FRED OLAVO ARAGAO ANDRADE CARNEIRO
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conferenceObject Endoscopic Papillary Large Balloon Dilation Associated With Sphincterotomy for Extraction of Large Bile Duct Stones(2012) LUZ, Gustavo O.; MOURA, Eduardo G. De; MEINE, Gilmara C.; CARNEIRO, Fred O.; MEDRADO, Bruno F.; ALMEIDA, Maira R.; MALUF-FILHO, Fauze; LERA, Marcos; IDE, Edson; FURUYA, Carlos K.; CHAVES, Dalton M.; CHENG, Spencer; MATUGUMA, Sergio E.; TOMISHIGE, Toshiro; HONDO, Fabio Y.; BARACAT, Renato; ARTIFON, Everson L.; FRANZINI, Tomazo; SAKAI, PauloCommon bile duct stones larger than 15mm are related to a higher rate of failure of endoscopic ductal clearance and need for mechanical lithotripsy. Recently, endoscopic papillary large balloon dilation (EPLBD) associated with endoscopic sphyncterotomy (ES) has been advocated for the management of difficult bile duct stones. Objective: Evaluate the efficacy and safety of EPLBD associated with ES for removal of large bile duct stones. Patients and methods: retrospective review of prospectively collected data in an academic tertiary referral center, from November 2009 to August 2011. Ampullary dilation was performed with a wire guided hydrostatic balloon (CRE/Boston Scientific) which size ranged from 12 to 20mm. The stone size and the duct diameter directed the choice of the balloon diameter. Balloon was inflated with diluted contrast medium under endoscopic and fluoroscopic control until waist disappearance and/or maximal balloon pressure. After dilation stones were extracted with the aid of standard accessories and techniques. Outcomes and adverse events were recorded. Results: A total of 730 patients with common bile duct stones were admitted for ERCP in our institution. 123 (16,8%) patients were submitted to EPLBD after sphincterotomy. The mean age was 56 years (22-98) and 77 were female (63%). The size of the stones ranged from 13 to 30mm. Initial procedure success rate without mechanical lithitripsy was 83% (102/123). In further 4 patients (3,2%) mechanical lithotripsy was used with 75% success rate (3/4). For the remaining 17 patients, mechanical litotripsy was not available and a 10Fr biliary stent was introduced to prevent obstruction and cholangitis. The total adverse events rate was 3,2%. There were 2 cases of perforation with 20mm balloon (1,6%), both treated conservatively, and two cases of mild acute pancreatitis (1,6%). None of the patients presented bleeding that required transfusion or hospitalization. Conclusion: EPLBD after sphincterotomy is a safe and effective technique for the management of large bile duct stones and it avoids mechanical lithotripsy in the majority of cases.bookPart Diagnóstico e tratamento de lesões císticas do pâncreas(2014) ARTIFON, Everson Luiz de Almeida; CARNEIRO, Fred Olavo Aragão Andrade; CHAVES, Dalton Marques; SOUSA, Marcelo Magno de Freitas- Endoscopic ultrasound-guided choledochoduodenostomy and duodenal stenting in patients with unresectable periampullary cancer: one-step procedure by using linear echoendoscope(2013) ARTIFON, Everson L. A.; FRAZAO, Mariana S. V.; WODAK, Stephanie; CARNEIRO, Fred Olavo A. A.; TAKADA, Jonas; RABELLO, Carolina; APARICIO, Dayse; MOURA, Eduardo Guimaraes Hourneaux De; SAKAI, Paulo; OTOCH, Jose PinhataObjective. Describe a case series of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (BUS-CD) associated with duodenal self-expandable metal stents (SEMS) placement using solely the linear echoendoscope in seven patients with obstructive jaundice and duodenal obstruction due to unresectable periampullary cancer. Material and methods. EUS-CD in the first portion of the duodenum, associated with duodenal SEMS placement was performed in seven patients with unresectable periampullary cancer with obstructive jaundice and invasive duodenal obstruction. Laboratory tests and clinical follow-up were performed until patient's death. The procedure was performed by an experienced endoscopist under conscious sedation. The puncture position was chosen based on EUS evaluation, at the common bile duct (CBD) above the tumor, through the distal part of the duodenal bulb. After that, the needle was withdrawn and a wire-guided needle knife was used to enlarge the site puncture in the duodenal wall. Then, a partially covered SEMS was passed over the guide, through the choledochoduodenal fistula. Duodenal SEMS placement was performed during the same endoscopic procedure. Results. The procedure was performed in seven patients, ranging between 34 and 86 years. Technical success of EUS-CD, by the stent placement, occurred in 100% of the cases. There were no early complications. Duodenal SEMS placement was effective in 100% of the cases that remained alive after a follow-up of 7 and 30 days. Conclusion. The results suggest therapeutic BUS one-step procedure drainage as an alternative for these patients, with good clinical success, feasible technique and safety.
conferenceObject Endoscopic Ultrasound Evaluation After Endoscopic Eradication of Esophageal Varices With Band Ligation: Does It Predict Variceal Recurrence?(2016) CARNEIRO, Fred O.; RETES, Felipe A.; MATUGUMA, Sergio E.; ALBERS, Debora V.; CHAVES, Dalton M.; SANTOS, Marcos E.; HERMAN, Paulo; CHAIB, Eleazar; SAKAI, Paulo; ALBUQUERQUE, Luiz C. D.; MALUF-FILHO, Fauze- Endoscopic ultrasound-guided drainage of giant liver abscess associated with transgastric migration of a self-expandable metallic stent(2013) MEDRADO, B. F.; CARNEIRO, F. O. A. A.; VILACA, T. G.; GOUVEIA, T. S.; FRAZAO, M. S. V.; MOURA, E. G. H. de; SAKAI, P.; OTOCH, J. P.; ARTIFON, E. L. A.
bookPart Esôfago de Barrett(2014) HASHIMOTO, Claudio Lyoiti; CARNEIRO, Fred Olavo Aragão Andrade; MACEDO, George Fred Soares de; MARQUES, Sergio B.; SAKAI, Paulo- 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
- Role of EUS evaluation after endoscopic eradication of esophageal varices with band ligation(2016) CARNEIRO, Fred Olavo Aragao Andrade; RETES, Felipe Alves; MATUGUMA, Sergio Eiji; ALBERS, Debora Vieira; CHAVES, Dalton Marques; SANTOS, Marcos Eduardo Lera dos; HERMAN, Paulo; CHAIB, Eleazar; SAKAI, Paulo; D'ALBUQUERQUE, Luiz Augusto Carneiro; MALUF FILHO, FauzeBackground and Aims: Variceal recurrence after endoscopic band ligation (EBL) for secondary prophylaxis is a frequent event. Some studies have reported a correlation between variceal recurrence and variceal rebleeding with the EUS features of paraesophageal vessels. A prospective observational study was conducted to correlate EUS evaluation of paraesophageal varices, azygos vein, and thoracic duct with variceal recurrence after EBL variceal eradication in patients with cirrhosis. Methods: EUS was performed before and 1 month after EBL variceal eradication. Paraesophageal varices, azygos vein, and thoracic duct maximum diameters were evaluated in predetermined anatomic stations. After EBL variceal eradication, patients were submitted to endoscopic examinations every 3 months for 1 year. We looked for EUS features that could predict variceal recurrence. Results: Thirty patients completed a 1-year endoscopic follow-up. Seventeen patients (57%) presented variceal recurrence. There was no correlation between azygos vein and thoracic duct diameter with variceal recurrence. Larger paraesophageal varices predicted variceal recurrence in both evaluation periods. Paraesophageal varices diameters that best correlated with variceal recurrence were 6.3 mm before EBL (52.9% sensitivity, 92.3% specificity, and .749 area under the receiver operating characteristic curve [AUROC]) and 4 mm after EBL (70.6% sensitivity, 84.6% specificity, and .801 AUROC). Conclusions: We conclude that paraesophageal varices diameter measured by EUS predicts variceal recurrence within 1 year after EBL variceal eradication. Paraesophageal diameter after variceal eradication is a better recurrence predictor, because it has a lower cut-off parameter, higher sensitivity, and higher AUROC.
- CHOLANGIOSCOPY IN BILE DUCT DISEASE: a case series(2014) MOURA, Eduardo Guimarães Hourneaux de; FRANZINI, Tomazo; MOURA, Renata Nobre; CARNEIRO, Fred Olavo Aragão Andrade; ARTIFON, Everson Luiz de Almeida; SAKAI, PauloContext Direct endoscopic visualization of biliopancreatic duct is certainly one of the greatest advances of therapeutic endoscopy. The use of a single-operator cholangioscopy platform (SpyGlass) is a promising technique in the evaluation of diseases such as indeterminate biliary stricture and giant choledocholitiasis. This is the first Brazilian case series using this technology. Methods We report a case series of 20 patients in whom SpyGlass was used with diagnostic and therapeutic intention. Results Most patients were female (60%) and the median age was 48 years (ranging from 14 to 94). Choledocholitiasis was the most common indication (12/20), and electrohydraulic lithotripsy was applied in eight (66%). Electrohydraulic lithotripsy was successful in seven (87.5%) patients. Partial stone fragmentation occurred in one patient with large stone causing stone-choledochal disproportion, which was conducted with biliary plastic stent placement and a second scheduled endoscopic approach in 3 months. In cases of undefined etiology of biliary strictures, it was possible to exclude malignancy due to direct visualization (7/8) or biopsy (1/8). One complication occurred (duodenal perforation) after papillary balloon dilation. Conclusion The use of SpyGlass demonstrated the benefits, especially in cases of large bile duct stones and indeterminate biliary strictures. Other potencial improvements such as reduction on radiation exposure should be confirmed in prospective studies.
bookPart Carcinoma precoce do esôfago(2013) MALUF-FILHO, Fauze; CARNEIRO, Fred Olavo Andrade; SATO, Cezar Fabiano Manabu