GUILHERME HENRIQUE PEIXOTO DE OLIVEIRA
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- 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 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.
- 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
- 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
- Colonoscopic Ultrasound-Guided Fine-Needle Aspiration Using a Curvilinear Array Transducer: A Single-Center Retrospective Cohort Study(2022) CHENG, Spencer; MATUGUMA, Sergio E.; OLIVEIRA, Guilherme H. P. de; SILVA, Gustavo L. R.; CHENG, Henrique; SANCHEZ-LUNA, Sergio A.; MINATA, Mauricio K.BACKGROUND: Curvilinear array ultrasound transducers enable tissue sampling and have therapeutic capabilities. Nevertheless, colonic intubation and maneuvering with these transducers is technically challenging and is therefore typically limited to the rectosigmoid area. This retrospective cohort study aimed to evaluate the safety, feasibility, and diagnostic yield of colonoscopic ultrasound-guided fine-needle aspiration in deep colonic intubation. IMPACT OF INNOVATION: The impact of this innovation is to enable tissue sampling of colonic and extracolonic lesions guided by endoscopic ultrasound. TECHNOLOGY, MATERIALS, AND METHODS: Curvilinear array ultrasound is used in the evaluation of luminal and extraluminal colonic diseases. Thirteen patients underwent colonoscopic ultrasound with a curvilinear array ultrasound endoscope in a single center for subepithelial lesions, cancer staging, and extracolonic lesions from July 2015 to February 2021. Endosonography was performed using an Olympus EU-ME1 and GF-UCT 180 with a 5-12MHz curvilinear array transducer. The primary outcome was the percentage of patients who were successfully scanned with the endoscopic ultrasound. The secondary outcomes included the success rate of fine-needle aspiration, the diagnostic yield of the tissue samples, and the adverse events related to the procedure. PRELIMINARY RESULTS: A total of 13 female patients underwent colonoscopic ultrasound. All patients (100%, 13/13) were successfully scanned. Fine-needle aspiration was deemed necessary and successfully performed in 100% (5/5) of the patients. Tissue samples collected by fine-needle aspiration resulted in a diagnostic yield of 60%, and no adverse events resulted from this intervention. CONCLUSIONS: This study demonstrates the feasibility of performing colonoscopic ultrasound with a curvilinear array transducer. Fine-needle aspiration for subepithelial, colonic, and extracolonic lesions is feasible and safe in this setting with no adverse events reported in our study. FUTURE DIRECTIONS: Future research should be directed toward validating colonoscopic ultrasound with a curvilinear array transducer technique in prospective randomized trials. Studies evaluating the feasibility and safety of endoscopic ultrasound-guided interventions in the colon, such as abscess drainage and enteral anastomosis, should be considered.