VICTOR LIRA DE OLIVEIRA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico

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Agora exibindo 1 - 7 de 7
  • article 0 Citação(ões) na Scopus
    Endoscopic Approaches for Post Roux-en-Y Gastric Bypass Leaks: How to Choose the Best Tool for Each Task
    (2023) BESTETTI, Alexandre Moraes; OLIVEIRA, Victor Lira de; SILVEIRA, Saullo Queiros; MOURA, Eduardo Guimaraes Hourneaux de; MOURA, Diogo Turiani Hourneaux de
  • article 7 Citação(ões) na Scopus
    The Effectiveness and Safety of the Duodenal-Jejunal Bypass Liner (DJBL) for the Management of Obesity and Glycaemic Control: a Systematic Review and Meta-Analysis of Randomized Controlled Trials
    (2023) YVAMOTO, Erika Yuki; MOURA, Diogo Turiani Hourneaux de; PROENCA, Igor Mendonca; MONTE JUNIOR, Epifanio Silvino do; RIBEIRO, Igor Braga; RIBAS, Pedro Henrique Boraschi Vieira; HEMERLY, Matheus Candido; OLIVEIRA, Victor Lira de; SANCHEZ-LUNA, Sergio A.; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
    Introduction The duodenal-jejunal bypass liner (DJBL) is a less-invasive treatment of obesity and type 2 diabetes mellitus (T2DM). Methods This is a systematic review and meta-analysis including randomized clinical trials (RCTs) comparing DJBL versus sham or pharmacotherapies aiming to evaluate the effectiveness and safety of DJBL. Results Ten RCTs (681 patients) were included. The DJBL group showed superior excess weight loss (+ 11.4% [+ 7.75 to + 15.03%], p < 0.00001) and higher decrease in HbA1c compared to the control group (- 2.73 +/- 0.5 vs. - 1.73 +/- 0.4, p = 0.0001). Severe adverse events (SAEs) occurred in 19.7%. Conclusion The DJBL did not reach the ASGE/ASMBS thresholds for the treatment of obesity. However, it is important to state that many SAEs were not really severe. Therefore, we believe this therapy plays an important role in the management obesity and T2DM.
  • article 5 Citação(ões) na Scopus
    Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations
    (2023) OLIVEIRA, Victor Lira de; BESTETTI, Alexandre Moraes; TRASOLINI, Roberto Paolo; MOURA, Eduardo Guimaraes Hourneaux de; MOURA, Diogo Turiani Hourneaux de
    Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.
  • article
    Endoscopic Treatment of Complex Walled-Off Necrosis in Necrotizing Pancreatitis With Two Simultaneous Lumen-Apposing Metal Stents: A Case Report
    (2022) SANTOS, Marcos Eduardo Lera dos; PROENCA, Igor Mendonca; SASSO, Joao Guilherme Ribeiro Jordao; OLIVEIRA, Victor Lira de; RIBAS, Pedro Henrique Boraschi Vieira; BESTETTI, Alexandre Moraes; RIBEIRO, Igor Braga; ANNA, Raoni Salomao Sant; OLIVEIRA, Guilherme Henrique Peixoto de; MOURA, Eduardo Guimaraes Hourneaux de
    Organized pancreatic and peripancreatic collections are complications of pancreatitis and should be treated when symptomatic or complicated. When feasible, the endoscopic ultrasound approach presents high efficacy and low morbidity and mortality, making it the first likely option. Among the available accessories for endoscopic drainage, the lumen-apposing metal stent can be a better option, with a low migration rate; furthermore, it allows endoscopic necrosectomy. Here, we present the case of complex walled-off necrosis treated with two lumen-apposing metal stents in the same procedure. A 41-year-old male patient with walled-off necrosis presented with delayed gastric emptying and obstruction of the main biliary duct. Magnetic resonance imaging and endoscopic ultrasound revealed two non-communicating collections. We opted for endoscopic ultrasound-guided drainage with the deployment of two simultaneous lumen-apposing metal stents: one transduodenal and the other transgastric, with clinical improvement. After three weeks, endoscopic retrograde cholangiopancreatography showed a biliary fistula communicating with the periduodenal collection, which was treated with a biliary plastic stent. An endoscopic necrosectomy was performed, and the metal stents were removed. Control magnetic resonance imaging demonstrated improvement. The patient was asymptomatic at the six-month follow-up. The treatment of symptomatic complex walled-off necrosis remains a challenge and may require multiple endoscopic approaches; moreover, surgical treatment may be necessary in case of failure. In the present report, we demonstrate that the deployment of two lumen-apposing metal stents in the same procedure is feasible when necessary as it was associated with technical success and short-term clinical success.
  • article
    Endoscopic Ultrasound-Guided Gastroenterostomy for the Palliation of Gastric Outlet Obstruction (GOO): A Systematic Review and Meta-analysis of the Different Techniques
    (2022) RIBAS, Pedro Henrique Boraschi V.; MOURA, Diogo Turiani H. De; PROENCA, Igor M.; MONTE JUNIOR, Epifanio S. Do; YVAMOTO, Erika Y.; HEMERLY, Matheus C.; OLIVEIRA, Victor L. De; RIBEIRO, Igor B.; SANCHEZ-LUNA, Sergio A.; BERNARDO, Wanderley M.; MOURA, Eduardo Guimaraes H. De
    Introduction: Gastric outlet obstruction (GOO) is usually associated with a poor prognosis and a significant decrease in a patient's quality of life. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMS) has emerged as a safe and effective palliation procedure for GOO in patients that are unfit for surgery. Without an exclusive gold-standard technique for EUS-GE, we aimed to compare the currently available ones in this systematic review and meta-analysis, the first on this subspecialty. Methods: A comprehensive search from multiple electronic databases was performed. The search had a particular emphasis on the techniques used in performing EUS-GE. We identified all the studies in which EUS-GE was performed as palliation for GOO from its inception to the current date. The outcomes analyzed were the following: technical and clinical success, total and severe adverse events (AEs), procedure duration, and length of hospital stay (LOHS). Results: Twenty studies involving 863 patients were the basis of this statistical analysis. Patients underwent the following techniques: direct gastroenterostomy (DGE) (n=718), balloon-assisted gastroenterostomy (BAGE) (n=27), and endoscopic ultrasound (EUS)-guided double-balloon-occluded gastrojejunostomy bypass (n=118). In comparison to balloon-assisted techniques, DGE had a lower rate of AEs,-0.121 (95% CI-0.191 to-0.051 p=0.001); and LOHS for the DGE group,-2.684 (95% CI-1.031 to-4.337 p=0.001). The other analyzed outcomes presented no statistically significant differences. On a sub-analysis, BAGE showed a lower rate of AEs than EUS-guided double-balloon-occluded gastrojejunostomy bypass,-0.196 (95% CI -0.061 to-0.331 p=0.004). Conclusions: EUS-GE is a safe and effective procedure for palliating GOO. When correctly administered, any of the analyzed techniques may be used to palliate GOO with similar technical and clinical outcomes. DGE had significantly lower rates of AEs and LOHS, which can be inferred as a safer procedure. These results should be interpreted cautiously due to the limited few studies that are available and accessible. Therefore, further well-designed, randomized clinical studies on the topic are warranted to compare the different techniques from more sources.
  • article
    Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography (ERCP) Versus Endoscopic Ultrasound-Directed Transgastric ERCP in Patients With Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis
    (2022) OLIVEIRA, Victor L. de; MOURA, Diogo Turiani H. de; MONTE JUNIOR, Epifanio S. do; PROENCA, Igor M.; RIBEIRO, Igor B.; SANCHEZ-LUNA, Sergio A.; RIBAS, Pedro Henrique Boraschi V.; HEMERLY, Matheus C.; BERNARDO, Wanderley M.; MOURA, Eduardo Guimaraes H. de
    Endoscopic retrograde cholangiopancreatography (ERCP) is a therapeutic procedure for skilled endoscopists that can be even more challenging in some situations, including patients' post-Roux-en-y Gastric Bypass (RYGB) surgery. There is still no consensus on whether laparoscopic-assisted ERCP (LA-ERCP) or endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) is the most appropriate, safe, and feasible approach in patients with this type of post-surgical anatomy. This systematic review and meta-analysis aimed to examine both approaches' feasibility, efficacy, and safety in this situation. We searched for electronic databases (MEDLINE, EMBASE, Lilacs, Google Scholar, and Central Cochrane) to identify studies comparing LA-ERCP versus EDGE. Outcomes measured included technical success, adverse events (AEs) and serious AEs, length of stay (LOS), and procedural time. Descriptive data related to the EDGE procedure was also extracted. The risk of bias and the quality of evidence of the enrolled studies were assessed. Five studies, totalizing 268 patients (176 LA-ERCP and 92 EDGE), were included. There was no statistical difference in technical success and AEs between groups; however, the LOS and procedural times were shorter for the EDGE group. High rates of fistula closure and no weight regain were observed in EDGE. Both methods are feasible and safe techniques to perform ERCP in patients with RYGB anatomy, with comparable technical success and adverse events rate. However, EDGE is associated with shorter LOS and procedural time.
  • article 1 Citação(ões) na Scopus
    Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control
    (2024) IGI, Willian Ferreira; OLIVEIRA, Victor Lira de; MATAR, Ayah; MOURA, Diogo Turiani Hourneaux de
    The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariatric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article compre hensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of RouxenY gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and nonalcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern ex ists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongo ing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to sup port its routine use in clinical practice.