GUILHERME HENRIQUE PEIXOTO DE OLIVEIRA
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- 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.
- 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.
- 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 deNon-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.
- Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis(2024) VERAS, Matheus de Oliveira; MOURA, Diogo Turiani Hourneaux de; MCCARTY, Thomas R.; OLIVEIRA, Guilherme Henrique Peixoto de; GOMES, Romulo Sergio Araujo; LANDIM, Davi Lucena; NUNES, Felipe Giacobo; FRANZINI, Tomazo Antonio Prince; SANTOS, Marcos Eduardo Lera dos; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBackground and study aims Recurrent biliary stent occlusion and tumor ingrowth remain a major concern among patients with malignant biliary obstruction (MBO) with significant impact on patient morbidity and survival. Intraductal radiofrequency ablation (RFA) has emerged as a promising treatment that seeks to extend stent patency. This study aimed to evaluate the impact of RFA on overall survival (OS) and stent patency among patients with unresectable MBO.Methods A comprehensive search of electronic databases was performed for randomized controlled trials (RCTs) comparing RFA plus biliary stent (RFA+S) versus biliary stent alone (S-alone). Outcomes assessed included overall survival, stent patency, and adverse events (AEs) with mean difference (MD) calculated from pooled proportions. Subgroup analyses were performed for hilar strictures and cholangiocarcinoma (CCA).Results Six RCTs (n=439 patients) were included and demonstrated improved survival among patients who received RFA+S (MD 85.80 days; 95% confidence interval [CI] 35.02-136.58; I 2 =97%; P <0.0009). The pooled MD for total stent patency was 22.25 days (95% CI 17.38-61.87; I (2) =97%; P =0.27). There was no difference in AEs between RFA+S vs S-alone ( P >0.05). On subgroup analyses, RFA+S was associated with improved stent patency (MD 76.73 days; 95% CI 50.11-103.34; I 2 =67%; P <0.01) and OS (MD 83.14 (95% CI 29.52-136.77; I- 2 =97%; P <0.01] for CCA. For hilar strictures, stent patency was improved among patients with RFA+S [MD 83.71 days (95% CI 24.85-142.56; I 2 =84%; P <0.01].Conclusions RFA+S improved OS in the treatment of MBO when compared with S-alone. Moreover, the RFA therapy prolonged stent patency in hilar strictures and CCA, with similar rates of AEs.