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

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

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Gastrointestinal symptoms in patients with COVID-19: Is there a relationship with mortality and new variations of SARS-CoV-2?

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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

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Mucosa-associated lymphoid tissue lymphoma in the terminal ileum:A case report

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World Journal of Gastrointestinal Endoscopy 2022年第3期14卷 176-182页

作者： Vitor Lauar Pimenta de Figueiredo Igor Braga Ribeiro Diogo Turiani hourneaux de moura Cristiano Claudino Oliveira eduardo guimarães hourneaux de moura Faculdade de Medicina Universidade de Sao PauloSão Paulo 05403-010Brazil Unidade Morumbi-Rede D`Or Hospital São LuizSão Paulo 05605-050Brazil departamento de Gastroenterologia Faculdade de MedicinaUniversidade de Sao PauloServiço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSPSão Paulo 05403-000Brazil

BACKGROUND The lymphoma of the mucosa-associated lymphoid tissue(MALT)is predominantly found in the *** few cases reported in the literature of MALT lymphomas affecting the ileum are in patients who are already symptomatic and with clear advanced endoscopic *** present the first case of an asymptomatic female patient who underwent colonoscopy as a routine examination with the findings of an ulcer in the distal ileum region,which histopathological examination and associated immunohistochemistry revealed the diagnosis of MALT *** SUMMARY A 57-year-old asymptomatic female patient underwent a colonoscopy exam for *** examination revealed an ulcer of medium depth with well-defined borders covered by a thin layer of fibrin and a halo of hyperemia in the distal ileum *** are nonspecific but may signal infections by viruses,protozoa,and parasites or inflammatory diseases such as Crohn's *** of the ulcer were *** anatomopathological result revealed an atypical diffuse lymphocytic infiltrate of small cells with a characteristic cytoplasmic halo of marginal zone *** immunohistochemical study was performed and the results demonstrated a negative neoplastic infiltrate for the expression of cyclin D1 and cytokeratin AE1/AE3 and a positive for BCL60 in the germinal *** test also revealed CD10 positivity in the glandular epithelium and germinal center of a reactive follicle with dual-labeling of CD20 and CD3 demonstrating the B lymphocyte nature of the neoplastic *** BCL2 protein labeling,the neoplastic infiltrate is strongly positive with a negative germinal *** findings are consistent with immunophenotype B non-Hodgkin's lymphoma,better classified as extranodal *** patient was treated with chemotherapy and showed complete regression of the disease,as evidenced by colonoscopy performed after *** MALT lymphomas in the terminal ileum are extremely rare and only 4 c

关键词： Mucosa-associated lymphoid tissue lymphoma Ileum Colonoscopy Diagnosis Biopsy Case report

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Fecal microbiota transplantation in patients with metabolic syndrome and obesity:A randomized controlled trial

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World Journal of Clinical Cases 2023年第19期11卷 4612-4624页

作者： Alberto Machado da Ponte Neto Aniele Cristine Ott Clemente Paula Waki Rosa Igor Braga Ribeiro Mateus Pereira Funari Gabriel Cairo Nunes Luana Moreira Luiz Gustavo Sparvoli Ramon Cortez Carla Romano Taddei Márcio C Mancini eduardo guimarães hourneaux de moura departament of Gastroenterology Faculdade de MedicinaUniversidade de Sao PauloServiço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSPSão Paulo 05403-010SPBrazil department of Endocrinology Hospital das ClínicasUniversity of São Paulo School of MedicineSão Paulo 05403-010SPBrazil department of Clinical and Toxicology Analysis School of Pharmaceutical SciencesUniversity of São PauloSão Paulo 05403-010SPBrazil School of Arts Science and HumanitiesUniversity of São PauloSão Paulo 05403-010SPBrazil

BACKGROUND Metabolic syndrome is a multifactorial disease,and the gut microbiota may play a role in its ***,especially abdominal obesity,is associated with insulin resistance,often increasing the risk of type two diabetes mellitus,vascular endothelial dysfunction,an abnormal lipid profile,hypertension,and vascular inflammation,all of which promote the development of atherosclerotic cardiovascular *** To evaluate the outcomes of fecal microbiota transplantation(FMT)in patients with metabolic *** This was a randomized,single-blind placebo-controlled trial comparing FMT and a sham procedure in patients with metabolic *** selected 32 female patients,who were divided into eight groups of four patients *** of the patients were submitted to upper gastrointestinal *** each group,two patients were randomly allocated to undergo FMT,and the other two patients received saline *** patients were followed for one year after the procedures,during which time anthropometric,bioimpedance,and biochemical data were *** patients also had periodic consultations with a nutritionist and an *** primary end point was a change in the gut *** There was evidence of a postprocedural change in microbiota composition in the patients who underwent FMT in relation to that observed in those who underwent the sham ***,we found no difference between the two groups in terms of the clinical parameters *** There were no significant differences in biochemical or anthropometric parameters,between the two groups ***,there were significant postprocedural differences in the microbiota composition between the placebo *** date,clinical outcomes related to FMT remain uncertain.

关键词： Fecal microbiota transplantation Metabolic syndrome Obesity Endoscopy Diabetes mellitus Endocrinology

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Antibiotic prophylaxis to prevent complications in endoscopic retrograde cholangiopancreatography:A systematic review and meta-analysis of randomized controlled trials

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World Journal of Gastrointestinal Endoscopy 2022年第11期14卷 718-730页

作者： Maria Fernanda Shinin Merchan Diogo Turiani hourneaux de moura Guilherme Henrique Peixoto de Oliveira Igor Mendonça Proença Epifanio Silvino do Monte Junior Edson Ide Caroline Moll Sergio A Sánchez-Luna Wanderley Marques Bernardo eduardo guimarães hourneaux de moura department of Gastroenterology Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil department of Internal Medicine University of Alabama at Birmingham Heersink School of MedicineBirminghamAL 35233United States

BACKGROUND The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography(ERCP)is still *** To assess whether antibiotic prophylaxis reduces the rates of complications in patients undergoing elective *** This systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.A comprehensive search of multiple electronic databases was *** randomized controlled trials were *** outcomes analyzed included bacteremia,cholangitis,sepsis,pancreatitis,and *** risk of bias was assessed by the Cochrane revised Risk-of-Bias tool for randomized controlled *** quality of evidence was assessed by the Grading of Recommendation Assessment,development,and ***-analysis was performed using the Review Manager 5.4 *** Ten randomized controlled trials with a total of 1757 patients that compared the use of antibiotic and non-antibiotic prophylaxis in patients undergoing elective ERCP were *** was no significant difference between groups regarding incidence of cholangitis after ERCP[risk difference(RD)=-0.02,95%confidence interval(CI):-0.05,0.02,P=0.32,cholangitis in patients with suspected biliary obstruction(RD=0.02,95%CI:-0.08 to 0.13,P=0.66),cholangitis on intravenous antibiotic prophylaxis(RD=-0.02,95%CI:-0.05 to 0.01,P=0.25),septicemia(RD=-0.02,95%CI:-0.06 to 0.01,P=0.25),pancreatitis(RD=-0.02,95%CI:-0.06 to 0.01,P=0.19),and allcause mortality(RD=0.00,95%CI:-0.01 to 0.01,P=0.71).However,the antibiotic prophylaxis group presented a 7%risk reduction in the incidence of bacteremia(RD=-0.07,95%CI:-0.14 to-0.01,P=0.03).CONCLUSION The prophylactic use of antibiotics in patients undergoing elective ERCP reduces the risk of bacteremia but does not appear to have an impact on the rates of cholangitis,septicemia,pancreatitis,and mortality.

关键词： Endoscopy Antibiotics Endoscopic retrograde cholangiopancreatography Cholangitis Infection

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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

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Pancreatitis after endoscopic retrograde cholangiopancreatography:A narrative review

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World Journal of Gastroenterology 2021年第20期27卷 2495-2506页

作者： Igor Braga Ribeiro Epifanio Silvino do Monte Junior Antonio Afonso Miranda Neto Igor Mendonça Proença Diogo Turiani hourneaux de moura Mauricio Kazuyoshi Minata Edson Ide Marcos eduardo Lera dos Santos Gustavo de Oliveira Luz Sergio Eiji Matuguma Spencer Cheng Renato Baracat eduardo guimarães hourneaux de moura department of Gastrointestinal Endoscopy Unit University of São Paulo School of MedicineSão Paulo 05403-010Brazil

Acute post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a feared and potentially fatal complication that can be as high as up to 30%in high-risk ***-examination measures,during the examination and after the examination are the key to technical and clinical success with a decrease in adverse *** studies have debated on the subject,however,numerous topics remain controversial,such as the effectiveness of prophylactic medications and the amylase dosage *** review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.

关键词： Endoscopic retrograde cholangiopancreatography Pan-creatitis Postendoscopic retrograde cholangiopancreatography pancreatitis Adverse events Pancreatitis Prevention

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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

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Effects of intragastric balloon placement in metabolic dysfunctionassociated fatty liver disease: A systematic review and metaanalysis

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World Journal of Hepatology 2021年第7期13卷 815-829页

作者： João Remíde Freitas Júnior Igor Braga Ribeiro Diogo Turiani hourneaux de moura Vitor Massaro Takamatsu Sagae Gabriel Mayo Vieira de Souza Guilherme Henrique Peixoto de Oliveira Sergio A Sánchez-Luna Thiago Ferreira de Souza eduardo Turiani hourneaux de moura Cláudia Pinto Marques Souza de Oliveira Wanderley Marques Bernardo eduardo guimarães hourneaux de moura Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP Departamento de GastroenterologiaFaculdade de MedicinaUniversidade de Sao PauloSao PauloSPBR Division of Gastroenterology and Hepatology Department of Internal MedicineBasil I.Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at BirminghamBirminghamAL 35294United States department of Gastroenterology Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil

BACKGROUND 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 *** 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 *** A comprehensive search was done of multiple electronic databases(MEDLINE,EMBASE,LILACS,Cochrane and Google Scholar)and grey literature from their inception until February *** criteria involved patients with a body mass index>25 kg/m2 with evidence or previous diagnosis of hepatic *** 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/m2)and liver volume(cm3).ResULTS Ten retrospective cohort studies evaluating a total of 508 patients were *** 6 mo of IGB placement,this significantly reduced alanine aminotransferase[mean difference(MD):10.2,95%confidence interval(CI):8.12-12.3],gammaglutamyltransferase(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 dysfunctionassociated fatty liver disease as well as improving metabolic markers related to disease progression.

关键词： Intragastric balloon Metabolic dysfunction-associated fatty liver disease Homeostatic model assessment Abdominal circumference Body mass index

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Endoscopic ultrasound artificial intelligence-assisted for prediction of gastrointestinal stromal tumors diagnosis:A systematic review and meta-analysis

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World Journal of Gastrointestinal Endoscopy 2023年第8期15卷 528-539页

作者： Rômulo Sérgio Araújo Gomes Guilherme Henrique Peixoto de Oliveira Diogo Turiani hourneaux de moura Ana Paula Samy Tanaka Kotinda Carolina Ogawa Matsubayashi Bruno Salomão Hirsch Matheus de Oliveira Veras João Guilherme Ribeiro Jordão Sasso Roberto Paolo Trasolini Wanderley Marques Bernardo eduardo guimarães hourneaux de moura department of Gastroenterology Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Division of Hepatology and Endoscopy Department of GastroenterologyHarvard Medical SchoolBrigham and Women’s HospitalBostonMA 02115United States

BACKGROUND Subepithelial lesions(SELs)are gastrointestinal tumors with heterogeneous malignant *** ultrasonography(EUS)is the leading method for evaluation,but without histopathological analysis,precise differentiation of SEL risk is *** intelligence(AI)is a promising aid for the diagnosis of gastrointestinal lesions in the absence of *** To determine the diagnostic accuracy of AI-assisted EUS in diagnosing SELs,especially lesions originating from the muscularis propria *** Electronic databases including PubMed,EMBASE,and Cochrane Library were *** of any sex and>18 years,with SELs assessed by EUS AIassisted,with previous histopathological diagnosis,and presented sufficient data values which were extracted to construct a 2×2 *** reference standard was *** primary outcome was the accuracy of AI for gastrointestinal stromal tumor(GIST).Secondary outcomes were AI-assisted EUS diagnosis for GIST vs gastrointestinal leiomyoma(GIL),the diagnostic performance of experienced endoscopists for GIST,and GIST vs *** sensitivity,specificity,positive,and negative predictive values were *** corresponding summary receiver operating characteristic curve and post-test probability were also *** Eight retrospective studies with a total of 2355 patients and 44154 images were included in this *** AI-assisted EUS for GIST diagnosis showed a sensitivity of 92%[95%confidence interval(CI):0.89-0.95;Pder the curve(AUC)of *** diagnosis of GIST vs GIL by AI-assisted EUS,specificity was 90%(95%CI:0.88-0.95;P=0.02)and AUC of *** experienced endoscopists’values were sensitivity of 72%(95%CI:0.67-0.76;P<0.01),specificity of 70%(95%CI:0.64-0.76;P<0.01),and AUC of 0.777 for *** GIST vs GIL,the experts achieved a sensitivity of 73%(95%CI:0.65-0.80;P<0.01)and an AUC of ***

关键词： Subepithelial lesions Ultrasound endoscopy Artificial intelligence

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