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A novel sampling method for the investigation of gut microbiota

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World Journal of Gastroenterology 2007年第29期13卷 3990-3995页

作者： Alina Guimares Quintanilha Bruno Zilberstein Manoel A A Santos Denis Pajecki Eduardo Guimares Hourneaux Moura Paulo Roberto Arruda Alves fauze maluf-filho Ivan Cecconello Digestive Surgery Division Department of Gastroenterology and Institute of Biomedical Sciences Department of Microbiology So Paulo University Medical School So Paulo SP Brazil

AIM： In order to characterize the qualitative and quantitative microorganisms in different sites of the lower digestive tract （LDT） in healthy volunteers, a specific technique was developed for collecting mucous of the distal ileum, colon and rectum. METHODS： A polyethylene tube was designed to go through the colonoscope channel with a No. 8 French tube. In order to avoid internal contamination, the distal extremity was protected with a membrane of microfilm after being sterilized in ethilene oxid. To facilitate the aspiration of a precise volume, its interior was coated with silicone. One hundred rnicrolliter （0.1 mL） sample of mucous was collected and transferred into an Eppenddorff tube containing nine hundred rnicrolliter （0.9mL） of VMGA-3 （viable medium of Goteborg）. This procedure was repeated at each site of the LDT with a new sterilized catheter. RESULTS： All sites revealed the ＂non pathogenic＂ anaerobic bacteria Veillonella sp （average 10s colony forming units/mL-CFU/mL）, allowing to conclude an environment of low oxidation-reduction potential （redox） in the LDT. It was also characterized the presence of Klebisiella sp with significant statistical predominance （SSP） in the ileum. Enterobacter sp was found with SSP in the sigrnoid colon, Bacteroides sp non-pigmented （npg） and Ecoli with SSP in the sigrnoid colon and rectum, Enterococcus sp and Lactobacillus sp with SSP in the rectum, all in a mean concentration of 10s CFU/mL CONCLUSION： This procedure is feasible and efficient and can point out a similar distribution of the aerobic and anaerobic bacteria with the presence of biological markers of normal microbiota in the LDT.

关键词： Colony count Microbial Fungi Aerobic bacteria Anaerobic bacteria Gastrointestinal endoscopy Large Intestine Bacterial translocation Microbiology Catheterization

Opinion: How to manage subepithelial lesions of the upper gastrointestinal tract?

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World Journal of Gastrointestinal Endoscopy 2015年第18期7卷 1262-1267页

作者： Matheus Cavalcante Franco Ricardo Teles Schulz fauze maluf-filho Digestive Endoscopy Unit Cancer Institute of Sao Paulo University

Subepithelial lesions(SELs) in the upper gastrointestinal(GI) tract are relatively frequent findings in patients undergoing an upper GI endoscopy. These tumors, which are located below the epithelium and out of reach of conventional biopsy forceps, may pose a diagnostic challenge for the gastroenterologist, especially when SELs are indeterminate after endoscopy and endoscopic ultrasound(EUS). The decision to proceed with further investigation should take into consideration the size, location in the GI tract, and EUS features of SELs. Gastrointestinal stromal tumor(GIST) is an example of an SEL that has a well-recognized malignant potential. Unfortunately, EUS is not able to absolutely differentiate GISTs from other benign hypoechoic lesions from the fourth layer, such as leiomyomas. Therefore, EUS-guided fine needle aspiration(EUS-FNA) is an important tool for correct diagnosis of SELs. However, small lesions(size < 2 cm) have a poor diagnostic yield with EUS-FNA. Moreover, studies with EUS-core biopsy needles did not report higher rates of histologic and diagnostic yields when compared with EUS-FNA. The limited diagnostic yield of EUS-FNA and EUS-core biopsies of SELs has led to the development of more invasive endoscopic techniques for tissue acquisition. There are initial studies showing good results for tissue biopsy or resection of SELs with endoscopic submucosal dissection, suck-ligate-unroof-biopsy, and submucosal tunneling endoscopic resection.

关键词： Gastrointestinal neoplasm Gastrointestinal endosco

Deep sedation during gastrointestinal endoscopy: Propofol-fentanyl and midazolam-fentanyl regimens

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World Journal of Gastroenterology 2013年第22期19卷 3439-3446页

作者： Marcos Eduardo Lera dos Santos fauze maluf-filho Dalton Marques Chaves Sergio Eiji Matuguma Edson Ide Gustavo de Oliveira Luz Thiago Ferreira de Souza Fernanda C Simoes Pessorrusso Eduardo Guimares Hourneaux de Moura Paulo Sakai Department of Gastroenterology Hospital das Clínicas University of Sao Paulo Medical School Sao Paulo CEP 05403-900 Brazil Cancer Institute of Sao Paulo State Sao Paulo CEP 01246-000 Brazil

AIM: To compare deep sedation with propofol-fentanyl and midazolam-fentanyl regimens during upper gastrointestinal endoscopy. METHODS: After obtaining approval of the research ethics committee and informed consent, 200 patients were evaluated and referred for upper gastrointestinal endoscopy. Patients were randomized to receive propofol-fentanyl or midazolam-fentanyl (n = 100/group).We assessed the level of sedation using the observer's assessment of alertness/sedation (OAA/S) score and bispectral index (BIS). We evaluated patient and physician satisfaction, as well as the recovery time and complication rates. The statistical analysis was performed using SPSS statistical software and included the MannWhitney test, χ 2 test, measurement of analysis of variance, and the κ statistic. RESULTS: The times to induction of sedation, recovery, and discharge were shorter in the propofolfentanyl group than the midazolam-fentanyl group. According to the OAA/S score, deep sedation events occurred in 25% of the propofol-fentanyl group and 11% of the midazolam-fentanyl group (P = 0.014). Additionally, deep sedation events occurred in 19% of the propofol-fentanyl group and 7% of the midazolamfentanyl group according to the BIS scale (P = 0.039). There was good concordance between the OAA/S score and BIS for both groups (κ = 0.71 and κ = 0.63, respectively). Oxygen supplementation was required in 42% of the propofol-fentanyl group and 26% of the midazolam-fentanyl group (P = 0.025). The mean time to recovery was 28.82 and 44.13 min in the propofolfentanyl and midazolam-fentanyl groups, respectively (P < 0.001). There were no severe complications in either group. Although patients were equally satisfied with both drug combinations, physicians were more satisfied with the propofol-fentanyl combination. CONCLUSION: Deep sedation occurred with propofolfentanyl and midazolam-fentanyl, but was more frequent in the former. Recovery was faster in the propofol-fentanyl group.

关键词： Endoscopy Deep sedation Anesthetic administration Anesthetic dose Adverse effects

Probe-based confocal endomicroscopy is accurate for differentiating gastric lesions in patients in a Western center

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Chinese Journal of Cancer Research 2018年第5期30卷 546-552页

作者： adriana vaz safatle-ribeiro elisa ryoka baba rodrigo corsato scomparin sheila friedrich faraj marcelo simas de lima luciano lenz bruno costa martins carla gusmon fábio shiguehissa kawaguti caterina pennacchi bruno zilberstein ulysses ribeiro jr. fauze maluf-filho Endoscopy Unit of Department of Gastroenterology Sao Paulo Cancer Institute University of Sao Paulo Medical School (ICESP-HCFMUSP) Sao Paulo 01246-000 Brazil

Objective： Probe-based confoeal laser endomicroscopy （pCLE） technique may improve the diagnosis of gastric mucosal lesions allowing acquisition of high-resolution in vivo images at the cellular and mierovaseular levels. This study aims to evaluate the accuracy of pCLE for the differential diagnosis of non-neoplastic and neoplastic gastric ***： Twenty gastric mucosal lesions from 10 patients were evaluated during endoscopic procedure and were examined by pCLE. Diagnostic pCLE was followed by biopsies or endoscopic resection of suspected lesions. A senior pathologist evaluated the specimens and was blinded to the pCLE ***： Patients＇ mean age was 68.3 （range, 42-83） years and six were men. Thirteen suspicious flat or elevated lesions （classified as 0-Is, 0-IIa or 0-IIa ＋ IIc） and seven pre-malignant lesions （atrophy and intestinal metaplasia） were evaluated. One patient was studied during his long-term follow-up after partial gastrectomy and presented severe atrophy, intestinal metaplasia, and xanthomas at the stump mucosa. The location of gastric lesions was in the body （n=10 lesions）, the antrum （n=9） and the incisura angularis （n=1）. All neoplastic lesions and all but one benign lesion were properly diagnosed by pCLE. pCLE incorrectly diagnosed one small antrum lesion as adenoma, however the final diagnosis was intestinal metaplasia. The final histological diagnosis was neoplastic in 9 and benign lesions in 11. In this small case series, pCLE accuracy was 95% （19/20 lesions）.Conclusions： pCLE is accurate for real time histology of gastric lesions, pCLE may change the management of patients with gastric mucosal lesions, guiding biopsies and endoscopic resection, and avoiding further diagnostic workup or unnecessary therapy.

关键词： Probe-based confocal endomieroscopy gastric cancer intestinal metaplasia atrophy gastric adenoma endoscopic resection

Comparison between endoscopic sclerotherapy and band ligation for hemostasis of acute variceal bleeding

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World Journal of Gastrointestinal Endoscopy 2011年第5期3卷 95-100页

作者： Gustavo Oliveira Luz fauze maluf-filho Sérgio Eiji Matuguma Fábio Yuji Hondo Edson Ide Jeane Martins Melo Spencer Cheng Paulo Sakai Gastrointestinal Endoscopy Unit Hospital das ClínicasSo Paulo University Medical School

AIM:To compare band ligation(BL) with endoscopic sclerotherapy(SCL) in patients admitted to an emergency unit for esophageal variceal rupture. METHODS:A prospective,randomized,single-center study without crossover was *** endoscopic diagnosis of esophageal variceal rupture,patients were randomized into groups for SCL or BL *** was performed by ethanolamine oleate intravascular injection both above and below the rupture point,with a maximum volume of 20 *** BL patients,banding at the rupture point was attempted,followed by ligation of all variceal tissue of the distal *** outcomes for both groups were initial failure of bleeding control(5 d) ,early re-bleeding(5 d to 6 wk),and complications,including *** May 2005 to May 2007,100 patients with variceal bleeding were enrolled in thestudy:50 SCL and 50 BL *** differences between groups were observed across gender,age,ChildPugh status,presence of shock at admission,mean hemoglobin levels,and variceal size. RESULTS:No differences were found between groups for bleeding control,early re-bleeding rates,complications,or *** 6 wk,36(80%) SCL and 33(77 %) EBL patients were alive and free of bleeding.A statistically significant association between Child-Pugh status and mortality was found,with 16%mortality in Child A and B patients and 84%mortality in Child C patients(P<0.001) . CONCLUSION:Despite the limited number of patients included,our results suggest that SCL and BL are equally efficient for the control of acute variceal bleeding.

关键词： Portal hypertension Hemorrhage Esophageal varices Gastrointestinal endoscopy Ligation Sclerotherapy

Endoscopic management and prevention of migrated esophageal stents

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World Journal of Gastrointestinal Endoscopy 2014年第2期6卷 49-54页

作者： Bruno da Costa Martins Felipe Alves Retes Bruno Frederico Medrado Marcelo Simas de Lima Caterina Maria Pia Simione Pennacchi Fabio Shiguehissa Kawaguti Adriana Vaz Safatle-Ribeiro Ricardo Sato Uemura fauze maluf-filho Department of Gastroenterology Endoscopy DivisionCancer Institute of the University of So Paulo

The use of self-expandable metallic stents has increased recently to palliate inoperable esophageal neoplasia and also in the management of benign strictures. Migration is one of the most common complications after stent placement and the endoscopist should be able to recognize and manage this situation. Several techniques for managing migrated stents have been described, as well as new techniques for preventing stent migration. Most stents have a "lasso" at the upper flange which facilitates stent repositioning or removal. An overtube, endoloop and large polypectomy snare may be useful for the retrieval of stents migrated into the stomach. External fixation of the stent with Shim's technique is efficient in preventing stent migration. Suturing the stent to the esophageal wall, new stent designs with larger flanges and double-layered stents are promising techniques to prevent stent migration but they warrant validation in a larger cohort of patients.

关键词： Endoscopy Stents Esophageal cancer Benign strictures Complications

Association between mucosal surface pattern under near focus technology and Helicobacter pylori infection

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World Journal of Gastrointestinal Endoscopy 2021年第10期13卷 518-528页

作者： Felipe Fiuza fauze maluf-filho Edson Ide Carlos Kiyoshi Furuya Jr Sonia Nadia Fylyk Jennifer Nakamura Ruas Luciana Stabach Gabriela Albuquerque Araujo Sergio Eiji Matuguma Ricardo Sato Uemura Christiano Makoto Sakai Kendi Yamazaki Sergio Shiguetoshi Ueda Paulo Sakai Bruno Costa Martins Department of Endoscopy Hospital Alemão Oswaldo CruzSão Paulo 01323-020Brazil

BACKGROUND Many studies evaluated magnification endoscopy(ME)to correlate changes on the gastric mucosal surface with Helicobacter pylori(***)***,few studies validated these concepts with high-definition endoscopy without *** To access the association between mucosal surface pattern under near focus technology and *** infection status in a western *** Cross-sectional study including all patients referred to routine upper *** exams were performed using standard high definition(S-HD)followed by near focus(NF-HD)*** of erythema,erosion,atrophy,and nodularity were recorded during S-HD,and surface mucosal pattern was classified using NF-HD in the gastric *** were taken for rapid urease test and *** One hundred and eighty-seven patients were analyzed from August to November *** those,47(25.1%)were ***+,and 42(22.5%)had a previous *** *** the examination with S-HD,erythema had the best sensitivity for *** detection(80.9%).Exudate(99.3%),nodularity(97.1%),and atrophy(95.7%)demonstrated better specificity values,but with low sensitivity(6.4%-19.1%).On the other hand,the absence of erythema was strongly associated with ***-(negative predictive value=92%).With NF-HD,56.2%of patients presented type 1 pattern(regular arrangement of collecting venules,RAC),and only 5.7%of RAC+patients were ***+.The loss of RAC presented 87.2%sensitivity for *** detection,70.7%specificity,50%positive predictive value,and 94.3%negative predictive value,indicating that loss of RAC was suboptimal to confirm *** infection,but when RAC was seen,*** infection was *** The presence of RAC at the NF-HD exam and the absence of erythema at S-HD were highly predictive of *** negative *** the other hand,the loss of RAC had a suboptimal correlation with the presence of ***.

关键词： Diagnosis Endoscopy Gastric infection Gastritis Helicobacter pylori Sensitivity and specificity

Histologyassessmentofbipolarcoagulationandargonplasmacoagulationon digestivetract

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World Journal of Gastrointestinal Endoscopy 2014年第7期6卷 304-311页

作者： Garrido T Baba ER Wodak S Sakai P Cecconello I maluf-filho F Teresa Garrido Elisa R Baba Stephanie Wodak Paulo Sakai Ivan Cecconello Fauze Maluf-Filho Endoscopy Division and Gastrointestinal Surgery Division Hospital das Clinicas of the University of S?o Paulo S?o Paulo SP 05403-000 Brazil

AIM: To analyze the effect of bipolar electrocoagula-tion and argon plasma coagulation on fresh specimens of gastrointestinal tract. METHODS: An experimental evaluation was performed at Hospital das Clinicas of the University of So Paulo, on 31 fresh surgical specimens using argon plasma coagulation and bipolar electrocoagulation at different time intervals. The depth of tissue damage was his-topathologically analyzed by single senior pathologist unaware of the coagulation method and power setting applied. To analyze the results, the mucosa was divided in superficial mucosa (epithelial layer of the esophagus and superficial portion of the glandular layer of the stomach and colon) intermediate mucosa (until thelamina propria of the esophagus and until the bottom of the glandular layer of the stomach and colon) and muscularis mucosa. Necrosis involvement of the layers was compared in several combinations of power and time interval. RESULTS: Involvement of the intermediate mucosa of the stomach and of the muscularis mucosa of the three organs was more frequent when higher amounts of en-ergy were used with argon plasma. In the esophagus and in the colon, injury of the intermediate mucosa was frequent, even when small amounts of energy were used. The use of bipolar electrocoagulation resulted in more frequent involvement of the intermediate mucosa and of the muscularis mucosa of the esophagus and of the colon when higher amounts of energy were used. In the stomach, these involvements were rare. The risk of injury of the muscularis propria was significant only in the colon when argon plasma coagulation was ***: Tissue damage after argon plasma coagulation is deeper than bipolar electrocoagulation. Both of them depend on the amount of energy used.

关键词： Argon plasma coagulation Electrocoagula-tion Gastrointestinal endoscopy Surgical procedures Endoscopic gastrointestinal Mucous membrane/injuries