatrics was not a good predictor of risk in this sample.
- UNDERWATER ENDOSCOPIC MUCOSAL RESECTION FOR NON-PEDUNCULATED COLORECTAL LESIONS. A PROSPECTIVE SINGLE-ARM STUDY(2020) LENZ, Luciano; MARTINS, Bruno; KAWAGUTI, Fabio Shiguehisa; TELLIAN, Alexandre; PENNACHI, Caterina Maria Pia Simoni; SORBELLO, Mauricio; GUSMON, Carla; PAULO, Gustavo Andrade de; UEMURA, Ricardo; GEIGER, Sebastian; LIMA, Marcelo Simas de; SAFATLE-RIBEIRO, Adriana; BABA, Elisa; HASHIMOTO, Claudio Lyoiti; MALUF-FILHO, Fauze; RIBEIRO JR, UlyssesABSTRACT BACKGROUND: Underwater endoscopic mucosal resection (UEMR) has emerged as a revolutionary method allowing resection of colorectal lesions without submucosal injection. Brazilian literature about this technique is sparse. OBJECTIVE: The aim of this study was evaluate the efficacy and safety of UEMR technique for removing non-pedunculated colorectal lesions in two Brazilian tertiary centers. METHODS: This prospective study was conducted between June 2016 and May 2017. Naïve and non-pedunculated lesions without signs of submucosal invasion were resected using UEMR technique. RESULTS: A total of 55 patients with 65 lesions were included. All lesions, except one, were successfully and completely removed by UEMR (success rate 98.5%). During UEMR, two cases of bleeding were observed (3.0%). One patient had abdominal pain on the day after resection without pneumoperitoneum. There was no perforation or delayed bleeding. CONCLUSION: This study supports the existing data indicating acceptable rates of technical success, and low incidence of adverse events with UEMR. The results of this Brazilian study were consistent with previous abroad studies.
- Less invasive than minimally invasive: peroral endoscopic myotomy with a slim scope in the treatment of esophageal achalasia(2018) CONRADO, Antonio Carlos Coelho; GUERRA, Joao Guilherme; HASHIMOTO, Claudio Lyoiti; AVERBACH, Marcelo; SANTOS, Miguel Arcanjo dos; DRAGANOV, Peter Vassilev
- High definition endoscopy and ""narrow band imaging"" in the diagnosis of gastroesophageal reflux disease(2014) ASSIRATI, Frederico Salvador; HASHIMOTO, Claudio Lyoiti; DIB, Ricardo Anuar; FONTES, Luiz Henrique Souza; NAVARRO-RODRIGUEZ, TomasIntroduction: The gastroesophageal reflux disease is a common condition in the western world but less than half of patients present endoscopic abnormalities, making a standard procedure unsuitable for diagnosis. High definition endoscopy coupled with narrow band imaging has shown potential for differentiation of lesions and possible biopsy, allowing early diagnosis and treatment. Methods: This review describes the principles of biotic and their influence in obtaining images with better definition of the vessels in the mucosa, through the narrow band imaging. Selected papers using it in patients with reflux disease and Barrett's esophagus are analyzed in several ways, highlighting the findings and limitations. Conclusion: The meaning of the narrow band imaging in the endoscopic diagnosis of reflux disease will be defined by large scale studies, with different categories of patients, including assessment of symptoms and response to treatment.
- Underwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trial(2023) LENZ, Luciano; MARTINS, Bruno; PAULO, Gustavo Andrade de; KAWAGUTI, Fabio Shiguehissa; BABA, Elisa Ryoka; UEMURA, Ricardo Sato; GUSMON, Carla Cristina; GEIGER, Sebastian Naschold; MOURA, Renata Nobre; PENNACCHI, Caterina; LIMA, Marcelo Simas de; SAFATLE-RIBEIRO, Adriana Vaz; HASHIMOTO, Claudio Lyoiti; RIBEIRO, Ulysses; MALUF-FILHO, FauzeBackground and aims: Conventional endoscopic mucosal resection (CEMR) is the standard modality for removing nonpedunculated colorectal lesions. Underwater endoscopic mucosal resection (UEMR) has emerged as an alternative method. There are few comparative studies between these techniques, especially evaluating recurrence. Therefore, the purpose of this trial was to compare CEMR and UEMR for the resection of colorectal lesions with respect to efficacy, safety, and recurrence rate. Methods: This was a randomized controlled trial of UEMR versus CEMR for naive and nonpedunculated lesions measuring between 10 and 40 mm. The primary outcome was adenoma recurrence at 6 months after the resec-tion. Secondary outcomes were rates of technical success, en bloc resection, and adverse events. Block random-ization was used to assign patients. Tattooing was performed to facilitate localization of the scars and eventual recurrences. Endoscopic follow-up was scheduled at 6 months after the procedure. The sites of resections were examined with white-light imaging, narrow-band imaging (NBI), and conventional chromoscopy with indigo carmine followed by biopsies. Results: One hundred five patients with 120 lesions were included, with a mean size of 17.5 +/- 7.1 (SD) mm. Sixty-one lesions were resected by UEMR and 59 by CEMR. The groups were similar at baseline regarding age, sex, average size, and histologic type. Lesions in the proximal colon in the CEMR group corresponded to 83% and in the UEMR group to 67.8% (P = .073). There was no difference between groups regarding success rate (1 failure in each group) and en bloc resection rate (60.6% UEMR vs 54.2% CEMR, P = .48). Intraprocedural bleeding was observed in 5 CEMRs (8.5%) and 2 UEMRs (3.3%) (P = .27). There was no perforation or delayed hemorrhage in either groups. Recurrence rate was higher in the CEMR arm (15%) than in the UEMR arm (2%) (P = .031). Therefore, the relative risk of 6-month recurrence rate in the CEMR group was 7.5-fold higher (95% CI, 0.98-58.20), with a number needed to treat of 7.7 (95% CI, 40.33-4.22). The higher recurrence rate in the CEMR group persisted only for lesions measuring 21 to 40 mm (35.7% vs 0%; P = .04). Conclusion: This study demonstrated that UEMR was associated with a lower adenoma recurrence rate than was CEMR. Both endoscopic techniques were effective and had similar rates of adverse events for the treatment of nonpedunculated colorectal lesions. (Gastrointest Endosc 2023;97:549-58.)