FABIO YUJI HONDO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
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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.- 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
- Etiology, endoscopic management and mortality of upper gastrointestinal bleeding in patients with cancer(2013) MALUF-FILHO, Fauze; MARTINS, Bruno da Costa; LIMA, Marcelo Simas de; LEONARDO, Daniel Valdivia; RETES, Felipe Alves; KAWAGUTI, Fabio Shiguehissa; SATO, Cezar Fabiano Manabu; HONDO, Fabio Yuji; SAFATLE-RIBEIRO, Adriana Vaz; RIBEIRO JR., UlyssesBackground: The source and outcomes of upper gastrointestinal bleeding (UGIB) in oncologic patients are poorly investigated. Objective: The study aimed to investigate these issues in a tertiary academic referral center specialized in cancer treatment. Methods: This was a retrospective study including all patients with cancer referred to endoscopy due to UGIB in 2010. Results: UGIB was confirmed in 147 (of 324 patients) referred to endoscopy for a suspected episode of GI bleeding. Tumor was the most common cause of bleeding (N = 35, 23.8%), followed by varices (N = 30, 19.7%), peptic ulcer (N = 29, 16.3%) and gastroduodenal erosions (N = 16, 10.9%). Among the 32 patients with cancer of the upper GI tract, the main causes of bleeding were cancer (N = 27, 84.4%) and peptic ulcer (N = 5, 6.3%). Forty-one patients (27.9%) presented with bleeding from the primary tumor or from a metastatic lesion, and seven received endoscopic therapy, with successful initial hemostasis in six (85.7%). Rebleeding and mortality rates were not different between endoscopically treated (N = 7) and nontreated (N = 34) patients (28.6% vs. 14.7%, p = 0.342; 43.9% vs. 44.1%, p = 0.677). Median survival was 20 days, and the overall 30-day mortality rate was 44.9%. There was no predictive factor of mortality or rebleeding. Conclusion: Tumor bleeding is the most common cause of UGIB in cancer patients. UGIB in cancer patients correlates with a high mortality rate regardless of the bleeding source. Current endoscopic treatments may not be effective in preventing rebleeding or improving survival.
- OCULAR MELANOMA WITH MULTIPLE GASTROINTESTINAL METASTASES(2011) KAWAGUTI, Fabio Shiguehissa; MALUF-FILHO, Fauze; MEDEIROS, Raphael Salles S.; MARTINS, Bruno Da Costa; LIMA, Marcelo Simas De; HONDO, Fabio Yuji; NAHAS, Caio Sergio Rizkallah; MARQUES, Carlos Frederico Sparapan; SAKAI, Paulo
- A new large-caliber trocar for percutaneous endoscopic gastrostomy by the introducer technique in head and neck cancer patients(2011) GIORDANO-NAPPI, J. H.; MALUF-FILHO, F.; ISHIOKA, S.; HONDO, F. Y.; MATUGUMA, S. E.; LIMA, M. Simas de; SANTOS, M. Lera dos; RETES, F. A.; SAKAI, P.Background and study aims In many patients, percutaneous endoscopic gastrostomy (PEG) can be limited by digestive tract stenosis. PEG placement using an introducer is the safest alternative for this group of patients, but the available devices are difficult to implement and require smaller-caliber tubes. The aim of this study was to evaluate the modification of an introducer technique device for PEG placement with regard to the following: procedure feasibility, possibility of using a 20-Fr balloon gastrostomy tube, tube-related function and problems, complications, procedure safety, and mortality. Patients and methods Between March 2007 and February 2008, 30 consecutive patients with head and neck malignancies underwent introducer PEG placement with the modified device and gastropexy. Each patient was evaluated for 60 days after the procedure for the success of the procedure, infection, pain, complications, mortality, and problems with the procedure. Results The procedure was successful in all cases with no perioperative complications. No signs of stomal infection were observed using the combined infection score. The majority of patients experienced mild-to-moderate pain both in the immediate postoperative period and at 72 hours. One major early complication (3.3%) and two minor complications (6.7%) were observed. No procedure-related deaths occurred during the first 60 days after the procedure. Conclusion The device modification for PEG using the introducer technique is feasible, safe, and efficient in outpatients with obstructive head and neck cancer. In this series, it allowed the use of a larger-caliber tube with low complication rates and no procedure-related mortality.
- Endoscopic removal of migrated esophageal stent - the ""grasper and pusher"" method(2012) MARTINS, B.; SORBELLO, M. P.; RETES, F.; KAWAGUTI, F. S.; LIMA, M. S.; HONDO, F. Y.; STELKO, G.; RIBEIRO, U.; MALUF-FILHO, F.
- CHARACTERIZATION OF THE MUCIN PHENOTYPE CAN PREDICT GASTRIC CANCER RECURRENCE AFTER ENDOSCOPIC MUCOSAL RESECTION(2017) HONDO, Fabio Yuji; KISHI, Humberto; SAFATLE-RIBEIRO, Adriana Vaz; PESSORRUSSO, Fernanda Cristina Simões; RIBEIRO JR, Ulysses; MALUF-FILHO, FauzeABSTRACT BACKGROUND: Endoscopic mucosal resection is still considered an accepted treatment for early gastric cancer for selected cases. Histopathologic criteria for curative endoscopic resection are intramucosal well-differentiated adenocarcinoma, lateral and deep margins free of tumor, no histological ulceration, and no venous or lymphatic embolism. A 5% local recurrence rate has been described even when all the above-mentioned criteria are met. On the other hand, antigen expression by tumoral cells has been related to the biological behavior of several tumors. OBJECTIVE: To evaluate whether early gastric cancer mucin immunoexpression, p53 and Ki-67, can predict recurrence after endoscopic mucosal resection, even when standard histopathologic criteria for curative measures have been attempted. METHODS: Twenty-two patients with early gastric cancer were considered to have been completely resected by endoscopic mucosal resection. Local recurrence occurred in 5/22 (22.7%). Immunohistochemical study was possible in 18 (81.8%) resected specimens. Patients were divided in two groups: those with and those without local recurrence. They were compared across demographic, endoscopic, histologic data, and immunohistochemical factors for MUC2, MUC5a, CD10, p53, and Ki-67. RESULTS: Mucin immunoexpression allowed a reclassification of gastric adenocarcinoma in intestinal (10), gastric (2), mixed (4), and null phenotypes (2). Mixed phenotype (positive for both MUC2 and MUC5a) was found in 80% of cases in the local recurrence group, while the intestinal type (positive MUC2 and negative MUC5a) was found in 76.9% of cases without local recurrence (P=0.004). Other observed features did not correlate with neoplastic recurrence. CONCLUSION: The mixed phenotype of early gastric adenocarcinoma is associated with a higher probability of local recurrence after endoscopic mucosal resection.
- Endoscopic treatment of Zenker's diyerticulum by harmonic scalpel(2011) HONDO, Fabio Yuji; MALUF-FILHO, Fauze; GIORDANO-NAPPI, Jose Humberto; NEVES, Carla Zanelatto; CECCONELLO, Ivan; SAKAI, PauloBackground: Zenker's diverticulum (ZD) is a rare condition with a reported prevalence of 0.01% to 0.11% in the general population. Endoscopic treatment consists of the division of the septum between the diverticulum and the esophagus, within which the cricopharyngeal muscle is contained. Diathermic monopolar current, argon plasma coagulation, and laser have been used to incise the muscular septum with satisfactory results. The main limitation of endoscopic treatment is the occurrence of complications. Perforation and hemorrhage are reported in as many as 23% and 10% of patients, respectively. Objective: The aim of this study was to use the technique of endoscopic diverticulotomy by using a harmonic scalpel in patients with ZD and to demonstrate the feasibility of using flexible and rigid devices in ZD treatment. Design: Case series study. Standard protocol was used for patient management, endoscopic procedure, and data collection. Setting: Single endoscopist demonstrating preliminary results. Patients: Five patients (4 men; median standard deviation [SD] age 69.6 +/- 9.06 years, range 59-83 years) with ZD were treated with this technique. All patients reported dysphagia and halitosis. The diagnosis was based on clinical, endoscopic, and radiographic findings. Interventions: All patients received general anesthesia and were placed in the left lateral position. A standard videogastroscope (9.8 mm) and a stiff guidewire were used to insert and achieve an adequate exposure of the ZD septum. The septum was divided using a harmonic scalpel under thin endoscope (5.2 mm) visualization through a soft diverticuloscope. Main Outcome Measurement: Feasibility of an endoscopic technique by using rigid and flexible devices to treat ZD. Results: Four patients (80%) were successfully treated in 1 session. The median SD size of the diverticulum was 3.6 +/- 0.89 cm (range 3-5 cm). Median SD procedure time was 17.33 +/- 2.33 minutes (range 15-20 minutes) in 6 procedures. No hemorrhage or perforation occurred. One patient (20%) required a second session to complete dissection of the ZD septum. All patients demonstrated improvement of dysphagia score after treatment. Limitations: Small case series design. Conclusions: Endoscopic treatment of ZD by harmonic scalpel through a soft diverticuloscope was feasible and effective in this small case series. Larger studies are warranted to further evaluate this technique.