MARCOS EDUARDO LERA DOS SANTOS

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

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Autor e Coautores FMUSP-HC Normalizados: GUSTAVO DE OLIVEIRA LUZ ×

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Agora exibindo 1 - 10 de 14
  • article 0 Citação(ões) na Scopus
    Acute esophageal necrosis (black esophagus) with active upper gastrointestinal bleeding: What to do?
    (2021) RIBEIRO, Igor Braga; LUZ, Gustavo de Oliveira; SOUZA, Gabriel Mayo Vieira de; BOGHOSSIAN, Mateus Bond; MONTE JUNIOR, Epifanio Silvino do; SANTOS, Marcos Eduardo Lera dos; MOURA, Eduardo Guimaraes Hourneaux de
  • conferenceObject
    Endoscopic Papillary Large Balloon Dilation Associated With Sphincterotomy for Extraction of Large Bile Duct Stones
    (2012) LUZ, Gustavo O.; MOURA, Eduardo G. De; MEINE, Gilmara C.; CARNEIRO, Fred O.; MEDRADO, Bruno F.; ALMEIDA, Maira R.; MALUF-FILHO, Fauze; LERA, Marcos; IDE, Edson; FURUYA, Carlos K.; CHAVES, Dalton M.; CHENG, Spencer; MATUGUMA, Sergio E.; TOMISHIGE, Toshiro; HONDO, Fabio Y.; BARACAT, Renato; ARTIFON, Everson L.; FRANZINI, Tomazo; SAKAI, Paulo
    Common bile duct stones larger than 15mm are related to a higher rate of failure of endoscopic ductal clearance and need for mechanical lithotripsy. Recently, endoscopic papillary large balloon dilation (EPLBD) associated with endoscopic sphyncterotomy (ES) has been advocated for the management of difficult bile duct stones. Objective: Evaluate the efficacy and safety of EPLBD associated with ES for removal of large bile duct stones. Patients and methods: retrospective review of prospectively collected data in an academic tertiary referral center, from November 2009 to August 2011. Ampullary dilation was performed with a wire guided hydrostatic balloon (CRE/Boston Scientific) which size ranged from 12 to 20mm. The stone size and the duct diameter directed the choice of the balloon diameter. Balloon was inflated with diluted contrast medium under endoscopic and fluoroscopic control until waist disappearance and/or maximal balloon pressure. After dilation stones were extracted with the aid of standard accessories and techniques. Outcomes and adverse events were recorded. Results: A total of 730 patients with common bile duct stones were admitted for ERCP in our institution. 123 (16,8%) patients were submitted to EPLBD after sphincterotomy. The mean age was 56 years (22-98) and 77 were female (63%). The size of the stones ranged from 13 to 30mm. Initial procedure success rate without mechanical lithitripsy was 83% (102/123). In further 4 patients (3,2%) mechanical lithotripsy was used with 75% success rate (3/4). For the remaining 17 patients, mechanical litotripsy was not available and a 10Fr biliary stent was introduced to prevent obstruction and cholangitis. The total adverse events rate was 3,2%. There were 2 cases of perforation with 20mm balloon (1,6%), both treated conservatively, and two cases of mild acute pancreatitis (1,6%). None of the patients presented bleeding that required transfusion or hospitalization. Conclusion: EPLBD after sphincterotomy is a safe and effective technique for the management of large bile duct stones and it avoids mechanical lithotripsy in the majority of cases.
  • article 8 Citação(ões) na Scopus
    Pancreatitis after endoscopic retrograde cholangiopancreatography: A narrative review
    (2021) RIBEIRO, Igor Braga; MONTE JUNIOR, Epifanio Silvino do; MIRANDA NETO, Antonio Afonso; PROENCA, Igor Mendonca; MOURA, Diogo Turiani Hourneaux de; MINATA, Mauricio Kazuyoshi; IDE, Edson; SANTOS, Marcos Eduardo Lera dos; LUZ, Gustavo de Oliveira; MATUGUMA, Sergio Eiji; CHENG, Spencer; BARACAT, Renato; MOURA, Eduardo Guimaraes Hourneaux de
    Acute post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a feared and potentially fatal complication that can be as high as up to 30% in high-risk patients. Pre-examination measures, during the examination and after the examination are the key to technical and clinical success with a decrease in adverse events. Several studies have debated on the subject, however, numerous topics remain controversial, such as the effectiveness of prophylactic medications and the amylase dosage time. This review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.
  • article
    Self-Expandable Metal Stent (SEMS) Versus Lumen-Apposing Metal Stent (LAMS) for Drainage of Pancreatic Fluid Collections: A Randomized Clinical Trial
    (2023) SANTOS, Marcos Eduardo Lera dos; PROENCA, Igor Mendonca; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; MATUGUMA, Sergio Eiji; CHENG, Spencer; JR, Joao Remi de Freitas; LUZ, Gustavo de Oliveira; MCCARTY, Thomas R.; JUKEMURA, Jose; MOURA, Eduardo Guimaraes Hourneaux de
    Background and aim Endoscopic ultrasound (EUS)-guided drainage is the gold standard approach for the treatment of encapsulated pancreatic collections (EPCs) including pseudocyst and walled-off pancreatic necrosis (WON), and is associated with an equivalent clinical efficacy to surgical drainage with fewer complications and less morbidity. Drainage may be achieved via several types of stents including a fully covered self-expandable metallic stent (SEMS) and lumen-apposing metal stent (LAMS). However, to date there have been no randomized trials to compare these devices. This study aimed to compare the efficacy and safety of the SEMS versus LAMS for EUS-guided drainage of EPCs. Methods A phase IIB randomized trial was designed to compare the SEMS versus LAMS for the treatment of EPCs. Technical success, clinical success, adverse events (AEs), and procedure time were evaluated. A sample size of 42 patients was determined.
    Results There was no difference between the two groups in technical (LAMS 80.95% vs 100% SEMS, p=0.107), clinical (LAMS 85.71% vs 95.24% SEMS, p=0.606) or radiological success (LAMS 92.86% vs 83.33% SEMS, p=0.613). There was no difference in AEs including stent migration rate and mortality. The procedure time was longer in the LAMS group (mean time 43.81 min versus 24.43 min, p=0.001). There was also a difference in the number of intra-procedure complications (5 LAMS vs 0 SEMS, p=0.048). Conclusion SEMS and LAMS have similar technical, clinical, and radiological success as well as AEs. However, SEMS has a shorter procedure time and fewer intra-procedure complications compared to non-electrocauteryenhanced LAMS in this phase IIB randomized controlled trial (RCT). The choice of the type of stent used for EUS drainage of EPCs should consider device availability, costs, and personal and local experience.
  • conferenceObject
    COMPARISON BETWEEN ENDOSCOPIC SPHINCTEROTOMY VERSUS ENDOSCOPIC SPHINCTEROTOMY ASSOCIATED WITH BALLOON DILATION FOR REMOVAL OF BILE DUCT STONES: A SYSTEMATIC REVIEW AND META-ANALYSIS BASED ON RANDOMIZED CONTROLLED TRIALS.
    (2018) CLEMENTE JUNIOR, Cesar C. de; BERNARDO, Wanderlei M.; FRANZINI, Tomazo; LUZ, Gustavo O.; SANTOS, Marcos E. dos; MARINHO, Fabio R.; CORONEL, Martin A.; SAKAI, Paulo; MOURA, Eduardo G. de
  • conferenceObject
    Deep Sedation Events During Diagnostic Upper Gastrointestinal Endoscopy: A Randomized Study of the Regimens Propofol-Fentanyl and Midazolam-Fentanyl
    (2012) SANTOS, Marcos E. Lera Dos; MOURA, Eduardo G. De; SAKAI, Paulo; MATUGUMA, Sergio E.; IDE, Edson; CHAVES, Dalton M.; LUZ, Gustavo; SOUZA, Thiago F.; PESSORRUSSO, Fernanda C.; MESTIERI, Luiz H.; MALUF-FILHO, Fauze
    Gastrointestinal Endoscopy Unit - Gastroenterology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil Background and Study Aims: For upper gastrointestinal endoscopy (UGIE), the use of sedation is nearly universal. The objective of this study was to compare two drug combinations in terms of the frequency of deep sedation events during UGIE. Patients and Methods: We evaluated 200 patients referred for UGIE. Patients were randomized to receive propofol-fentanyl or midazolam-fentanyl (n = 100/group). We assessed the level of sedation with the Observer’s Assessment of Alertness/Sedation (OAA/S) and the bispectral index (BIS). We evaluated patient and physician satisfaction, as well as recovery time and complication rates. Results: The times to induction sedation, recovery, and discharge were shorter in the propofol-fentanyl group than in the midazolam-fentanyl group. According to the OAA/S, deep sedation events occurred in 25% of the propofol-fentanyl group patients and 11% of the midazolam-fentanyl group patients (p = 0.014), compared with 19% and 7%, respectively, for the BIS (p = 0.039). There was good concordance between the OAA/S and the BIS for both groups (k = 0.71 and k = 0.63, respectively). Oxygen supplementation was required in 42% of the propofol-fentanyl group patients and in 26% of the midazolam-fentanyl group patients (p = 0.025). The mean time to recovery was 28.82 and 44.13 min in the propofol-fentanyl and midazolam-fentanyl groups, respectively (p < 0.001). There were no severe complications in either group. Although patients were equally satisfied with both drug combinations, physicians were more satisfied with the propofol-fentanyl combination. Conclusions: Despite the greater risk of deep sedation, propofol is preferable to midazolam.
  • article 111 Citação(ões) na Scopus
    Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in COVID-19 Patient: A Case Report
    (2020) MONTE JUNIOR, Epifanio Silvino do; SANTOS, Marcos Eduardo Lera dos; RIBEIRO, Igor Braga; LUZ, Gustavo de Oliveira; BABA, Elisa Ryoka; HIRSCH, Bruno Salomao; FUNARI, Mateus Pereira; MOURA, Eduardo Guimaraes Hourneaux de
    The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptoms of COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections. Mucormycosis is a rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Five days following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three units of red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deep hemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died 36 hours after the esophagogastroduodenoscopy.
  • article
    Comparison between endoscopic sphincterotomy vs endoscopic sphincterotomy associated with balloon dilation for removal of bile duct stones: A systematic review and meta-analysis based on randomized controlled trials
    (2018) CLEMENTE JUNIOR, Cesar Capel de; BERNARDO, Wanderley Marques; FRANZINI, Tomazo Prince; LUZ, Gustavo Oliveira; SANTOS, Marcos Eduardo Lera dos; COHEN, Jonah Maxwell; MOURA, Diogo Turiani Hourneaux de; MARINHO, Fabio Ramalho Tavares; CORONEL, Martin; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux de
    AIM To compare gallstones removal rate and incidence of bleeding, pancreatitis, use of mechanical lithotripsy, cholangitis and perforation between isolated sphincterotomy vs sphincterotomy associated with balloon dilation of papilla in choledocholithiasis through the meta-analysis of randomized clinical trials. METHODS We conducted a systematic review according to the PRISMA guidelines. Literature search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane Library, LILACS, and EMBASE database platforms in July 2017. The manual search included references of retrieved articles. We extracted data focusing on outcomes: The primary endpoint was the stones removal rate; Secondary endpoints were rates of pancreatitis, bleeding, use of mechanical lithotripsy (ML), perforation and cholangitis. RESULTS Eleven RCTs with 1824 patients were included. EST was associated with more post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding [FE RD-0.02, CI (-0.03, -0.00), I-2 = 33%, P = 0.05] and more need of mechanical lithotripsy in general [RE RD-0.16, CI (-0.25, -0.06), I-2 = 90%, P = 0.002] and in subgroup analysis of stones greater than 15 mm [RE RD-0.20, CI (-0.38, -0.02), I-2 = 82%, P = 0.003]. Incidence of pancreatitis [FE RD-0.01, CI (-0.03, 0.01), I-2 = 0, P = 0.36], cholangitis [FE RD-0.00, CI (-0.01, 0.01), I-2 = 0, P = 0.97] and perforation [FE RD-0.01, CI (-0.01, 0.00), I-2 = 0, P = 0.23] was similar between the groups as well as similar stone removal rates in general [FE RD-0.01, CI (-0.01, 0.04), I-2 = 0, P = 0.23] and pooled analysis of stones greater than 15 mm [FE RD-0.02, CI (-0.02, 0.07), I-2 = 11%, P = 0.31]. CONCLUSION Through meta-analysis of randomized clinical trials we found that isolated sphincterotomy was associated with more post-ERCP bleeding and more need for mechanical lithotripsy. However, there was no statistical difference in the stone removal rate between isolated sphincterotomy and sphincterotomy associated with balloon dilation in the approach to remove gallstones.
  • conferenceObject
    METALLIC STENT VS. MULTIPLE PLASTIC STENTS FOR THE ANASTOMOTIC BILIARY STRICTURE AFTER LIVER TRANSPLANTATION. SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
    (2018) VISCONTI, Thiago A.; BERNARDO, Wanderlei M.; MOURA, Diogo T. de; MOURA, Eduardo T.; GONCALVES, Caio V. Tranquillini; FARIAS, Galileu F.; GUEDES, Hugo G.; FRANZINI, Tomazo; LUZ, Gustavo O.; SANTOS, Marcos E. dos; MOURA, Eduardo G. de
  • article 8 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.