GUILHERME HENRIQUE PEIXOTO DE OLIVEIRA
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- Long-term follow-up after transoral outlet reduction following Roux-en-Y gastric bypass: Back to stage 0?(2023) BRUNALDI, Vitor Ottoboni; OLIVEIRA, Guilherme Henrique Peixoto de; KERBAGE, Anthony; RIBAS, Pedro Henrique; NUNES, Felipe; FARIA, Galileu; MOURA, Diogo de; RICCIOPPO, Daniel; SANTO, Marco; MOURA, Eduardo deBackground and study aims Significant weight regain affects up to one-third of patients after Roux-en-Y gastric bypass (RYGB) and demands treatment. Transoral outlet reduction (TORe) with argon plasma coagulation (APC) alone or APC plus full-thickness suturing TORe (APC-FTS) is effective in the short term. However, no study has investigated the course of gastrojejunostomy (GJ) or quality of life (QOL) data after the first post-procedure year.Patients and methods Patients eligible for a 36-month follow-up visit after TORe underwent upper gastrointestinal endoscopy with measurement of the GJ and answered QOL questionnaires (RAND-36). The primary aim was to evaluate the long-term outcomes of TORe, including weight loss, QOL, and GJ anastomosis (GJA) size. Comparisons between APC and APC-FTS TORe were a secondary aim.Results Among 39 eligible patients, 29 returned for the 3-year follow-up visit. There were no significant differences in demographics between APC and APC-FTS TORe groups. At 3 years, patients from both groups regained all the weight lost at 12 months, and the GJ diameter was similar to the pre-procedure assessment. As to QOL, most improvements seen at 12 months were lost at 3 years, returning to pre-procedure levels. Only the energy/fatigue domain improvement was kept between the 1- and 3-year visits.Conclusions Obesity is a chronic relapsing disease. Most effects of TORe are lost at 3 years, and redilation of the GJA occurs. Therefore, TORe should be considered iterative rather than a one-off procedure.
conferenceObject FLEXIBLE ENDOSCOPIC APPROACH VERSUS NONFLEXIBLE ENDOSCOPIC THERAPIES FOR THE MANAGEMENT OF ZENKER'S DIVERTICULUM: A SYSTEMATIC REVIEW AND META-ANALYSIS(2023) AGUIRRE, Diegocadena; HIRSCH, Bruno Salomao; OLIVEIRA, Guilherme Henrique Peixoto de; LANDIM, Davi; NUNES, Felipe; BERNARDO, Wanderley; GONZALEZ, Juan; SASSO, Joao Guilherme Ribeiro Jordao; MOURA, Eduardo De- Antibiotic prophylaxis to prevent complications in endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis of randomized controlled trials(2022) MERCHAN, Maria Fernanda Shinin; MOURA, Diogo Turiani Hourneaux de; OLIVEIRA, Guilherme Henrique Peixoto de; PROENCA, Igor Mendonca; MONTE JUNIOR, Epifanio Silvino do; IDE, Edson; MOLL, Caroline; SANCHEZ-LUNA, Sergio A.; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBACKGROUNDThe prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography (ERCP) is still controversial.AIMTo assess whether antibiotic prophylaxis reduces the rates of complications in patients undergoing elective ERCP.METHODSThis systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A comprehensive search of multiple electronic databases was performed. Only randomized controlled trials were included. The outcomes analyzed included bacteremia, cholangitis, sepsis, pancreatitis, and mortality. The risk of bias was assessed by the Cochrane revised Risk-of-Bias tool for randomized controlled trials. The quality of evidence was assessed by the Grading of Recommendation Assessment, Development, and Evaluation. Meta-analysis was performed using the Review Manager 5.4 software.RESULTSTen randomized controlled trials with a total of 1757 patients that compared the use of antibiotic and non-antibiotic prophylaxis in patients undergoing elective ERCP were included. There was no significant difference between groups regarding incidence of cholangitis after ERCP [risk difference (RD) = -0.02, 95% confidence interval (CI): -0.05, 0.02, P = 0.32], cholangitis in patients with suspected biliary obstruction (RD = 0.02, 95%CI: -0.08 to 0.13, P = 0.66), cholangitis on intravenous antibiotic prophylaxis (RD = -0.02, 95%CI: -0.05 to 0.01, P = 0.25), septicemia (RD = -0.02, 95%CI: -0.06 to 0.01, P = 0.25), pancreatitis (RD = -0.02, 95%CI: -0.06 to 0.01, P = 0.19), and all-cause mortality (RD = 0.00, 95%CI: -0.01 to 0.01, P = 0.71]. However, the antibiotic prophylaxis group presented a 7% risk reduction in the incidence of bacteremia (RD= -0.07, 95%CI: -0.14 to -0.01, P = 0.03).CONCLUSIONThe prophylactic use of antibiotics in patients undergoing elective ERCP reduces the risk of bacteremia but does not appear to have an impact on the rates of cholangitis, septicemia, pancreatitis, and mortality.
- Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials(2021) HIRSCH, Bruno Salomao; RIBEIRO, Igor Braga; FUNARI, Mateus Pereira; MOURA, Diogo Turiani Hourneaux de; MATUGUMA, Sergio Eiji; SANCHEZ-LUNA, Sergio A.; MANCINI, Fabio Catache; OLIVEIRA, Guilherme Henrique Peixoto de; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBackground/Aims: Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for gastric antral vascular ectasia (GAVE). Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review that included only randomized controlled trials (RCTs) on this topic. Methods: A comprehensive search was performed using electronic databases to identify RCTs comparing APC and EBL for the treatment of GAVE following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results: Four RCTs were included, with a total of 204 patients. EBL was related to higher endoscopic eradication rates risk difference [RD], 0.29; 95% confidence interval [CI] [0.14, 0.44]; I-2=0%) and less bleeding recurrence than APC (RD, 0.29; 95% CI [0.15, 0.44]; I-2=0%). Patients treated with EBL required fewer blood transfusions (mean difference [MD], 1.49; 95% CI [0.28, 2.71]; I-2=96%) and hospitalizations (MD, 0.29; 95% CI [0.19, 0.39]; I-2=0%). The number of sessions required for the obliteration of lesions was higher with APC. There was no difference in the incidence of adverse events. Conclusions: EBL is superior to APC in the treatment of GAVE in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements.
- 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 deOrganized 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.
conferenceObject ENDOSCOPIC VERSUS RADIOLOGIC GASTROSTOMY FOR ENTERAL FEEDING: A SYSTEMATIC REVIEW AND META-ANALYSIS(2023) SANTOS, Evellin dos; OLIVEIRA, Guilherme Henrique Peixoto de; MOURA, Diogo De; HIRSCH, Bruno Salomao; BERNARDO, Wanderley; MOURA, Eduardo De- Endoscopic management of acute leak after sleeve gastrectomy: principles and techniques(2022) MOURA, Diogo Turiani Hourneaux de; FREITAS JUNIOR, Joao Remi de; SOUZA, Gabriel Mayo Vieira de; OLIVEIRA, Guilherme Henrique Peixoto de; MCCARTY, Thomas R.; THOMPSON, Christopher C.; MOURA, Eduardo Guimaraes Hourneaux de
conferenceObject HOT VERSUS COLD SNARE FOR COLORECTAL POLYPECTOMIES SIZED UP TO 10MM. A SYSTEMATIC REVIEW AND META-ANALYSIS(2023) CAVASSOLA, Paulo; HIRSCH, Bruno Salomao; BESTETTI, Alexandre; OLIVEIRA, Guilherme Henrique Peixoto de; GOMES, Romulo; VERAS, Matheus; BERNARDO, Wanderley; MOURA, Diogo De; MOURA, Eduardo De- Endoscopic treatment of gastric antral vascular ectasia(2022) HIRSCH, Bruno Salomao; RIBEIRO, Igor Braga; FUNARI, Mateus Pereira; SAGAE, Vitor Massaro Takamatsu; MANCINI, Fabio Catache; OLIVEIRA, Guilherme Henrique Peixoto de; MOURA, Eduardo Guimaraes Hourneaux de; BERNARDO, Wanderley MarquesThe Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field, to standardize how to conduct, and to assist in the reasoning and decision-making of doctors. The information provided by this project must be critically evaluated by the physician responsible for the conduct that will be adopted depending on the conditions and the clinical condition of each patient.
- Tips and tricks in the endoscopic management of a complex biliary stone in Billroth II gastrectomy(2022) OLIVEIRA, Guilherme Henrique Peixoto de; MOURA, Diogo Turiani Hourneaux de; MCCARTY, Thomas R.; OLIVEIRA, Pedro Victor Aniz Gomes de; FUNARI, Mateus Pereira; CHENG, Spencer; MOURA, Eduardo Guimaraes Hourneaux de