TOMAZO ANTONIO PRINCE FRANZINI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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bookPart Coledocolitíase(2014) ARTIFON, Everson Luiz de Almeida; BARACAT, Renato; KUGA, Rogério; FRANZINI, Tomazo A. PrinceconferenceObject 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.- Pure Cut or Endocut for Biliary Sphincterotomy? A Multicenter Randomized Clinical Trial(2023) FUNARI, Mateus Pereira; BRUNALDI, Vitor Ottoboni; PROENCA, Igor Mendonca; GOMES, Pedro Victor Aniz; QUEIROZ, Lucas Tobias Almeida; VIEIRA, Yuri Zamban; MATUGUMA, Sergio Eiji; IDE, Edson; FRANZINI, Tomazo Antonio Prince; SANTOS, Marcos Eduardo Lera dos; CHENG, Spencer; MINATA, Mauricio Kazuyoshi; SANTOS, Jose Sebastio dos; MOURA, Diogo Turiani Hourneaux de; KEMP, Rafael; MOURA, Eduardo Guimares Hourneaux deINTRODUCTION: Adverse events (AE) after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and post-ERCP acute pancreatitis (PEP) is the most important one. Thermal injury from biliary sphincterotomy may play an important role and trigger PEP or bleeding. Therefore, this study evaluated the outcomes of 2 electric current modes used during biliary sphincterotomy. METHODS: From October 2019 to August 2021, consecutive patients with native papilla undergoing ERCP with biliary sphincterotomy were randomized to either the pure cut or endocut after cannulation. The primary outcome was PEP incidence. Secondary outcomes included intraprocedural and delayed bleeding, infection, and perforation. RESULTS: A total of 550 patients were randomized (272 pure cut and 278 endocut). The overall PEP rate was 4.0% and significantly higher in the endocut group (5.8% vs 2.2%, P = 0.034). Univariate analysis revealed >5 attempts (P = 0.004) and endocut mode (P = 0.034) as risk factors for PEP. Multivariate analysis revealed >5 attempts (P = 0.005) and a trend for endocut mode as risk factors for PEP (P = 0.052). Intraprocedural bleeding occurred more often with pure cut (P = 0.018), but all cases were controlled endoscopically during the ERCP. Delayed bleeding was more frequent with endocut (P = 0.047). There was no difference in perforation (P = 1.0) or infection (P = 0.4999) between the groups. DISCUSSION: Endocut mode may increase thermal injury leading to higher rates of PEP and delayed bleeding, whereas pure cut is associated with increased intraprocedural bleeding without clinical repercussion. The electric current mode is not related to perforation or infection. Further RCT assessing the impact of electric current on AE with overlapping preventive measures such as rectal nonsteroidal anti-inflammatory drugs and hyperhydration are needed. The study was submitted to the Brazilian Clinical Trials Platform (http://www.ensaiosclinicos.gov.br) under the registry number RBR-5d27tn.
- Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis(2019) SERRANO, Juan Pablo Roman; MOURA, Diogoturiani Hourneaux de; BERNARDO, Wanderley Marques; RIBEIRO, Igor Braga; FRANZINI, Tomazo Prince; MOURA, Eduardo Turiani Hourneaux de; BRUNALDI, Vitor Ottoboni; SALESSE, Marianne Torrezan; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux DeBackground and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic procedure for treatment of diseases that affect the biliary tree and pancreatic duct. While the therapeutic success rate of ERCP is high, the procedure can cause complications, such as acute pancreatitis (PEP), bleeding, and perforation. This meta-analysis aimed to assess the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing PEP following (ERCP). Materials and methods We searched databases, such as MEDLINE, Embase, and Cochrane Central Library. Only randomized controlled trials (RCTs) that compared the efficacy of NSAIDs and placebo for the prevention of PEP were included. Outcomes assessed included incidence of PEP, severity of pancreatitis, route of administration, and type of NSAIDs. Results Twenty-one RCTs were considered eligible with a total of 6854 patients analyzed. Overall, 3427 patients used NSAIDs before ERCP and 3427 did not use the drugs (control group). In the end, 250 cases of acute pancreatitis post-ERCP were diagnosed in the NSAIDs group and 407 cases in the placebo group. Risk for PEP was lower in the NSAID group (risk difference (RD): -0.05; 95% confidence interval (CI): -0.07 to -0.03; number need to treat (NNT), 20; P<0.05). Use of NSAIDs effectively prevented mild pancreatitis compared with use of placebo (2.5% vs. 4.1%; 95% CI, -0.05 to -0.01; NNT, 33; P<0.05), but the information on moderate and severe PEP could not be completely elucidated. Only rectal administration reduced incidence of PEP (6.8% vs. 13 %; 95% CI, -0.10 to -0.04; NNT, 20; P<0.05). Furthermore, only diclofenac or indomethacin use was effective in preventing PEP. Conclusions Rectal administration of diclofenac and indomethacin significantly reduced risk of developing mild PEP. Further RCTs are needed to compare efficacy between NSAID administration pathways in prevention of PEP after ERCP.
conferenceObject PURE CUT OR ENDOCUT FOR BILIARY SPHINCTEROTOMY? A MULTICENTER RANDOMIZED CLINICAL TRIAL(2023) FUNARI, Mateus; BRUNALDI, Vitor; PROENCA, Igor; OLIVEIRA, Pedro Victor Aniz Gomes De; QUEIROZ, Lucas; VIEIRA, Yuri; MATUGUMA, Sergio; IDE, Edson; FRANZINI, Tomazo; SANTOS, Marcos Eduardo Lera Dos; CHENG, Spencer; MINATA, Mauricio; SANTOS, Jose Sebastiao Dos; MOURA, Diogo De; KEMP, Rafael; MOURA, Eduardo De- THE ROLE OF THE ENDOSCOPIC BALLOON DILATION OF THE MAJOR PAPILLA IN MANAGING COMMON BILE DUCT STONES: A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS(2019) MATSUBAYASHI, Carolina O.; BERNARDO, Wanderlei M.; MARCO, Michele O. De; RESENDE, Ricardo H.; REZENDE, Daniel T.; MOTA, Raquel Cristina L.; BRUNALDI, Vitor O.; LUZ, Gustavo O.; FRANZINI, Tomazo; MOURA, Eduardo G. de
- Common bile duct intussusception during ERCP for stone removal(2018) ROCHA, R. S. D. P.; MINATA, M. K.; MOURA, D. T. H. de; MOURA, E. G. H. de; FRANZINI, T. A. P.[No abstract available]
- Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures: a systematic review and meta-analysis(2020) OLIVEIRA, Pedro Victor Aniz Gomes de; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; BAZARBASHI, Ahmad Najdat; FRANZINI, Tomazo Antonio Prince; SANTOS, Marcos Eduardo Lera dos; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deObjective Indeterminate biliary strictures remain a significant diagnostic challenge. Digital single-operator cholangioscopy (D-SOC) incorporates digital imaging which enables higher resolution for better visualization and diagnosis of biliary pathology. We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to determine the efficacy of D-SOC in the visual interpretation of indeterminate biliary strictures. Material and methods Electronic searches were performed using Medline (PubMed), EMBASE, and Cochrane Library. All D-SOC studies that reported the diagnostic performance in visual interpretation of indeterminate biliary strictures and biliary malignancies were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was used to evaluate the quality of the included studies. All data were extracted and pooled to construct a 2 x 2 table. The visual interpretation of D-SOC was compared to resected surgical specimens or clinical follow-up in the included patients. Pooled sensitivity, specificity, positive predictive value, negative predictive value, prevalence, positive likelihood ratio (+LR), negative likelihood ratio (-LR), and diagnostic odds ratio (OR) were calculated. The summarized receiver operating characteristic (SROC) curve corresponding with the area under the curve (AUC) was also analyzed. Results The search yielded 465 citations. Of these, only six studies with a total of 283 procedures met inclusion criteria and were included in the meta-analysis. The overall pooled sensitivity and specificity of D-SOC in the visual interpretation of biliary malignancies was 94% (95% CI 89-97) and 95% (95%CI 90-98), respectively, while +LR, -LR, diagnostic OR, and AUC were 15.20 (95%CI 5.21-44.33), 0.08 (95%CI 0.04-0.14), 308.83 (95%CI 106.46-872.82), and 0.983, respectively. The heterogeneity among 6 included studies was moderate for specificity (I-2 = 0.51) and low for sensitivity (I-2 = 0.17) and diagnostic OR (I-2 = 0.00). Conclusion D-SOC is associated with high sensitivity and specificity in the visual interpretation of indeterminate biliary strictures and malignancies. D-SOC should be considered routinely in the diagnostic workup of indeterminate biliary lesions.
conferenceObject Biliary Stenosis Extreme Endoscopy Treatment - Very Large Balloon Dilation: Case Series (EBD)(2016) MOURA, Eduardo T. de; SILVA, Gustavo L.; PASSOS, Marina Lordello; AQUINO, Julio Cesar M.; CASTRO, Vinicius L.; MOURA, Diogo T. de; FRANZINI, Tomazo; SAKAI, Paulo- A novel approach in benign biliary stricture - balloon dilation combined with cholangioscopy-guided steroid injection(2015) FRANZINI, Tomazo; MOURA, Renata; RODELA, Gustavo; ANDRAUS, Wellington; HERMAN, Paulo; D'ALBUQUERQUE, Luiz; MOURA, Eduardo de