MARCOS EDUARDO LERA DOS SANTOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
15 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 15
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, PauloCommon 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.- A new large-caliber trocar for percutaneous endoscopic gastrostomy by the introducer technique in head and neck cancer patients(2011) GIORDANO-NAPPI, J. H.; MALUF-FILHO, F.; ISHIOKA, S.; HONDO, F. Y.; MATUGUMA, S. E.; LIMA, M. Simas de; SANTOS, M. Lera dos; RETES, F. A.; SAKAI, P.Background and study aims In many patients, percutaneous endoscopic gastrostomy (PEG) can be limited by digestive tract stenosis. PEG placement using an introducer is the safest alternative for this group of patients, but the available devices are difficult to implement and require smaller-caliber tubes. The aim of this study was to evaluate the modification of an introducer technique device for PEG placement with regard to the following: procedure feasibility, possibility of using a 20-Fr balloon gastrostomy tube, tube-related function and problems, complications, procedure safety, and mortality. Patients and methods Between March 2007 and February 2008, 30 consecutive patients with head and neck malignancies underwent introducer PEG placement with the modified device and gastropexy. Each patient was evaluated for 60 days after the procedure for the success of the procedure, infection, pain, complications, mortality, and problems with the procedure. Results The procedure was successful in all cases with no perioperative complications. No signs of stomal infection were observed using the combined infection score. The majority of patients experienced mild-to-moderate pain both in the immediate postoperative period and at 72 hours. One major early complication (3.3%) and two minor complications (6.7%) were observed. No procedure-related deaths occurred during the first 60 days after the procedure. Conclusion The device modification for PEG using the introducer technique is feasible, safe, and efficient in outpatients with obstructive head and neck cancer. In this series, it allowed the use of a larger-caliber tube with low complication rates and no procedure-related mortality.
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. deconferenceObject Endoscopic Ultrasound Evaluation After Endoscopic Eradication of Esophageal Varices With Band Ligation: Does It Predict Variceal Recurrence?(2016) CARNEIRO, Fred O.; RETES, Felipe A.; MATUGUMA, Sergio E.; ALBERS, Debora V.; CHAVES, Dalton M.; SANTOS, Marcos E.; HERMAN, Paulo; CHAIB, Eleazar; SAKAI, Paulo; ALBUQUERQUE, Luiz C. D.; MALUF-FILHO, Fauze- Massive bleeding after plastic stent removal during ERCP: what's next?(2017) LERA, Marcos Eduardo; MINATA, Mauricio Kazuyoshi; DUARTE, Ralph Braga; MATUGUMA, Sergio Eiji; SAKAI, Paulo; ANDRAUS, Wellington; MOURA, Eduardo Guimaraes Hourneaux 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, FauzeGastrointestinal 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.- Endoscopic versus surgical treatment for pancreatic pseudocysts Systematic review and meta-analysis(2019) FARIAS, Galileu F. A.; BERNARDO, Wanderley M.; MOURA, Diogo T. H. De; GUEDES, Hugo G.; BRUNALDI, Vitor O.; VISCONTI, Thiago A. de C.; GONCALVES, Caio V. T.; SAKAI, Christiano M.; MATUGUMA, Sergio E.; SANTOS, Marcos E. L. dos; SAKAI, Paulo; MOURA, Eduardo G. H. DeObjective: This systematic review and meta-analysis aims to compare surgical and endoscopic treatment for pancreatic pseudocyst (PP). Methods: The researchers did a search in Medline, EMBASE, Scielo/Lilacs, and Cochrane electronic databases for studies comparing surgical and endoscopic drainage of PP s in adult patients. Then, the extracted data were used to perform a meta-analysis. The outcomes were therapeutic success, drainage-related adverse events, general adverse events, recurrence rate, cost, and time of hospitalization. Results: There was no significant difference between treatment success rate (risk difference [RD] -0.09; 95% confidence interval [CI] [0.20,0.01]; P = .07), drainage-related adverse events (RD -0.02; 95% CI [-0.04,0.08]; P = .48), general adverse events (RD -0.05; 95% CI [-0.12, 0.02]; P = .13) and recurrence (RD: 0.02; 95% CI [-0.04,0.07]; P = .58) between surgical and endoscopic treatment. Regarding time of hospitalization, the endoscopic group had better results (RD: -4.23; 95% CI [-5.18, -3.29]; P < .00001). When it comes to treatment cost, the endoscopic arm also had better outcomes (RD: -4.68; 95% CI [-5.43,-3.94]; P < .00001). Conclusion: There is no significant difference between surgical and endoscopic treatment success rates, adverse events and recurrence for PP. However, time of hospitalization and treatment costs were lower in the endoscopic group.
conferenceObject Learning Curve for ESD: Experience From a South American Center(2012) MOURA, Eduardo G. H. De; YAMAZAKI, Kendi; MESTIERI, Luiz H.; MIYAJIMA, Nelson T.; CHAVES, Dalton M.; SANTOS, Marcos E. Lera Dos; IDE, Edson; FRANZINI, Tomazo; PESSORRUSSO, Fernanda C.; SAKAI, PauloIntroduction: Endoscopic resection techniques such as endoscopic submucosal dissection (ESD) for early gastric cancer are gaining acceptance in many countries. However complication rates on this procedure reaches 20% on non-experienced hands. Experts recommend that ESD should first be carried out in animal models before starting to be performed in humans, in order to overcome the initial learning curve. Aims: To evaluate the learning curve during intensive ESD training on live porcine models under supervision of experts. Material and Methods: Forty endoscopists have performed ESD during an intensive training course on live porcine models, under experts’ supervision. This training had duration of two days. Simulation of a gastric lesion was obtained by aspirating the gastric mucosa with a cap on the tip of the endoscope. The following variables were analyzed: procedure time, resected specimen size, complete en bloc resection rate, circumferential incision time, submucosal solution injected volume, distance between the circumferential incision and the lesion (lateral margin) and complication rates as perforation, bleeding and death. And from the beginning to the end of the last procedure a questionnaire was given to the participants to see if they felt secure to perform ESD without supervision. Results: At the end of 2 days training, 125 gastric ESDs were achieved. Each participant performed at least 3 complete ESDs. The mean procedure time for the first cases were 32.69 min ± 15.89 (CI 95% 6.52 - 19.36) and at the end of the third case 19.7min ± 8.57 (CI 95% 6.52 - 19.36), p 0.001; the distance between the circumferential incision and the lesion (lateral margin) has increased from 2.54mm 1.75 (CI 95% 1.24 - 1.05) to 2.71mm ± 2.70(CI 95% 1.24 - 1.05), p=0.87 at the end of the third case. Bleeding rate has decreased from 18.75% to 15.63%. At the end of the training course 56.25% of the endoscopists felt secure to do ESD without supervision, a percentage that was 6.25% at the beginning of the course. Conclusion: Training ESD on live porcine models may help endoscopist overcome the learning curve but more training is needed to make it secure in humans.- ENDOSCOPIC ULTRASOUND IN THE EVALUATION OF UPPER SUBEPITHELIAL LESIONS(2015) CHAVES, Dalton Marques; MEINE, Gilmara Coelho; MOURA, Diogo Turiani Hourneaux de; MATUGUMA, Sergio Eiji; LERA, Marcos Eduardo; ARTIFON, Everson Luiz de Almeida; MOURA, Eduardo Guimarães Hourneaux de; SAKAI, PauloBackgroundEndoscopic ultrasound is considered the best imaging test for the diagnosis and evaluation of subepithelial lesions of the gastrointestinal tract.ObjectiveThe present study aims to describe the endosonographic characteristics of upper gastric subepithelial lesions and our experience using endoscopic ultrasound for evaluation of such lesions.MethodsRetrospective data study of 342 patients who underwent endoscopic ultrasound evaluation of subepithelial lesions.ResultsLesions of the fourth layer were more common in the stomach (63.72%) than in the esophagus (44.68%) and duodenum (29.03%). In stomach, 81.1% of the lesions ≥2 cm, and 96.5% ≥3 cm, were from the fourth layer. Endosonographic signs that could be related to malignant behavior, such as irregular borders, echogenic foci, cystic spaces and/or size greater than 3 cm were identified in 34 (15.81%) lesions at the first endoscopic ultrasound evaluation. Endoscopic ultrasound-fine needle aspiration did the diagnosis in 21 (61.76%) patients who were submitted a puncture. Three (12.0%) lesions of 25 who were submitted to regular endoscopic ultrasound surveillance increased the size.ConclusionStomach is the organ most affected with subepithelial lesions of the gastrointestinal tract and the fourth layer was the most common layer of origin. More than 80% of gastric subepithelial lesions from the fourth layer are ≥2 cm. Endoscopic ultrasound evaluation of subepithelial lesions has been very important for stratification into risk groups and to determine the best management.
- 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 deAIM 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.