HUGO GONCALO GUEDES

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: DIOGO TURIANI HOURNEAUX DE MOURA ×

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Agora exibindo 1 - 10 de 10
  • article 24 Citação(ões) na Scopus
    A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis
    (2018) GUEDES, Hugo Goncalo; MOURA, Diogo Turiani Hourneaux de; DUARTE, Ralph Braga; CORDERO, Martin Andres Coronel; SANTOS, Marcos Eduardo Lera dos; CHENG, Spencer; MATUGUMA, Sergio Eiji; CHAVES, Dalton Marques; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
    Our aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.
  • article
    A rare non-oncological pancreatic mass: eosinophilic pancreatitis diagnosis through EUS-FNA
    (2019) MOURA, Diogo Turiani Hourneaux De; ROCHA, Rodrigo Silva de Paula; JUKEMURA, Jose; BRUNALDI, Vitor Ottoboni; GUEDES, Hugo Goncalo; TORREZ, Franz Robert Apodaca; RIBEIRO, Igor Braga; GELRUD, Andres; MOURA, Eduardo Guimaraes Hourneaux De
    Background and study aims Eosinophilic pancreatitis (EP) is a rare etiology of chronic pancreatitis, and few cases have been reported. It is characterized by eosinophilic infiltration of the pancreas and elevated IgE levels. EP is difficult to distinguish from pancreatic cancer based on clinical symptoms and auxiliary exams. We present a case of EP and debate the routine performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for resectable pancreatic mass.
  • article 0 Citação(ões) na Scopus
    Gastrointestinal ischemia: endoscopic findings in the context of vascular insufficiency
    (2019) HOURNEAUX DE MOURA, Diogo Turiani; MADRUGA NETO, Antonio C; BARSOTTI, Gabriel C; CORONEL, Martin; GUEDES, Hugo G; BRUNALDI, Vitor O; ARTIFON, Everson L.A; DE MOURA, Eduardo G.H
    Gastrointestinal ischemia may result from different causes: hemodynamic shock, thromboembolism, endoscopic or surgical complications, among other causes. Its symptoms are pain, vomiting, bleeding and bloating. Endoscopic findings are pale or blackened mucosa, and exudative and confluent ulcerative lesions. This paper aims to report a case of gastroduodenal ischemia associated with hemodynamic shock and disseminated intravascular coagulation (DIC). This is a case of a 56-yearsold male with multiple comorbidities, presenting with refractory septic shock and DIC. He underwent an upper gastrointestinal endoscopy (UGE) for investigation of melena, which revealed an extensive deep and exudative gastric ulcer, associated with edematous purplish duodenal mucosa. Due to the severity of the underlying condition, the patient evolved to death, evidencing septic shock as cause of death. Gastroduodenal ischemia is associated with a poor prognosis, in which early diagnosis by UGE is fundamental to guide potential interventions.
  • article 12 Citação(ões) na Scopus
    LUGOL’S IODINE CHROMOENDOSCOPY VERSUS NARROW BAND IMAGE ENHANCED ENDOSCOPY FOR THE DETECTION OF ESOPHAGEAL CANCER IN PATIENTS WITH STENOSIS SECONDARY TO CAUSTIC/CORROSIVE AGENT INGESTION
    (2017) PENNACHI, Caterina Maria Pia Simoni; MOURA, Diogo Turiani Hourneaux de; AMORIM, Renato Bastos Pimenta; GUEDES, Hugo Gonçalo; KUMBHARI, Vivek; MOURA, Eduardo Guimarães Hourneaux de
    ABSTRACT BACKGROUND The diagnosis of corrosion cancer should be suspected in patients with corrosive ingestion if after a latent period of negligible symptoms there is development of dysphagia, or poor response to dilatation, or if respiratory symptoms develop in an otherwise stable patient of esophageal stenosis. Narrow Band Imaging detects superficial squamous cell carcinoma more frequently than white-light imaging, and has significantly higher sensitivity and accuracy compared with white-light. OBJECTIVE To determinate the clinical applicability of Narrow Band Imaging versus Lugol´s solution chromendoscopy for detection of early esophageal cancer in patients with caustic/corrosive agent stenosis. METHODS Thirty-eight patients, aged between 28-84 were enrolled and examined by both Narrow Band Imaging and Lugol´s solution chromendoscopy. A 4.9mm diameter endoscope was used facilitating examination of a stenotic area without dilation. Narrow Band Imaging was performed and any lesion detected was marked for later biopsy. Then, Lugol´s solution chromoendoscopy was performed and biopsies were taken at suspicious areas. Patients who had abnormal findings at the routine, Narrow Band Imaging or Lugol´s solution chromoscopy exam had their stenotic ring biopsied. RESULTS We detected nine suspicious lesions with Narrow Band Imaging and 14 with Lugol´s solution chromendoscopy. The sensitivity and specificity of the Narrow Band Imaging was 100% and 80.6%, and with Lugol´s chromoscopy 100% and 66.67%, respectively. Five (13%) suspicious lesions were detected both with Narrow Band Imaging and Lugol’s chromoscopy, two (40%) of these lesions were confirmed carcinoma on histopathological examination. CONCLUSION Narrow Band Imaging is an applicable option to detect and evaluate cancer in patients with caustic /corrosive stenosis compared to the Lugol´s solution chromoscopy.
  • article 35 Citação(ões) na Scopus
    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. De
    Objective: 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
    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
  • conferenceObject
    COMPARISON BETWEEN BOUGIE AND BALLOON DILATION IN PATIENTS WITH BENIGN ESOPHAGEAL STRICTURES: A SYSTEMATIC REVIEW AND META-ANALYSIS
    (2018) JOSINO, Iatagan R.; PONTE, Alberto M. da; CORONEL, Martin A.; GUEDES, Hugo G.; MOURA, Diogo T. de; IDE, Edson; MARQUES, Sergio B.; BERNARDO, Wanderlei M.; SAKAI, Paulo; MOURA, Eduardo G. de
  • article
    Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials
    (2018) VISCONTI, Thiago Arantes de Carvalho; BERNARDO, Wanderley Marques; MOURA, Diogo Turiani Hourneaux; MOURA, Eduardo Turiani Hourneaux; GONCALVES, Caio Vinicius Tranquillini; FARIAS, Galileu Ferreira; GUEDES, Hugo Goncalo; RIBEIRO, Igor Braga; FRANZINI, Tomazo Prince; LUZ, Gustavo Oliveira; SANTOS, Marcos Eduardo dos Lera dos; MOURA, Eduardo Guimaraes Hourneaux de
    Background and study aims The first-line approach to anastomotic biliary stricture after orthotopic liver transplantation (OLTX) involves endoscopic retrograde cholangiopancreatography (ERCP). The most widely used technique is placement of multiple plastic stents, but discussions are ongoing on the benefits of fully-covered self-expandable metallic stents (FCEMS) in this situation. This study aimed to compare results from use of plastic and metal stents to treat biliary stricture after transplantation. Patients and methods Searches were performed in the Medline, EMBASE, SciELO/LILACS, and Cochrane databases, and only randomized studies comparing the two techniques were included in the meta-analysis. Results Our study included four randomized clinical trials totaling 205 patients. No difference was observed between the stricture resolution rate (RD: 0.01; 95%CI [-0.08-0.10]), stricture recurrence (RD: 0.13; 95%CI [-0.03-0.28]), and adverse events (RD: -0.10; 95%CI [-0.65-0.44]) between the plastic and metallic stent groups. The metallic stent group demonstrated benefits in relation to the number of ERCPs performed (MD: -1.86; 95%CI [-3.12 to -0.6]), duration of treatment (MD: -105.07; 95%CI [-202.38 to -7.76 days]), number of stents used (MD: -10.633; 95%CI [-20.82 to -0.44]), and cost (average $8,288.50 versus $18,580.00, P <0.001). Conclusions Rates of resolution and recurrence of stricture are similar, whereas the number of ERCPs performed, number of stents used, duration of treatment, and costs were lower in patients treated with FCEMS, which shows that this device is a valid option for initial treatment of post-OLTX biliary stricture.
  • article
    Pancreatic Stent Placement for Prevention of Post-ERCP Pancreatitis in High-Risk Patients: A Systematic Review and Meta-Analysis
    (2019) PORTELA, Joaquim Coelho da Cruz; BERNARDO, Wanderley Marques; MOURA, Diogo Turiani Hourneaux de; FRANZINI, Tomazo Antonio Prince; COUTINHO, Lara Meireles de Azeredo; BRUNALDI, Vitor Ottoboni; GUEDES, Hugo Goncalo; MOURA, Eduardo Turiani Hourneaux de; SANTOS, Marcos Eduardo Lera dos; LUZ, Gustavo Oliveira; MOURA, Eduardo Guimaraes Hourneaux de
    Background and Aims Acute pancreatitis is one common and severe complication after endoscopic retrograde cholangiopancreatography. Randomized controlled trials have reported that pancreatic stenting may efficiently prevent post-ERCP pancreatitis. Methods Systematic review was conducted on MEDLINE/PubMed and other databases randomized controlled trials comparing patients undergoing endoscopic retrograde cholangiopancreatography with pancreatic stent versus endoscopic retrograde cholangiopancreatography without stent. Two independent reviewers assessed the eligibility. Primary outcome is to assess the degree of severity of pancreatitis (mild, moderate, and severe) and secondary hyperamylasemia, cholangitis, abdominal pain, duration of endoscopic retrograde cholangiopancreatography and length of hospital stay. Results Twelve randomized controlled trials selected a total of 3.310 patients. Meta-analysis showed that pancreatic stenting reduced pancreatitis risk to PEP (mild PEP: RD 0.06, 95% CI-0.09 - 0.03; moderate PEP: RD 0.03, 95 % CI-0.06 - 0.01; severe PEP: (RD 0.02, 95% CI-0.05-0.01); Hyperaylasemia (RD-0.62, 95% CI-0.65-0.59) showed statistically significant difference. Cholangitis (RD 0.03, 95% CI-0.03-0.09), abdominal pain (RD 0.10, 95% CI-0.21-0.01), length of hospital stay after ERCP (RD 1.55, 95% CI-4.39 - 1.29), total duration of the procedure (RD 2.97, 95% CI-0.19-6.12), showed no statistical significance. Conclusions Pancreatic stent placement is effective in reducing post-endoscopic retrograde cholangiopancreatography acute pancreatitis incidence in high-risk patients.
  • article 48 Citação(ões) na Scopus
    Endoscopic Dilation with Bougies versus Balloon Dilation in Esophageal Benign Strictures: Systematic Review and Meta-Analysis
    (2018) JOSINO, Iatagan R.; MADRUGA-NETO, Antonio C.; RIBEIRO, Igor B.; GUEDES, Hugo G.; BRUNALDI, Vitor O.; MOURA, Diogo T. H. de; BERNARDO, Wanderley M.; MOURA, Eduardo G. H. de
    Background. The use of bougies and balloons to dilate benign esophageal strictures (BES) is a consolidated procedure. However, the amount of evidence available in scientific literature supporting which is the best technique is very low, despite the great prevalence and importance of such pathology. This systematic review with meta-analysis aims at comparing both techniques, providing good quality of evidence. Methods. We searched for randomized clinical trials (RCTs) published from insertion to November 2017, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, and grey literature. After the data extraction, a meta-analysis was performed. The main outcomes were symptomatic relief and recurrence rate. The secondary outcomes were bleeding, perforation, and postprocedure pain. Results. We included 5 randomized clinical trials (RCTs), totalizing 461 patients. Among them, 151 were treated with bougie dilation and 225 underwent balloon dilation. Regarding symptomatic relief, recurrence, bleeding, and perforation rates, there were no differences between the methods. Concerning postprocedure pain, patients submitted to balloon dilation had less intense pain (RD 0.27, 95% IC -0.42 to -0.07, P = 0 007). Conclusion. We conclude that there is no difference between bougie and balloon dilation of BESs regarding symptomatic relief, recurrence rate at 12 months, bleeding, and perforation. Patients undergoing balloon dilation present less severe postprocedure pain.