TOMAZO ANTONIO PRINCE FRANZINI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
17 resultados
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Agora exibindo 1 - 10 de 17
- 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.
- 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]
- Approach to Endoscopic Procedures: A Routine Protocol from a Quaternary University Referral Center Exclusively for Coronavirus Disease 2019 Patients(2020) FRANZINI, Tomazo Antonio Prince; KOTINDA, Ana Paula Samy Tanaka; MOURA, Diogo Turiani Hourneaux de; BADANA, Marcia Lopes Vicente; MEDEIROS, Marion Sielfeld de; LIMA, Patricia Goulart Rodrigues; MELLO, Brigitte Feiner de; KAYANO, Rafael Priante; CARMONA, Maria Jose Carvalho; ROCHA, Marcelo Cristiano; CAMPOS, Aleia Faustina; MCCARTY, Thomas R.; GUIMARAES, Thais; MOURA, Maria Luisa do Nascimento; THOMPSON, Christopher C.; MOURA, Eduardo Guimaraes Hourneaux deOBJECTIVES: The present coronavirus disease (COVID-19) pandemic has ushered in an unprecedented era of quality control that has necessitated advanced safety precautions and the need to ensure the adequate protection of healthcare professionals (HCPs). Endoscopy units, endoscopists, and other HCP may be at a significant risk for transmission of the virus. Given the immense burden on the healthcare system and surge in the number of patients with COVID-19, well-designed protocols and recommendations are needed. We aimed to systematically characterize our approach to endoscopic procedures in a quaternary university hospital setting and provide summary protocol recommendations. METHOD: This descriptive study details a COVID-19-specific protocol designed to minimize infection risks to patients and healthcare workers in the endoscopy unit. RESULTS: Our institution, located in Sao Paulo, Brazil, includes a 900-bed hospital, with a 200-bed-specific intensive care unit exclusively designed for patients with moderate and severe COVID-19. We highlighted recommendations for infection prevention and control during endoscopic procedures, including appropriate triage and screening, outpatient management and procedural recommendations, role and usage of personal protective equipment (PPE), and role and procedural logistics involving COVID-19-positive patients. We also detailed hospital protocols for reprocessing endoscopes and cleaning rooms and also provided recommendations to minimize severe acute respiratory syndrome coronavirus 2 transmission. CONCLUSION: This COVID-19-specific administrative and clinical protocol can be replicated or adapted in multiple institutions and endoscopy units worldwide. Furthermore, the recommendations and summary protocol may improve patient and HCP safety in these trying times.
- Cholangioscopy in a post-Covid-19 cholangiopathy patient(2022) FRANZINI, T. A. P.; GUEDES, M. M. F.; ROCHA, H. L. O. G.; FLEURY, C. A.; BESTETTI, A. M.; MOURA, E. G. H. de
- Biliary drainage in inoperable malignant biliary distal obstruction: A systematic review and meta-analysis(2021) SCATIMBURGO, Maria Vitoria Cury Vieira; RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; SAGAE, Vitor Massaro Takamatsu; HIRSCH, Bruno Salomao; BOGHOSSIAN, Mateus Bond; MCCARTY, Thomas R.; SANTOS, Marcos Eduardo Lera dos; FRANZINI, Tomazo Antonio Prince; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deY BACKGROUND Endoscopic drainage remains the treatment of choice for unresectable or inoperable malignant distal biliary obstruction (MDBO). AIM To compare the safety and efficacy of plastic stent (PS) vs self-expanding metal stent (SEMS) placement for treatment of MDBO. METHODS This meta-analysis was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A comprehensive search was performed in MEDLINE, Cochrane, Embase, Latin American and Caribbean Health Sciences Literature, and grey literature to identify randomized clinical trials (RCTs) comparing clinical success, adverse events, stent dysfunction rate, reintervention rate, duration of stent patency, and mean survival. Risk difference (RD) and mean difference (MD) were calculated and heterogeneity was assessed with I-2 statistic. Subgroup analyses were performed by SEMS type. RESULTS Twelve RCTs were included in this study, totaling 1005 patients. There was no difference in clinical success (RD = -0.03, 95% confidence interval [CI]: -0.01, 0.07; I-2 = 0%), rate of adverse events (RD = -0.03, 95%CI: -0.10, 0.03; I-2 = 57%), and mean patient survival (MD = -0.63, 95%CI: -18.07, 19.33; I-2 = 54%) between SEMS vs PS placement. However, SEMS placement was associated with a lower rate of reintervention (RD = -0.34, 95%CI: -0.46, -0.22; I-2 = 57%) and longer duration of stent patency (MD = 125.77 d, 95%CI: 77.5, 174.01). Subgroup analyses revealed both covered and uncovered SEMS improved stent patency compared to PS (RD = 152.25, 95%CI: 37.42, 267.07; I-2 = 98% and RD = 101.5, 95%CI: 38.91, 164.09; I-2 = 98%; respectively). Stent dysfunction was higher in the covered SEMS group (RD = -0.21, 95%CI: -0.32, -0.1; I-2 = 205%), with no difference in the uncovered SEMS group (RD = -0.08, 95%CI: -0.56, 0.39; I-2 = 87%). CONCLUSION While both stent types possessed a similar clinical success rate, complication rate, and patient-associated mean survival for treatment of MDBO, SEMS were associated with a longer duration of stent patency compared to PS.
- Impact of coronavirus pandemic crisis in endoscopic clinical practice: Results from a national survey in Brazil(2020) ARANTES, Vitor Nunes; MARTINS, Bruno Costa; SEQATTO, Raphael; MILHOMEN-CARDOSO, Daniela Medeiros; FRANZINI, Tomazo Prince; ZUCCARO, Anna Maria; ALVES, Jairo Silva; MALUF-FILHO, FauzeBackground and study aims In March 2020, the World Health Organization declared coronavirus disease of 2019 (COVID-19) as a pandemic, mobilizing all countries to contain the disease spread. Activity in endoscopy centers globally was severely affected. We conducted a national survey aiming to assess the impact of the COVID-19 outbreak on endoscopic clinical practice in Brazil. Methods In April 2020, 3,719 associate members of SOBED (Brazilian Society of Digestive Endoscopy) were invited to respond to an electronic survey. An Internet link was established to provide access to the online questionnaire with 40 questions regarding personal profile, endoscopy unit logistics and schedule, availability and use of personal protective equipment (PPE), financial impact, and exposure to COVID-19. Results A total of 2,131 individuals (67 %) accessed the questionnaire and 1155 responses were received. After review, 980 responses were considered valid. According to almost 90 % of respondents, endoscopy activity was restricted to urgent procedures, in both public and private hospitals. All respondents increased PPE use after the outbreak, however, institutions provided adequate PPE to only 278 responders (28.7 %). Significant income loss was universally reported. A total of 10 practitioners (1 %) reported COVID-19 infection and attributed the contamination to endoscopic procedures. Conclusions Based on this nationwide survey with almost 1,000 respondents, the COVID-19 pandemic substantially reduced the activity of endoscopy units in private and public settings. The pandemic increased awareness of PPE use, but its availability was not universal and 1 % of the respondents became infected with COVID-19, allegedly due to exposure during endoscopic procedures.
- Cholangioscopy-guided steroid injection for refractory post liver transplant anastomotic strictures: a rescue case series(2019) FRANZINI, Tomazo; SAGAE, Vitor M. T.; GUEDES, Hugo G.; SAKAI, Paulo; WAISBERG, Daniel R.; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz A. C.; SETHI, Amrita; MOURA, Eduardo G. H. deBackground and aims: Post liver transplant biliary anastomotic strictures have traditionally been treated with balloon dilation and multiple plastic stents. Fully covered self-expandable metallic stents may be used as an initial alternative or after multiple plastic stents failure. Refractory strictures can occur in 10-22% and require revisional surgery. Alternatively, cholangioscopy allows direct visualization and therapeutic approaches. We aimed to assess the feasibility, safety, and efficacy of balloon dilation combined with cholangioscopy-guided steroid injection for the treatment of refractory anastomotic biliary strictures. Methods: Three post-orthotopic liver transplant patients who failed standard treatment of their biliary anastomotic strictures underwent endoscopic retrograde cholangiopancreatography with balloon dilation followed by cholangioscopy-guided steroid injection at a tertiary care center. Patients had follow-up with images and laboratorial tests to evaluate for residual stricture. Results: Technical success of balloon dilation+cholangioscopy-guided steroid injection was achieved in all patients. Cholangioscopy permitted accurate evaluation of bile ducts and precise localization for steroid injection. No adverse events occurred. Mean follow-up was 26 months. Two patients are stent free and remain well in follow-up, with no signs of biliary obstruction. No further therapeutic endoscopic procedures or revisional surgery were required. One patient did not respond to balloon dilation+cholangioscopy-guided steroid injection after 11 months of follow-up and required repeat balloon dilation of new strictures above the anastomosis. Conclusion: Cholangioscopy-guided steroid injection combined with balloon dilation in the treatment of refractory post liver transplant strictures is feasible and safe. This method may be used as a rescue alternative before surgical approach. Randomized controlled trials comparing balloon dilation+cholangioscopy-guided steroid injection to fully covered self-expandable metallic stents are needed to determine the role of this treatment for anastomotic biliary strictures.
- Cholangioscopy-guided lithotripsy vs. conventional therapy for complex bile duct stones: a systematic review and meta-analysis(2020) GALETTI, Facundo; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; FUNARI, Mateus Pereira; CORONEL, Martin; SACHDE, Amit H.; BRUNALDI, Vitor Ottoboni; FRANZINI, Tomazo Prince; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deIntroduction: Endoscopic removal of common bile duct stones has a high success rate ranging from 85% to 95%. Bile duct stones >15 mm are difficult and frequently require lithotripsy. Peroral cholangioscopy (POC) allows lithotripsy with similar success rates. Aim: To determine the efficacy and safety of cholangioscopy-guided lithotripsy used in the treatment of difficult to remove bile duct stones vs. conventional therapy. Methods: Search was based in Medlin, Embase, Cochrane Central, Lilacs/Bireme. Studies enrolling patients referred for the removal of difficult bile duct stones via POC were considered eligible. Two analyses were carried out separately, one included randomized controlled trials (RCTs) and another observational studies. Results: Forty-six studies were selected (3 RTC and 43 observational). In the analysis there was no statistical significant difference between successful endoscopic clearance (RD=-0.02 CI: -0.17, 0.12/I-2-0%), mean fluoroscopy time (MD--0.14 CI -1.60, 1.32/I-2 -21%) and adverse events rates (RD=-0.06 CI: -0.14, 0.02/I-2=0%), by contrast, the mean procedure time favored conventional therapy with statistical significance (MD-27.89 CI: 16.68, 39.10/I-2-096). In observational studies, the successful endoscopic clearance rate was 8829% (CI95: 86.996-90.7%), the first session successful endoscopic clearance rate was 72.7 % (CI95: 69.9%-75.3%), the mean procedure time was 47.50 +/- 6 min for session and the number of sessions to clear bile duct was 15 +/- 0.18. The adverse event rate was 8.7% (C195: 7%-10.9%). Concussions: For complex common bile duct stones, cholangioscopy-guided lithotripsy has a success rate that is similar to traditional ERCP techniques in terms of therapeutic success, adverse event rate and means fluoroscopy time. Conventional ERCP methods have a shorter mean procedure time.
- 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.
- Efficacy and safety of carbon dioxide insufflation versus air insufflation during endoscopic retrograde cholangiopancreatography in randomized controlled trials: a systematic review and meta-analysis(2019) PASSOS, Marina Lordello; RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; KORKISCHKO, Nadia; SILVA, Gustavo Luis Rodela; FRANZINI, Tomazo Prince; BERNANDO, Wanderley Marques; MOURA, Eduardo Guimaraes Horneaux deBackground and study aims Ambient air is the most commonly used gas for insufflation in endoscopic procedures worldwide. However, prolonged absorption of air during endoscopic examinations may cause pain and abdominal distension. Carbon dioxide insufflation (CO (2) i) has been increasingly used as an alternative to ambient air insufflation (AAi) in many endoscopic procedures due to its fast diffusion properties and less abdominal distention and pain. For endoscopic retrograde cholangiopancreatography (ERCP), use of CO (2) for insufflation is adequate because this procedure is complex and prolonged. Some randomized controlled trials (RCTs) have evaluated the efficacy and safety of CO (2) as an insufflation method during ERCP but presented conflicting results. This systematic review and meta-analysis with only RCTs evaluated the efficacy and safety of CO (2) i versus AAi during ERCP. Methods A literature search was performed using online databases with no restriction regarding idiom or year of publication. Data were extracted by two authors according to a predefined data extraction form. Outcomes evaluated were abdominal pain and distension, complications, procedure duration, and CO (2) levels. Results Eight studies (919 patients) were included. Significant results favoring CO (2) i were less abdominal distension after 1h (MD: -1.41 [-1.81; -1.0], 95% CI, I-2=15%, P <0.00001) and less abdominal pain after 1h (MD: -23.80 [-27.50; -20.10], 95%CI, I-2=9%, P <0.00001) and after 6h (MD: -7.00 [-8.66; -5.33]; 95% CI, I-2=0%, P <0.00001). Conclusion Use of CO (2) i instead of AAi during ERCP is safe and associated with less abdominal distension and pain after the procedure.