JONAS TAKADA
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4 resultados
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Agora exibindo 1 - 4 de 4
- EUS-guided choledochoantrostomy: an alternative for biliary drainage in unresectable pancreatic cancer with duodenal invasion(2011) ARTIFON, Everson L. A.; OKAWA, Luciano; TAKADA, Jonas; GUPTA, Kapil; MOURA, Eduardo G. H.; SAKAI, Paulo
- PEG rescue with gastropexy after early tube withdrawal: an application of natural orifice transluminal endoscopic surgery (with video)(2011) MARTINS, Bruno da Costa; TAKADA, Jonas; KAWAGUTI, Fabio Shiguehissa; RIBEIRO, Joao Paulo Aguiar; HONDO, Fabio Yuji; LIMA, Marcelo Simas de; NEVES, Carla Zanellatto; NAHAS, Caio Sergio R.; MARQUES, Carlos Frederico Sparapan; SAKAI, Paulo; MALUF-FILHO, Fauze
- 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 After that, the needle was withdrawn and a wire-guided needle knife was used to enlarge the site puncture in the duodenal wall.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.
- Management of Common Bile Duct Stones in Cirrhotic Patients with Coagulopathy: A Comparison of Supra-Papillary Puncture and Standard Cannulation Technique(2011) ARTIFON, Everson L. A.; SILVEIRA, Eduardo B. da; APARICIO, Dayse; TAKADA, Jonas; BARACAT, Renato; SAKAI, Christiano M.; GARCIA, Ruel T.; TEICH, Vanessa; COUTO, Decio S.Bleeding is not uncommon following endoscopic sphincterotomy. Supra-papillary puncture (SPP) might be safer than standard cannulation (SC) techniques in patients with coagulopathy. The aim of the study was to compare the safety and effectiveness of SPP and SC. This was a prospective case control intervention study. Decompensated cirrhotic patients with coagulopathy and choledocolithiasis underwent SC and SPP methods for biliary access. One hundred five patients (56 [53.3%] men, mean [SD] age 56 [15.8]) underwent ERCP. SC and SPP were performed in 63 and 42 patients, respectively. Biliary access was achieved in 56/63 (89%) and 40/42 (95%) of patients undergoing SC and SPP, respectively (P = 0.13; 95% CI [-0.16; 0.03]). Complications occurred in 10/63 (15.8%) patients undergoing SC and 5/42 (11.9%) SPP (P = 0.28; 95% CI [-0.17, 0.16]). Five (7.9%) and two (3.2%) episodes of post-sphincterotomy bleeding was seen in the SC and SPP groups, respectively (P = 0.36; 95% CI [-0.16, 0.05]). In contrast, three (4.8%) episodes of pancreatitis were seen in the SC and none in the SPP group (P = 0.05; 95% CI [0.001; 0.004]). A cost-effectiveness analysis demonstrated that SPP is an acceptable alternative at an ICER of US$ 5,974.92 per additional successful procedure. SPP is a safe and effective technique for the management of common bile duct stones in decompensated cirrhotic patients. Conditional to the willingness-to-pay and to the local ERCP-related costs, SPP is also a cost-effective alternative to the SC methods. SPP is associated with a lower rate of complications but larger studies to validate these findings are necessary.