EVERSON LUIZ DE ALMEIDA ARTIFON
Projetos de Pesquisa
Unidades Organizacionais
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina - Líder
9 resultados
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Agora exibindo 1 - 9 de 9
- Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography(2016) KHASHAB, Mouen A.; MERWE, Schalk Van der; KUNDA, Rastislav; ZEIN, Mohamad H. El; TEOH, Anthony Y.; MARSON, Fernando P.; FABBRI, Carlo; TARANTINO, Ilaria; VARADARAJULU, Shyam; MODAYIL, Rani J.; STAVROPOULOS, Stavros N.; PENAS, Irene; NGAMRUENGPHONG, Saowanee; KUMBHARI, Vivek; ROMAGNUOLO, Joseph; SHAH, Raj; KALLOO, Anthony N.; PEREZ-MIRANDA, Manuel; ARTIFON, Everson L.Background and aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. Patients and methods: Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50% at 2 weeks or to below 3mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon's severity grading system. Overall survival and duration of stent patency were calculated using Kaplan-Meier analysis. Results: A total of 96 patients (mean age 66 years, female 45%, pancreatic cancer 55%) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8%) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5%) patients. A total of 10 (10.5%) adverse events occurred: pneumoperitoneum (n=2), sheared wire (n=1), bleeding (n=1), bile leak (n=3), cholangitis (n=2), and unintentional perforation (n=1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44%) patients died of disease progression during the study period. The median patient survival was 167 days (95%CI 112-221) days. The 6-month stent patency rate was 95% (95%CI 94.94-95.06%) and the 1-year stent patency was 86% (95%CI 85.74-86.26%). Conclusion: This study on EUS-BD demonstrates excellent efficacy and safety of EUS-BD when performed by experts. Study registration: NCT01889953
- Endoscopic ultrasonography guided drainage: Summary of consortium meeting, May 21, 2012, San Diego, California(2015) KAHALEH, Michel; ARTIFON, Everson L. A.; PEREZ-MIRANDA, Manuel; GAIDHANE, Monica; RONDON, Carlos; ITOI, Takao; GIOVANNINI, MarcEndoscopic retrograde cholangiopancreatography ( ERCP) is the preferred procedure for biliary and pancreatic drainage. While ERCP is successful in about 95% of cases, a small subset of cases are unsuccessful due to altered anatomy, peri-ampullary pathology, or malignant obstruction. Endoscopic ultrasound-guided drainage is a promising technique for biliary, pancreatic and recently gallbladder decompression, which provides multiple advantages over percutaneous or surgical biliary drainage. Multiple retrospective and some prospective studies have shown endoscopic ultrasound-guided drainage to be safe and effective. Based on the currently reported literature, regardless of the approach, the cumulative success rate is 84%-93% with an overall complication rate of 16%-35%. endoscopic ultrasound-guided drainage seems a viable therapeutic modality for failed conventional drainage when performed by highly skilled advanced endoscopists at tertiary centers with expertise in both echo-endoscopy and therapeutic endoscopy
- EUS-guided drainage: Summary of Therapeutic EUS consortium meeting(2019) KAHALEH, Michel; ARTIFON, Everson L. A.; PEREZ-MIRANDA, Manuel; GAIDHANE, Monica; RONDON, Carlos; FREEMAN, Martin; ATTAM, Rajeev; ITOI, Takao; GIOVANNINI, MarcEUS-guided drainage is a safe and efficacious endoscopic technique for biliary, pancreatic, and gallbladder decompression. Recent literature has described many successful procedural techniques and devices to achieve EUS-guided drainage. This consortium gathering advanced endoscopists with expertise in both ultrasonography and therapeutic endoscopy, discuss the introduction to learning several EUS-guided drainage approaches, devices, and technology involved, possible obstacles to certain procedural and all potential complications.
- A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction(2018) GUO, Jintao; GIOVANNINI, Marc; V, Anand Sahai; SAFTOIU, Adrian; DIETRICH, Christoph F.; SANTO, Erwin; FUSAROLI, Pietro; SIDDIQUI, Ali A.; BHUTANI, Manoop S.; TEOH, Anthony Yuen Bun; IRISAWA, Atsushi; ARIAS, Brenda Lucia Arturo; ACHANTA, Chalapathi Rao; JENSSEN, Christian; SEO, Dong-Wan; ADLER, Douglas G.; KALAITZAKIS, Evangelos; ARTIFON, Everson; ITOKAWA, Fumihide; POLEY, Jan Werner; MISHRA, Girish; HO, Khek Yu; WANG, Hsiu-Po; OKASHA, Hussein Hassan; LACHTER, Jesse; VILA, Juan J.; IGLESIAS-GARCIA, Julio; YAMAO, Kenji; YASUDA, Kenjiro; KUBOTA, Kensuke; PALAZZO, Laurent; SABBAGH, Luis Carlos; SHARMA, Malay; KIDA, Mitsuhiro; EL-NADY, Mohamed; NGUYEN, Nam Q.; VILMANN, Peter; GARG, Pramod Kumar; RAI, Praveer; MUKAI, Shuntaro; CARRARA, Silvia; PARUPUDI, Sreeram; SRIDHAR, Subbaramiah; LAKHTAKIA, Sundeep; RANA, Surinder S.; OGURA, Takeshi; BARON, Todd H.; DHIR, Vinay; SUN, SiyuBackground and Objectives: EUS-guided biliary drainage (EUS-BD) w as shown to be useful for malignant bill obstruction (MBO). However. there is lack of consensus on how EUS-BD should be performed. Methods: This was a worldivide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD. Results; Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stewing technique should be the first choice. Self-expandable metal steins (SEMSs) mere recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach. longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach. 6-cm SEMS was recommended. During the intrahepatic (IH) approach. the IH segment 3 eras recommended. Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice. and randomized studies arc urgently needed to establish the best approach for the management of this condition.
- Percutaneous passage of an extraction balloon to assist recanalization of the common bile duct after surgical transection(2015) ARTIFON, Everson L. A.; SILVA, Gustavo L. R.; UEMURA, Ricardo S.; TERAN, Alvaro; BUCH, Marco
- International collaborative study on EUS-guided gallbladder drainage: Are we ready for prime time?(2016) KAHALEH, Michel; PEREZ-MIRANDA, Manuel; ARTIFON, Everson L.; SHARAIHA, Reem Z.; KEDIA, Prashant; PENAS, Irene; SERNA, Carlos De la; KUMTA, Nikhil A.; MARSON, Fernando; GAIDHANE, Monica; BOUMITRI, Christine; PARRA, Viviana; CLAVO, Carlos M. Rondon; GIOVANNINI, MarcBackground: Cholecystectomy remains the gold standard treatment of cholecystitis. Endoscopic treatment of cholecystitis includes transpapillary gallbladder drainage. Recently, endoscopic ultrasound-guided transmural drainage of the gallbladder (EUS-GBD) has been reported. This study reports the cumulative experience of an international group performing EUS-GBD. Methods: Cases of EUS-GBD from January 2012 to November 2013 from 3 tertiary-care institutions were captured in a registry. Patient demographics, disease characteristics, procedural and clinical outcomes were recorded. Results: 35 patients (15 malignant, 20 benign) were included. Median age was 81 years (SD = 13.76 years), sixteen (46%) were males. Median follow-up was 91.5 days (SD = 157 days). Transmural access was obtained from the stomach (n = 17) or duodenum (n = 18). Stents placed included plastic (n = 6), metal (n = 20), or combination (n = 7). Technical success was achieved in 91.4% (n = 32). Immediate adverse events (14%) included: bleeding, stent migration, cholecystitis and hemoperitoneum. Delayed adverse events (11%) included abscess formation and recurrence of cholecystitis. Long-term clinical success rate was 89%. Stent type and puncture site were not associated with immediate (p = 0.88, p = 0.62), or long-term (p = 0.47, p = 0.27) success. Conclusions: EUS-GBD appears to be feasible, safe, and effective. Prospective studies are needed to confirm these findings and identify the best technique to use. Clinical trial registration: NCT01522573.
- Endoscopic Ultrasound-assisted Bile Duct Access and Drainage Multicenter, Long-term Analysis of Approach, Outcomes, and Complications of a Technique in Evolution(2014) GUPTA, Kapil; PEREZ-MIRANDA, Manuel; KAHALEH, Michel; ARTIFON, Everson L. A.; ITOI, Takao; FREEMAN, Martin L.; DE-SERNA, Carlos; SAUER, Bryan; GIOVANNINI, MarcBackground and Study Aims:When endoscopic retrograde cholangio-pancreatography fails, the bile duct is drained percutaneously or surgically. Evolution of endoscopic ultrasound (EUS) has provided the ability to visualize and also drain the biliary tree. The aim of this study was to review different techniques of EUS-guided bile duct access and drainage, and compare extrahepatic (EH) and intrahepatic (IH) approaches and benign with malignant indications.Patients and Methods:EUS-guided attempts at bile duct drainage from 6 international centers were reviewed. This is a multicenter, nonrandomized retrospective study.Results:Two hundred forty patients underwent EUS-guided bile duct access and drainage (EUS-BD) with a mean age of 67.3 years. The IH approach was used in 60% of the cases. In 99% of the subjects, a 19-G needle was used. Success was achieved in 87% cases, with a similar success rate in EH and IH approaches (84.3% vs. 90.4%; P=0.15). Metal stents were placed in 60% and plastic stents in 27% of the cases. A higher success rate was noted in malignant diseases compared with benign diseases (90.2% vs. 77.3%; P=0.02). Complications for all techniques included pneumoperitoneum 5%, bleeding 11%, bile leak/peritonitis 10%, and cholangitis 5%. No significant difference was noted between the IH and the EH approaches (32.6% vs. 35.6%; P=0.64), with similar rates in benign and malignant diseases (26.7% vs. 37.1%; P=0.19).Conclusions:The EUS-BD technique is currently limited by a lack of dedicated devices and large data reporting outcomes and complications. Larger prospective and multicenter studies are needed to better define the indications, outcomes, and complications. With greater experience and dedicated devices, EUS-BD can be an effective alternative.
- Endoscopic ultrasonography guided biliary drainage: Summary of consortium meeting, May 7th, 2011, Chicago(2013) KAHALEH, Michel; ARTIFON, Everson L. A.; PEREZ-MIRANDA, Manuel; GUPTA, Kapil; ITOI, Takao; BINMOELLER, Kenneth F.; GIOVANNINI, MarcEndoscopic retrograde cholangiopancreatography (ERCP) has become the preferred procedure for biliary or pancreatic drainage in various pancreatico-biliary disorders. With a success rate of more than 90%, ERCP may not achieve biliary or pancreatic drainage in cases with altered anatomy or with tumors obstructing access to the duodenum. In the past those failures were typically managed exclusively by percutaneous approaches by interventional radiologists or surgical intervention. The morbidity associated was significant especially in those patients with advanced malignancy, seeking minimally invasive interventions and improved quality of life. With the advent of biliary drainage via endoscopic ultrasound (EUS) guidance, EUS guided biliary drainage has been used more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that encompasses various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS guided biliary and pancreatic drainage techniques. This diversity has resulted in variations and improvements in EUS Guided biliary and pancreatic drainage; and over the years has led to an extensive nomenclature. The diversity of techniques, nomenclature and recent progress in our intrumentation has led to a dedicated meeting on May 7th, 2011 during Digestive Disease Week 2011. More than 40 advanced endoscopists from United States, Brazil, Mexico, Venezuela, Colombia, Italy, France, Austria, Germany, Spain, Japan, China, South Korea and India attended this pivotal meeting. The meeting covered improved EUS guided biliary access and drainage procedures, terminology, nomenclature, training and credentialing; as well as emerging devices for EUS guided biliary drainage. This paper summarizes the meeting's agenda and the conclusions generated by the creation of this consortium group.
- Therapeutic Endoscopic Ultrasonography(2013) ARTIFON, Everson L. A.; GIOVANNINI, Marc; SUN, Siyu; VILA, Juan J.