GALILEU FERREIRA AYALA FARIAS

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  • article
    Peroral endoscopic myotomy (POEM): a comparative study between Chagasic and idiopathic achalasia
    (2020) FARIAS, Galileu F. A.; MOURA, Diogo T. H. de; MOURA, Eduardo T. H. de; REZENDE, Daniel T. de; HATHORN, Kelly E.; NASI, Ary; QUEIROZ, Natalia S. F.; MOURA, Eduardo G. H. de
    Background and study aims Achalasia can be classified as either primary (idiopathic) achalasia or secondary achalasia, which is a consequence of another systemic disease. Peroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia. We evaluated the efficacy and safety of POEM in patients with Chagasic achalasia compared to idiopathic achalasia. Patients and methods We evaluated POEM procedures performed at a single institution from November 2016 to January 2018. Demographic data, Eckardt score, lower esophageal sphincter (LES) pressure, body mass index, post-operative erosive esophagitis, adverse events, length of hospital stay, and procedure-related parameters were analyzed. Results Fifty-one patients underwent POEM as a treatment for achalasia in this period (20 patients with Chagasic and 31 with Idiopathic etiology). The overall clinical success rate was 92.1 %, with no statistical difference between groups (90 % in the Chagasic group vs. 93.5 % in the Idiopathic group, P = 0.640). Both groups had significant reduction in Eckardt score and in LES pressure, and increase in bodey mass index (BMI) at 1-year follow-up. There was no statistical difference between groups regarding Eckardt score ( P = 0.439), LES pressure (p = 0.507), BMI ( P = 0.254), post erosive esophagitis (35 % vs. 38.7 %, P = 0.789), adverse events (30 % vs. 12 %, P = 0.163,) length of hospital stay (3.75 days vs. 3.58 days, P = 0.622), and operative time (101.3 min vs. 99.1 min, P = 0.840). Conclusion POEM is an effective and safe treatment for patients with achalasia. There is no difference in POEM outcomes for those patients with Chagasic or Idiopathic achalasia.
  • article
    Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials
    (2018) VISCONTI, Thiago Arantes de Carvalho; BERNARDO, Wanderley Marques; MOURA, Diogo Turiani Hourneaux; MOURA, Eduardo Turiani Hourneaux; GONCALVES, Caio Vinicius Tranquillini; FARIAS, Galileu Ferreira; GUEDES, Hugo Goncalo; RIBEIRO, Igor Braga; FRANZINI, Tomazo Prince; LUZ, Gustavo Oliveira; SANTOS, Marcos Eduardo dos Lera dos; MOURA, Eduardo Guimaraes Hourneaux de
    Background and study aims The first-line approach to anastomotic biliary stricture after orthotopic liver transplantation (OLTX) involves endoscopic retrograde cholangiopancreatography (ERCP). The most widely used technique is placement of multiple plastic stents, but discussions are ongoing on the benefits of fully-covered self-expandable metallic stents (FCEMS) in this situation. This study aimed to compare results from use of plastic and metal stents to treat biliary stricture after transplantation. Patients and methods Searches were performed in the Medline, EMBASE, SciELO/LILACS, and Cochrane databases, and only randomized studies comparing the two techniques were included in the meta-analysis. Results Our study included four randomized clinical trials totaling 205 patients. No difference was observed between the stricture resolution rate (RD: 0.01; 95%CI [-0.08-0.10]), stricture recurrence (RD: 0.13; 95%CI [-0.03-0.28]), and adverse events (RD: -0.10; 95%CI [-0.65-0.44]) between the plastic and metallic stent groups. The metallic stent group demonstrated benefits in relation to the number of ERCPs performed (MD: -1.86; 95%CI [-3.12 to -0.6]), duration of treatment (MD: -105.07; 95%CI [-202.38 to -7.76 days]), number of stents used (MD: -10.633; 95%CI [-20.82 to -0.44]), and cost (average $8,288.50 versus $18,580.00, P <0.001). Conclusions Rates of resolution and recurrence of stricture are similar, whereas the number of ERCPs performed, number of stents used, duration of treatment, and costs were lower in patients treated with FCEMS, which shows that this device is a valid option for initial treatment of post-OLTX biliary stricture.