JOAO REMI DE FREITAS JUNIOR
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6 resultados
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- Sequential Endoscopic Therapies for Treatment of Complex Gastrointestinal Transmural Leak Following Bariatric Surgery(2022) BESTETTI, Alexandre Moraes; SANTO, Marco Aurelio; TRASOLINI, Roberto Paolo; FREITAS JUNIOR, Joao Remi de; HIRSCH, Bruno Salomao; MOURA, Eduardo Guimaraes Hourneaux de; MOURA, Diogo Turiani Hourneaux de
- 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 deBackground 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. - 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 retrograde cholangiopancreatography drainage for palliation of malignant hilar biliary obstruction - stent-in-stent or side-by-side? A systematic review and meta-analysis(2021) SOUZA, Gabriel Mayo Vieira de; RIBEIRO, Igor Braga; FUNARI, Mateus Pereira; MOURA, Diogo Turiani Hourneaux de; SCATIMBURGO, Maria Vitoria Cury Vieira; FREITAS JUNIOR, Joao Remi de; SANCHEZ-LUNA, Sergio A.; BARACAT, Renato; MOURA, Eduardo Turiani Hourneaux de; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBACKGROUND Biliary drainage, either by the stent-in-stent (SIS) or side-by-side (SBS) technique, is often required when treating a malignant hilar biliary obstruction (MHBO). Both methods differ from each other and have distinct advantages. AIM To compare both techniques regarding their efficacy and safety in achieving drainage of MHBO. METHODS A comprehensive search of multiple electronic databases (MEDLINE, Embase, LILACS, BIREME, Cochrane) was conducted and grey literature from their inception until December 2020 with no restrictions regarding the year of publication or language, since there was at least an abstract in English. The included studies compared SIS and SBS techniques through endoscopic retrograde cholangiopancreatography. Outcomes analyzed included technical and clinical success, early and late adverse events (AEs), stent patency, reintervention, and procedure-related mortality. RESULTS Four cohort studies and one randomized controlled trial evaluating a total of 250 patients (127 in the SIS group and 123 in the SBS group) were included in this study. There were no statistically significant differences between the two groups concerning the evaluated outcomes, except for stent patency, which was higher in the SIS compared with the SBS technique [mean difference (d) = 33.31; 95% confidence interval: 9.73 to 56.90, I-2 = 45%, P = 0.006]. CONCLUSION The SIS method showed superior stent patency when compared to SBS for achieving bilateral drainage in MHBO. Both techniques are equivalent in terms of technical success, clinical success, rates of both early and late AEs, reintervention, and procedure-related mortality.
- Metabolic Effects of Endoscopic Duodenal Mucosal Resurfacing: a Systematic Review and Meta-analysis(2021) OLIVEIRA, Guilherme Henrique Peixoto de; MOURA, Diogo Turiani Hourneaux de; FUNARI, Mateus Pereira; MCCARTY, Thomas R.; RIBEIRO, Igor Braga; BERNARDO, Wanderley Marques; SAGAE, Vitor Massaro Takamatsu; FREITAS JR., Joao Remi; SOUZA, Gabriel Mayo de Vieira; MOURA, Eduardo Guimaraes Hourneaux deDuodenal mucosal resurfacing (DMR) is an innovative endoscopic bariatric and metabolic therapy (EBMT) emerging in recent years. It uses the duodenum to achieve better glycemic and weight control. This study aimed to evaluate in a critical and systematic way the metabolic effects of this procedure. Electronic searches were performed evaluating the DMR procedure based on predefined inclusion and exclusion criteria. Changes in measured outcomes were evaluated using random-effects models by computing weighted mean differences (MD) and corresponding 95% CIs between pre-and post-procedure metabolic characteristics. Four studies were selected for qualitative and quantitative analysis. DMR demonstrated beneficial glycemic and hepatic metabolic effects among patients with non-insulin dependent type 2 diabetes (T2D) at 3 and 6 months post-procedure.
- Effects of intragastric balloon placement in metabolic dysfunction-associated fatty liver disease: A systematic review and meta-analysis(2021) FREITAS JUNIOR, Joao Remi de; RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; SAGAE, Vitor Massaro Takamatsu; SOUZA, Gabriel Mayo Vieira de; OLIVEIRA, Guilherme Henrique Peixoto de; SANCHEZ-LUNA, Sergio A.; SOUZA, Thiago Ferreira de; MOURA, Eduardo Turiani Hourneaux de; OLIVEIRA, Claudia Pinto Marques Souza de; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBACKGROUND Metabolic dysfunction-associated fatty liver disease corresponds to a clinical entity that affects liver function triggered by the accumulation of fat in the liver and is linked with metabolic dysregulation. AIM To evaluate the effects of the intragastric balloon (IGB) in patients with metabolic dysfunction-associated fatty liver disease through the assessment of liver enzymes, imaging and several metabolic markers. METHODS A comprehensive search was done of multiple electronic databases (MEDLINE, EMBASE, LILACS, Cochrane and Google Scholar) and grey literature from their inception until February 2021. Inclusion criteria involved patients with a body mass index > 25 kg/m(2) with evidence or previous diagnosis of hepatic steatosis. Outcomes analyzed before and after 6 mo of IGB removal were alanine aminotransferase (IU/L), gamma-glutamyltransferase (IU/L), glycated hemoglobin (%), triglycerides (mg/dL), systolic blood pressure (mmHg), homeostatic model assessment, abdominal circumference (cm), body mass index (kg/m(2)) and liver volume (cm(3)). RESULTS Ten retrospective cohort studies evaluating a total of 508 patients were included. After 6 mo of IGB placement, this significantly reduced alanine aminotransferase [mean difference (MD): 10.2, 95% confidence interval (CI): 8.12-12.3], gamma-glutamyltransferase (MD: 9.41, 95%CI: 6.94-11.88), glycated hemoglobin (MD: 0.17%, 95%CI: 0.03-0.31), triglycerides (MD: 38.58, 95%CI: 26.65-50.51), systolic pressure (MD: 7.27, 95%CI: 4.79-9.76), homeostatic model assessment (MD: 2.23%, 95%CI: 1.41-3.04), abdominal circumference (MD: 12.12, 95%CI: 9.82-14.41) and body mass index (MD: 5.07, 95%CI: 4.21-5.94). CONCLUSION IGB placement showed significant efficacy in improving alanine aminotransferase and gamma-glutamyltransferase levels in patients with metabolic dysfunction-associated fatty liver disease as well as improving metabolic markers related to disease progression.