EVERSON LUIZ DE ALMEIDA ARTIFON
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LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina - Líder
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- EUS-Guided Biliary Drainage Versus ERCP in Malignant Biliary Obstruction Before Hepatobiliary Surgery(2023) TYBERG, Amy; SARKAR, Avik; SHAHID, Haroon M.; SHAH-KHAN, Sardar M.; GAIDHANE, Monica; SIMON, Alexa; EISENBERG, Ian A.; LAJIN, Michael; KARAGYOZOV, Petko; LIAO, Kelvin; PATEL, Roohi; ZHAO, Eric; MARTINEZ, Ma Guadalupe; ARTIFON, Everson L.; LINO, Andre D.; VANELLA, Giuseppe; ARCIDIACONO, Paolo G.; KAHALEH, MichelIntroduction:Endoscopic ultrasound-guided biliary drainage (EUS-BD) is the procedure of choice for patients who cannot undergo endoscopic retrograde cholangiopancreatography (ERCP). The outcomes of patients undergoing surgery after EUS-BD for malignancy are unknown.Methods:We conducted an international, multicenter retrospective comparative study of patients who underwent hepatobiliary surgery after having undergone EUS-BD or ERCP from 6 tertiary care centers. Patient demographics, procedural data, and follow-up care were collected in a registry.Results:One hundred forty-five patients were included: EUS-BD n=58 (mean age 66, 45% male), ERCP n=87 (mean age 68, 53% male). The majority of patients had pancreatic cancer, cholangiocarcinoma, or gallbladder malignancy. In the EUS-BD group, 29 patients had hepaticogastrostomy, 24 had choledochoduodenostomy, and 5 had rendezvous technique done. The most common surgery was Whipple in both groups (n=41 EUS-BD, n=56 ERCP) followed by partial hepatectomy (n=7 EUS-BD, n=14 ERCP) and cholecystectomy (n=2 EUS-BD, n=2 ERCP). Endoscopy clinical success was comparable in both groups (98% EUS-BD, 94% ERCP). Adverse event rates were similar in both groups: EUS-BD (n=10, 17%) and ERCP (n=23, 26%). Surgery technical success and clinical success were significantly higher in the EUS-BD group compared with the ERCP group (97% vs. 83%, 97% vs. 75%). Total Hospital stay from surgery to discharge was significantly higher in the ERCP group (19 d vs. 10 d, P=0.0082).Discussion:Undergoing EUS-BD versus ERCP before hepatobiliary surgery is associated with fewer repeat endoscopic interventions, shorter duration between endoscopy and surgical intervention, higher rates of surgical clinical success, and shorter length of hospital stay after surgery.
- Endoscopic Ultrasonography–Guided Hemostasis Techniques(2017) ARTIFON, E. L. D. A.; MARSON, F. P.; KHAN, M. A.Endoscopic ultrasonography (EUS)–guided hemostasis is an evolving technique that has the potential to improve the care of patients with refractory variceal and nonvariceal gastrointestinal bleeding. EUS-guided treatment of fundal varices with coil and/or cyanoacrylate seems to be highly effective in active bleeding, as well as for primary and secondary bleeding prophylaxis. Reports of EUS-guided treatment of refractory nonvariceal sources of bleeding are more scarce, but show high success rates. The procedures involve a medium to high technical difficulty level, and this has been replicated worldwide. © 2017 Elsevier Inc.
conferenceObject EUS-FNA OF PANCREATIC SOLID MASSES: A PROSPECTIVE RANDOMIZED TRIAL COMPARING SUCTION WITH SLOW PULL(2018) CHENG, Spencer; DANIELLE, Chacon A.; ARTIFON, Everson L.; MATUGUMA, Sergio E.; SANTOS, Marcos E. dos; SAKAI, Christiano M.; CHAVES, Dalton; MOURA, Diogo T. De; MOURA, Eduardo T.bookPart Balões intragástricos na obesidade(2014) SOUZA, Thiago Ferreira de; ALBERS, Débora da Costa Vieira; MOURA, Eduardo Guimarães Hourneaux de; ARTIFON, Everson Luiz de AlmeidabookPart Drenagem biliar e pancreática ecoguiada(2014) ARTIFON, Everson Luiz de Almeida; CHENG, Spencer; UEMURA, Ricardo SatobookPart Endoscopia de Alta Tecnologia de Imagem(2015) CASTAñO, Rodrigo; CABARCAS, Edilberto Nuñez; FAVARO, Gabriel; OTOCH, José Pinhata; ARTIFON, Everson L. A.bookPart Coledocolitíase(2014) ARTIFON, Everson Luiz de Almeida; BARACAT, Renato; KUGA, Rogério; FRANZINI, Tomazo A. Prince- Virtual reality simulator versus box-trainer to teach minimally invasive procedures: A meta-analysis(2019) GUEDES, Hugo Goncalo; FERREIRA, Zemia Maria Camara Costa; LEAO, Layra Ribeiro de Sousa; MONTERO, Edna Frasson Souza; OTOCH, Jose Pinhata; ARTIFON, Everson Luiz de AlmeidaBackground: To evaluate the effectiveness of virtual reality simulator (VRS) training compared to box-trainer training (BT) for learning outcomes in minimally invasive surgery (MIS) techniques. Materials and Methods: A systematic review of the literature was performed using CENTRAL, MEDLINE, EMBASE, Scopus, CINAHL, LILACS. The primary outcomes were time to perform MIS and performance score in MIS. After being selected, the articles were evaluated for methodological quality and risk of bias. The results were evaluated for quality of evidence and meta-analysis was performed. Results: 20 randomized clinical trials were included in the qualitative analysis and 14 were used in the meta-analysis. VRS training was more efficient than BT training (P < 0.00001, 95% CI: 35.08 to -25.01) when evaluating participant time needed to complete the peg task. In descriptive analysis, VRS training was better than BT training in participant performance score to perform MIS. There was no statistical difference in the meta-analysis in the time needed to perform surgery, time to complete basic or advanced tasks and performance score for basic or advanced tasks. Conclusions: VRS training was better than BT training in participant performance scores when performing MIS and in the time needed to complete the basic task of peg transfer. In all other outcomes, regardless of the student's level of experience or type of activity, the two forms of training were equivalent.
- 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.
- Suction versus slow-pull for endoscopic ultrasound-guided fine-needle aspiration of pancreatic tumors: a prospective randomized trial(2020) CHENG, Spencer; BRUNALDI, Vitor O.; MINATA, Mauricio K.; CHACON, Danielle A.; SILVEIRA, Eduardo B.; MOURA, Diogo T. H. de; SANTOS, Marcos E. L. Dos; MATUGUMA, Sergio E.; CHAVES, Dalton M.; FRANCA, Raony F.; JACOMO, Alfredo L.; ARTIFON, Everson L. A.Background: Suction (S) is commonly used to improve cell acquisition during endoscopic ultrasoundguided fine-needle aspiration (EUS-FNA). Slow-pull (SP) sampling is another technique that might procure good quality specimens with less bloodiness. We aimed to determine if SP improves the diagnostic yield of EUS-FNA of pancreatic masses. Methods: Patients with pancreatic solid masses were randomized to four needle passes with both techniques in an alternate fashion. Sensitivity, specificity, positive, and negative predictive values were calculated. Cellularity and bloodiness of cytological samples were assessed and compared according to the technique. Results: Sensitivity, specificity, and accuracy of suction vs. SP were 95.2% vs. 92.3%; 100% vs. 100; 95.7% vs. 93%, respectively. As to the association of methods, they were 95.6, 100 and 96%, respectively. Positive predictive values for S and SP were 100%. There was no difference in diagnostic yield between S and SP (p = 0.344). Cellularity of samples obtained with SP and Suction were equivalent in both smear evaluation (p = 0.119) and cell-block (0.980). Bloodiness of SP and suction techniques were similar as well. Conclusions: S and SP techniques provide equivalent sensitivity, specificity, and accuracy. Association of methods seems to improve diagnostic yield. Suction does not increase the bloodiness of samples compared to slow-pull.