DIOGO TURIANI HOURNEAUX DE MOURA

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

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Autor: MOURA, Eduardo Guimaraes Hourneaux de × Assunto: Obesity ×

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  • 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 42 Citação(ões) na Scopus
    Efficacy and Safety of Endoscopic Sleeve Gastroplasty at Mid Term in the Management of Overweight and Obese Patients: a Systematic Review and Meta-Analysis
    (2020) MIRANDA NETO, Antonio Afonso de; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; KHAN, Ahmad; SINGH, Shailendra; PONTE NETO, Alberto Machado da; MADRUGA NETO, Antonio Coutinho; MONTE JUNIOR, Epifanio Silvino do; TUSTUMI, Francisco; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
    Background Endoscopic sleeve gastroplasty (ESG) has emerged as a promising technique in endoscopic bariatric and metabolic therapies (EBMTs). We aimed to perform a systematic review and meta-analysis to provide an update on its efficacy and safety. Methods This is a systematic review and meta-analysis was performed following the PRISMA guidelines. MEDLINE, Cochrane, EMBASE, and LILACS were searched to identify the studies related to ESG. Results Eleven studies with a total of 2170 patients were included. The average BMI pre-ESG was 35.78 kg/m(2). Pooled mean %TWL observed at 6, 12, and 18 months was 15.3%, 16.1%, and 16.8% respectively. Pooled mean %EWL at 6, 12, and 18 months was 55.8%, 60%, and 73% respectively. No procedure-related mortality was reported. Conclusion ESG is a safe and effective procedure for primary obesity therapy with promising short- and mid-term results.
  • article 32 Citação(ões) na Scopus
    EUS-Guided Intragastric Injection of Botulinum Toxin A in the Preoperative Treatment of Super-Obese Patients: a Randomized Clinical Trial
    (2019) MOURA, Eduardo Guimaraes Hourneaux de; RIBEIRO, Igor Braga; FRAZAO, Mariana Souza Varela; MESTIERI, Luiz Henrique Mazzonetto; MOURA, Diogo Turiani Hourneaux de; BO, Creusa Maria Roveri Dal; BRUNALDI, Vitor Ottoboni; MOURA, Eduardo Turiani Hourneaux de; NUNES, Gabriel Cairo; BUSTAMANTE, Fabio Alberto Castillo; GALVAO NETO, Manoel dos Passos; MATUGUMA, Sergio Eiji; BERNARDO, Wanderley Marques; SANTO, Marco Aurelio
    BackgroundObesity is a disease that is highly prevalent in Brazil, and the associated comorbidities represent a major global public health challenge. Botulinum toxin type A (BTX-A) is a potent neurotoxin and inhibitor of gastric smooth muscle activity. In theory, BTX-A administration should promote early satiety and weight loss because it delays gastric emptying by inhibiting acetylcholine-mediated peristalsis, which is primarily responsible for gastric motility. Because results in the literature are discrepant, the efficacy of intragastric injections of BTX-A as a primary treatment for obesity remains unknown. The objective of this prospective, double-blind, single-center randomized study was to evaluate the effects of endoscopic ultrasound-guided intragastric BTX-A injections, as a bridge to bariatric surgery, in super-obese patients.MethodsThirty-two super-obese patients were randomized to one of two groups: BTX-A, in which 200units of BTX-A were injected into the gastric antrum and body; and control, in which the same injections were performed with 0.9% saline. Weight, body mass index (BMI), and loss of excess weight were measured monthly over a 6-month period. Gastric emptying scintigraphy was performed before and after the procedure.ResultsThe patients in both groups showed significant weight loss over the course of the study (p<0.001). There were no statistically significant differences between the groups regarding weight loss, excess weight, total loss of excess weight, total weight loss, or change in BMI.ConclusionsIntragastric injection of BTX-A does not appear to be an effective method of achieving preoperative weight loss in super-obese patients.
  • article 9 Citação(ões) na Scopus
    Endoscopic Vacuum Therapy (EVT) for the Treatment of Post-Bariatric Surgery Leaks and Fistulas: a Systematic Review and Meta-analysis
    (2022) INTRIAGO, Josselyn Mariana Vera; MOURA, Diogo Turiani Hourneaux de; MONTE JUNIOR, Epifanio Silvino do; PROENCA, Igor Mendonca; RIBEIRO, Igor Braga; SANCHEZ-LUNA, Sergio A.; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
    Bariatric surgery remains the most effective treatment for morbid obesity and its comorbidities. However, post-surgical leaks and fistulas can occur in about 1-5% of patients, with challenging treatment approaches. Endoscopic vacuum therapy (EVT) has emerged as a promising tool due to its satisfactory results and accessibility. In this first systematic review and meta-analysis on the subject, EVT revealed rates of 87.2% clinical success, 6% moderate adverse events, and 12.5% system dislodgements, requiring 6.47 EVT system exchanges every 4.39 days, with a dwell time of 25.67 days and a total length of hospitalization of 44.43 days. Although our results show that EVT is a safe and effective therapy for post-surgical leaks and fistulas, they should be interpreted with caution due to the paucity of available data.
  • article
    Endoscopic sleeve gastroplasty: From whence we came and where we are going
    (2019) MOURA, Diogo Turiani Hourneaux de; MOURA, Eduardo Guimaraes Hourneaux de; THOMPSON, Christopher C.
    The most effective and durable treatment for obesity is bariatric surgery. However, less than 2% of eligible patients who fulfill the criteria for bariatric surgery undergo the procedure. As a result, there is a drive to develop less invasive therapies to combat obesity. Endoscopic bariatric therapies (EBT) for weight loss are important since they are more effective than pharmacological treatments and lifestyle changes and present lower adverse event rates compared to bariatric surgery. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive EBT that involves remodeling of the greater curvature. ESG demonstrated favorable outcomes in several centers, with up to 20.9% total body weight loss and 60.4% excess weight loss (EWL) on 2-year follow-up, with a low rate of severe adverse events (SAE). As such, it could be considered safe and effective in light of ASGE/ASMBS thresholds of > 25% EWL and <= 5% SAE, although there are no comparative trials to support this. Additionally, ESG showed improvement in diabetes mellitus type 2, hypertension, and other obesity-related comorbidities. As this procedure continues to develop there are several areas that can be addressed to improve outcomes, including device improvements, technique standardization, patient selection, personalized medicine, combination therapies, and training standardization. In this editorial we discuss the origins of the ESG, current data, and future developments.
  • article 2 Citação(ões) na Scopus
    Impact of Endoscopic Sleeve Gastroplasty in Non-alcoholic Fatty Liver Disease: a Systematic Review and Meta-analysis
    (2023) NUNES, Beanie Conceicao Medeiros; MOURA, Diogo Turiani Hourneaux de; KUM, Angelo So Taa; OLIVEIRA, Guilherme Henrique Peixoto de; HIRSCH, Bruno Salomao; RIBEIRO, Igor Braga; GOMES, Igor Logetto Caetite; OLIVEIRA, Claudia Pinto Marques de; MAHMOOD, Sultan; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
    Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. Endoscopic sleeve gastroplasty (ESG) has proven to be feasible, safe, and effective in the management of obesity. We performed the first systematic review and meta-analysis evaluating NAFLD and other metabolic parameters 12 months post-ESG. Four observational studies with a total of 175 patients were included. The results showed a significant (p < 0.05) reduction of 4.85 in hepatic steatosis index (95% CI - 6.02, - 3.67), 0.5 in NAFLD fibrosis score (95% CI - 0.80, - 0.19), 6.32 U/l in ALT (95% CI - 9.52, - 3.11), 17.28% in TWL (95% CI - 18.24, - 16.31), 6.31 kg/m(2) in BMI (95% CI - 8.11, - 4.52), 47.97% in EWL (95% CI - 49.10, - 46.84), and 0.51% in HbA1c (95% CI - 0.90, - 0.12). ESG improves liver parameters, provides weight loss, and reduces HbA1c levels in patients suffering from NAFLD.
  • article 30 Citação(ões) na Scopus
    Efficacy of Intragastric Balloons for Weight Loss in Overweight and Obese Adults: a Systematic Review and Meta-analysis of Randomized Controlled Trials
    (2020) KOTINDA, Ana Paula Samy Tanaka; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; SINGH, Shailendra; PONTE NETO, Alberto Machado da; PROENCA, Igor Mendonca; FLOR, Marcelo Mochate; SOUZA, Karina Lopes de; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
    Intragastric balloons (IGB) are the most widely used endoscopic bariatric and metabolic therapies. We aimed to evaluate the efficacy of IGB in comparison with sham or lifestyle interventions for weight loss in overweight and obese patients. This systematic review and meta-analysis was performed following the PRISMA guidelines. Electronic searches were performed to identify randomized controlled trials, which compared IGB with sham or lifestyle intervention. Thirteen RCTs with 1523 patients were included. The difference in mean %EWL and %TWL at follow-up was 17.98%, and 4.40%, respectively, which was significantly higher in the IGB group. Similarly, the difference in mean AWL and BMIL was 6.12 kg, and 2.13 kg/m(2), respectively. IGB therapy is more effective than lifestyle intervention alone for weight loss in overweight and obese adults.
  • article 9 Citação(ões) na Scopus
    Adverse Events and Complications with Intragastric Balloons: a Narrative Review (with Video)
    (2021) RIBEIRO, Igor Braga; KOTINDA, Ana Paula Samy Tanaka; SANCHEZ-LUNA, Sergio A.; MOURA, Diogo Turiani Hourneaux de; MANCINI, Fabio Catache; SOUZA, Thiago Ferreira de; MATUGUMA, Sergio Eiji; SAKAI, Christiano Makoto; ROCHA, Rodrigo Silva de Paula; LUZ, Gustavo de Oliveira; SANTOS, Marcos Eduardo Lera dos; CHAVES, Dalton Marques; FRANZINI, Tomazo Antonio Prince; MOURA, Eduardo Turiani Hourneaux de; MOURA, Eduardo Guimaraes Hourneaux de
    Intragastric balloon (IGB) is a minimally invasive and reversible therapy for weight loss with a good efficacy and safety profile. Introduced in the 1980s, IGBs have significantly evolved in the last couple of decades. They mechanically act by decreasing the volume of the stomach and its reservoir capacity, delaying gastric emptying, and increasing satiety leading to a subsequent weight loss. Despite the low rates of complications and mortality associated with IGBs, adverse events and complications still occur and can range from mild to fatal. This review aims to provide an update on the current scientific evidence in regard to complications and adverse effects of the use of the IGB and its treatment. This is the first comprehensive narrative review in the literature dedicated to this subject.
  • article 21 Citação(ões) na Scopus
    Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study
    (2019) MOURA, Diogo Turiani Hourneaux de; MOURA, Eduardo Guimaraes Hourneaux de; NETO, Manoel Galvao; JIRAPINYO, Pichamol; TEIXEIRA, Newton; ORSO, Ivan; QUADROS, Luiz Gustavo; AMORIM, Artagnan; MEDEIROS, Filipe; NETO, Durval Rosa; NETO, Joao de Siqueira; ALBANO, Alvaro; SOUSA, Luiz Henrique de; ALMEIDA, Delano; MARCHETTI, Igor Antunes; IVANO, Flavio; LIMA, Joao Henrique Felicio de; FALCAO, Marcelo; THOMPSON, Christopher C.
    Background: The management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced. Objectives: The aim of this study was to evaluate the safety and efficacy of a novel stent specifically designed for postsleeve leaks treatment. Setting: Multicenter retrospective study. Methods: This is a multicenter study, including patients with acute and early post laparoscopic sleeve gastrectomy leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success. Results: Thirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the postpyloric (POST) and 7 in the prepyloric position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size, and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21.62%) and all were in a POST position. AE poststent removal were also evaluated (prepyloric: 57.14% vs POST: 33.3%, P = .45). There was no difference between prepyloric and POST position in the severe AE analysis. Conclusions: This novel, large-caliber, fully covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate and may be associated with higher overall severe AE rates. Avoiding placement in the POST position may help mitigate migration risk; however, owing to the risk profile this stent should be used with caution.
  • article
    Status of bariatric endoscopy-what does the surgeon need to know? A review
    (2022) MOURA, Diogo Turiani Hourneaux de; DANTAS, Anna Carolina Batista; RIBEIRO, Igor Braga; MCCARTY, Thomas R.; TAKEDA, Flavio Roberto; SANTO, Marco Aurelio; NAHAS, Sergio Carlos; MOURA, Eduardo Guimaraes Hourneaux de
    BACKGROUND & nbsp;Obesity is a chronic and multifactorial disease with a variety of potential treatment options available. Currently, there are several multidisciplinary therapeutic options for its management, including conservative, endoscopic, and surgical treatment.& nbsp;AIM & nbsp;To clarify indications, technical aspects, and outcomes of bariatric endoscopy.& nbsp;METHODS & nbsp;Narrative review of current literature based on electronic databases including MEDLINE (PubMed), Cochrane Library, and SciELO.& nbsp;RESULTS & nbsp;Bariatric endoscopy is in constant development and comprises primary and revisional treatment options as well as management of surgical complications. Various devices act upon different mechanisms of action, which may be individualized to each patient. Despite favorable results for the endoscopic treatment of obesity, prospective randomized studies with long-term follow-up are required to fully validate primary and revisional endoscopic therapies. Regarding the management of bariatric surgery complications, endoscopic therapy may be considered the procedure of choice in a variety of situations. Still, as there is no standardized algorithm, local experience should be considered in decision-making.& nbsp;CONCLUSION & nbsp;The treatment of patients with obesity is complex, and a multidisciplinary approach is essential. Bariatric endoscopy has shown impressive results both in the treatment of obesity and its surgical complications, and therefore, must be part of the armamentarium in the fight against this disease.