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World Journal of Gastroenterology 2021年第37期27卷 6345-6347页

作者： Igor Braga Ribeiro diogo turiani hourneaux de moura Eduardo Guimarães hourneaux de moura departamento de Gastroenterologia Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloSao Paulo 05403-010Brazil

Coronavirus disease 2019(COVID-19)is caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Although,respiratory symptoms are typical the digestive system is also a susceptible target with gastrointestinal symptoms present even in the absence of respiratory *** gastrointestinal symptoms of COVID-19 include diarrhea,abdominal pain,anorexia,and nausea among other *** questions that remain to be answered include:Do patients with gastrointestinal symptoms have a higher mortality?SARS-CoV-2 variants are already a global reality:Do these variants present with a greater prevalence of gastrointestinal symptoms?Do patients with these symptoms warrant more intensive care unit care?

关键词： COVID-19 SARS-CoV-2 Gastrointestinal symptoms Intensive care unit Variant

Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas:Basic principles and recommendations

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World Journal of Gastroenterology 2023年第7期29卷 1173-1193页

作者： Victor Lira de Oliveira Alexandre Moraes Bestetti Roberto Paolo Trasolini Eduardo Guimaraes hourneaux de moura diogo turiani hourneaux de moura Serviço de Endoscopia Gastrointestinal Departamento de GastroenterologiaHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403010Brazil Division of Gastroenterology Hepatology and EndoscopyHarvard Medical SchoolBrigham and Women's HospitalBostonMA 021115United States

Post-surgical leaks and fistulas are the most feared complication of bariatric *** have become more common in clinical practice given the increasing number of these procedures and can be very difficult to *** two related conditions must be distinguished and characterized to guide the appropriate *** is defined as a transmural defect with communication between the intra and extraluminal compartments,while fistula is defined as an abnormal communication between two epithelialized ***,surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality ***,with the development of novel devices and techniques,endoscopic therapy plays an increasingly essential role in managing these *** diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and *** endoscopic techniques are available with different mechanisms of action,including direct closure,covering/diverting or *** treatment should be individualized by considering the characteristics of both the patient and the *** there is a lack of high-quality studies to provide standardized treatment algorithms,this narrative review aims to provide a summary of the current scientific evidence and,based on this data and our extensive experience,make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.

关键词： Endoscopy Surgery Bariatric Gastrointestinal Fistulas Leaks

Use of omental patch and endoscopic closure technique as an alternative to surgery after endoscopic full thickness resection of gastric intestinal stromal tumors: A series of cases

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World Journal of Clinical Cases 2020年第1期8卷 120-125页

作者： Amit H Sachdev Shahzad Iqbal Igor Braga Ribeiro diogo turiani hourneaux de moura Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States Good Samaritan Hospital NY 11795United States Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-000Brazil

BACKGROUND Gastrointestinal stromal tumors(GISTs)originate from interstitial cells of *** can occur anywhere along the gastrointestinal *** lesions have traditionally been removed ***,with recent innovations in advanced endoscopy,GISTs located within the stomach are now removed *** describe a new innovative endoscopic technique to close large and hard to access defects after endoscopic full-thickness resection of gastric *** SUMMARY We present a series of three patients who were diagnosed with a gastric *** patients underwent full-thickness endoscopic *** all cases,for closure of the surgical bed,conventional endoscopic techniques including hemoclips,endoloop and suturing were *** performed a new technique in which we pulled omental fat into the gastric lumen and completely closed the defect using endoscopic *** patients performed well post-procedure and computed tomography was carried out one day after the procedures which showed no extravasation of *** The omental plug technique may be used as an alternative to surgery in selected cases of gastric perforation.

关键词： Gastric perforation Gastrointestinal stromal tumors Gastric tumor Surgery Endoscopy Suturing

Endoscopy vs surgery in the treatment of early gastric cancer:Systematic review

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World Journal of Gastroenterology 2015年第46期21卷 13177-13187页

作者： André Kondo Eduardo Guimaraes hourneaux de moura Wanderley Marques Bernardo Osmar Kenji Yagi diogo turiani hourneaux de moura Eduardo turiani hourneaux de moura José Gon?alves Pereira Bravo Kendi Yamazaki Paulo Sakai Gastrointestinal Endoscopy Division Department of GastroenterologyHospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo Guidelines Program Coordinator Brazilian Medical Association (AMB) Gastrointestinal Surgery Division Sao Paulo State Cancer Institute (ICESP)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo

AIM: To report a systematic review,establishing the available data to an unpublished 2a strength of evidence,better handling clinical ***: A systematic review was performed using MEDLINE,EMBASE,Cochrane,LILACS,Scopus and CINAHL databases. Information of the selected studies was extracted on characteristics of trial participants,inclusion and exclusion criteria,interventions(mainly,mucosal resection and submucosal dissection vs surgical approach) and outcomes(adverse events,different survival rates,mortality,recurrence and complete resection rates). To ascertain the validity of eligible studies,the risk of bias was measured using the Newcastle-Ottawa Quality Assessment Scale. The analysis of the absolute risk of the outcomes was performed using the software Rev Man,by computingrisk differences(RD) of dichotomous variables. Data on RD and 95%CIs for each outcome were calculated using the Mantel-Haenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%,a subsequent assay was done and other findings were ***: Eleven retrospective cohort studies were selected. The included records involved 2654 patients with early gastric cancer that filled the absolute or expanded indications for endoscopic resection. Threeyear survival data were available for six studies(n = 1197). There were no risk differences(RD) after endoscopic and surgical treatment(RD = 0.01,95%CI:-0.02-0.05,P = 0.51). Five-year survival data(n = 2310) showed no difference between the two groups(RD = 0.01,95%CI:-0.01-0.03,P = 0.46). Recurrence data were analized in five studies(1331 patients) and there was no difference between the approaches(RD = 0.01,95%CI:-0.00-0.02,P = 0.09). Adverse event data were identified in eight studies(n = 2439). A significant difference was detected(RD =-0.08,95%CI:-0.10--0.05,P demonstrating better results with endoscopy. Mortality data were

关键词： Gastric cancer Endoscopy Gastroscopy Gastrectomy Surgery Systematic review

Acute bleeding after argon plasma coagulation for weight regain after gastric bypass: A case report

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World Journal of Clinical Cases 2019年第15期7卷 2038-2043页

作者： diogo turiani hourneaux de moura Amit H Sachdev Po-Wen Lu Igor Braga Ribeiro Christopher C Thompson Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States department of Gastroenterology Clinics Hospital of Sao Paulo UniversitySao Paulo 05403-00Brazil department of Gastroenterology and Hepatology Linkou Chang Gung Memorial HospitalTaoyuan City33305Taiwan

BACKGROUND Roux-en-Y gastric bypass(RYGB) is the most commonly performed surgical procedure used to treat obesity worldwide. despite satisfactory results in terms of weight loss, over time many patients experience weight regain. There are many factors that contribute to weight regain after RYGB, including the diameter of the gastric-jejunal anastomosis(GJA). One of the most commonly performed endoscopic procedures for weight regain after RYGB is argon plasma coagulation(APC). We report a case of hematemesis after outlet revision with APC. We highlight several treatment modalities that can be used to treat this *** SUMMARY A 45-year-old female with a history of weight regain after RYGB was referred for possible endoscopic treatment for weight regain. On endoscopic evaluation, the diameter of the GJA was 22 mm. Due to the dilated GJA, treatment with APC was performed. Several months later she reported a return of poor satiety and an increased appetite. A repeat endoscopy was then performed. The GJA was approximately 15 mm and was incompetent. APC was performed. One day post procedure she had four episodes of hematemesis. An endoscopy was performed and a large ulcer with a visible arterial vessel was visualized at the *** was attempted using a Coagrasper and after initial contact with the vessel, the vessel started oozing. Due to fibrosis and the depth of ulceration in the area, clips and repeat APC could not be used. Therefore, an attempt to inject epinephrine injection was made. However, persistent oozing was noted. As a result, hemostatic powder was applied to the region of the bleeding ***, no more bleeding was observed. On follow-up, the patient remained hemodynamically stable and a second look endoscopy was not performed. The patient was discharged three days *** APC revision of the GJA is known to be a relatively safe and effective strategy to manage weight regain post RYGB. Anastomotic site bleeding is an i

关键词： Anastomosis Roux-en-Y Argon plasma coagulation Bariatric Gastric bypass Gastrointestinal hemorrhage Case report

Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial

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World Journal of Gastroenterology 2022年第33期28卷 4875-4889页

作者： Eduardo turiani hourneaux de moura Jose Jukemura Igor Braga Ribeiro Galileu Ferreira Ayala Farias Aureo Augusto de Almeida delgado Lara Meireles Azeredo Coutinho diogo turiani hourneaux de moura Rubens Antonio Aissar Sallum Ary Nasi Sergio A Sanchez-Luna Paulo Sakai Eduardo Guimaraes hourneaux de moura departamento de Gastroenterologia Faculdade de MedicinaUniversidade de Sao PauloServico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSPSao Paulo 05403-010Brazil Division of Esophageal Surgery Hospital das ClinicasUniversity of Sao Paulo School of MedicineSao Paulo 05403-010Brazil departamento de Gastroenterologia Faculdade de MedicinaUniversidade de Sao PauloHospital das ClinicasUniversity of Sao Paulo School of MedicineSao Paulo 05403-010Brazil department of Internal Medicine The University of Alabama at Birmingham Heersink School of MedicineBasil I.Hirschowitz Endoscopic Center of ExcellenceDivision of Gastroenterology and HepatologyBirminghamAL 35233United States

BACKGROUND Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter(LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy(POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy,has emerged as a promising minimally invasive technique for the management of this *** To compare POEM and laparoscopic myotomy and partial fundoplication(LM-PF) regarding their efficacy and outcomes for the treatment of *** Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria(dysphagia score ≥ II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis(as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min(on a barium esophagogram), pressure at the LES, the occurrence of adverse events(AEs), length of stay(LOS), and quality of life(QoL).RESULTS There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up(P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group(P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group(185.00 ± 56.89 and 95.70 ± 30.47 min v

关键词： Esophageal achalasia Gastroesophageal reflux deglutition disorders Heller myotomy Fundoplication Randomized controlled trial

Status of bariatric endoscopy–what does the surgeon need to know? A review

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World Journal of Gastrointestinal Surgery 2022年第2期14卷 185-199页

作者： diogo turiani hourneaux de moura Anna Carolina Batista Dantas Igor Braga Ribeiro Thomas R McCarty Flávio Roberto Takeda Marco Aurelio Santo Sergio Carlos Nahas Eduardo Guimarães hourneaux de moura departamento de Gastroenterologia Faculdade de MedicinaUniversidade de Sao PauloServiço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSPSao Paulo 05403-010Brazil departamento de Gastroenterologia Hospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloUnidade de Cirurgia Bariátrica e MetabólicaDisciplina de Cirurgia do Aparelho Digestivo e ColoproctologiaSao Paulo 05403-010Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalBostonMA 021115United States

BACKGROUND Obesity is a chronic and multifactorial disease with a variety of potential treatment options ***,there are several multidisciplinary therapeutic options for its management,including conservative,endoscopic,and surgical *** To clarify indications,technical aspects,and outcomes of bariatric *** Narrative review of current literature based on electronic databases including MEDLINE(PubMed),Cochrane Library,and *** Bariatric endoscopy is in constant development and comprises primary and revisional treatment options as well as management of surgical *** devices act upon different mechanisms of action,which may be individualized to each *** favorable results for the endoscopic treatment of obesity,prospective randomized studies with long-term follow-up are required to fully validate primary and revisional endoscopic *** the management of bariatric surgery complications,endoscopic therapy may be considered the procedure of choice in a variety of ***,as there is no standardized algorithm,local experience should be considered in *** The treatment of patients with obesity is complex,and a multidisciplinary approach is *** endoscopy has shown impressive results both in the treatment of obesity and its surgical complications,and therefore,must be part of the armamentarium in the fight against this disease.

关键词： Endoscopy Gastrointestinal Surgery Obesity Bariatric Weight regain

Role of pancreatography in the endoscopic management of encapsulated pancreatic collections-review and new proposed classification

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World Journal of Gastroenterology 2020年第45期26卷 7104-7117页

作者： Igor Mendonca Proença Marcos Eduardo Lera dos Santos diogo turiani hourneaux de moura Igor Braga Ribeiro Sergio Eiji Matuguma Spencer Cheng Thomas R McCarty Epifanio Silvino do Monte Junior Paulo Sakai Eduardo Guimaraes hourneaux de moura Gastrointestinal Endoscopy Unit Department of GastroenterologyHospital das ClinicasUniversity of Sao PauloSao Paulo 05403000Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s Hospital-Harvard Medical SchoolBostonMA 02115United States

Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or *** the last decade,endoscopic management of these collections via endoscopic ultrasound-guided transmural drainage has become the gold standard treatment for encapsulated pancreatic collections with high clinical success and lower morbidity compared to traditional surgery and percutaneous *** understanding of anatomic landmarks,including assessment of the main pancreatic duct and any associated lesions–such as disruptions and strictures-are key to achieving clinical success,reducing the need for reintervention or recurrence,especially in cases with suspected disconnected pancreatic duct ***,proper review of imaging and anatomic landmarks,including collection location,are pivotal to determine type and size of pancreatic stenting as well as approach using long-term transmural indwelling plastic *** to adequately assess the main pancreatic duct may be performed by two methods:Either non-invasively using magnetic resonance cholangiopancreatography or endoscopically via retrograde *** the critical need to understand anatomy via pancrea tography and assess the main pancreatic duct,a standardized approach or uniform assessment strategy has not been described in the ***,the aim of this review was to clarify the role of pancreatography in the endoscopic management of encapsulated pancreatic collections and to propose a new classification system to aid in proper assessment and endoscopic treatment.

关键词： Endoscopic retrograde cholangiopancreatography Endoscopy Endoscopic ultrasound Pseudocyst Endosonography Pancreatic ducts

Endoscopic retrograde cholangiopancreatography drainage for palliation of malignant hilar biliary obstruction——stent-in-stent or side-by-side?A systematic review and meta-analysis

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World Journal of Hepatology 2021年第5期13卷 595-610页

作者： Gabriel Mayo Vieira de Souza Igor Braga Ribeiro Mateus Pereira Funari diogo turiani hourneaux de moura Maria Vitória Cury Vieira Scatimburgo João Remíde Freitas Júnior Sergio A Sánchez-Luna Renato Baracat Eduardo turiani hourneaux de moura Wanderley Marques Bernardo Eduardo Guimarães hourneaux de moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Division of Gastroenterology Hepatology and NutritionCenter for Advanced Therapeutic EndoscopyAllegheny Health NetworkPittsburghPA 15212United States Division of Gastroenterology and Hepatology Department of Internal MedicineBasil I.Hirschowitz Endoscopic Center of ExcellenceBirminghamAL 35294United States

BACKGROUND 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 *** To compare both techniques regarding their efficacy and safety in achieving drainage of *** 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 *** included studies compared SIS and SBS techniques through endoscopic retrograde *** analyzed included technical and clinical success,early and late adverse events(AEs),stent patency,reintervention,and procedure-related *** 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 *** 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,I2=45%,P=0.006].CONCLUSION The SIS method showed superior stent patency when compared to SBS for achieving bilateral drainage in *** techniques are equivalent in terms of technical success,clinical success,rates of both early and late AEs,reintervention,and procedure-related mortality.

关键词： Endoscopic retrograde cholangiopancreatography Biliary tract neoplasms Biliary Hilar Stenting Drainage

Endoscopic sleeve gastroplasty: From whence we came and where we are going

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World Journal of Gastrointestinal Endoscopy 2019年第5期11卷 322-328页

作者： diogo turiani hourneaux de moura Eduardo Guimar?es hourneaux de moura Christopher C Thompson Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical School department of Endoscopy of Clinics Hospital of S?o Paulo University

The most effective and durable treatment for obesity is bariatric ***,less than 2% of eligible patients who fulfill the criteria for bariatric surgery undergo the procedure. As a result,there is a drive to develop less invasive therapies to combat obesity. Endoscopic bariatric therapies(EBT) for weight loss are important since they are more effective than pharmacological treatments and lifestyle changes and present lower adverse event rates compared to bariatric surgery. Endoscopic sleeve gastroplasty(ESG) is a minimally invasive EBT that involves remodeling of the greater curvature. ESG demonstrated favorable outcomes in several centers,with up to 20.9% total body weight loss and 60.4% excess weight loss(EWL) on 2-year follow-up,with a low rate of severe adverse events(SAE). As such,it could be considered safe and effective in light of ASGE/ASMBS thresholds of > 25% EWL and ≤ 5% SAE,although there are no comparative trials to support this. Additionally,ESG showed improvement in diabetes mellitus type 2,hypertension,and other obesity-related comorbidities. As this procedure continues to develop there are several areas that can be addressed to improve outcomes,including device improvements,technique standardization,patient selection,personalized medicine,combination therapies,and training standardization. In this editorial we discuss the origins of the ESG,current data,and future developments.

关键词： Endoscopy Surgery Bariatric Obesity Overweight Comorbidities Gastroplasty Sleeve Endoscopic sleeve gastroplasty Editorial