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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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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

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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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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

Roux-en-Y gastric bypass(RYGB)is the most commonly performed surgical procedure used to treat obesity *** satisfactory results in terms of weight loss,over time many patients experience weight *** 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 *** 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 *** endoscopic evaluation,the diameter of the GJA was 22 *** to the dilated GJA,treatment with APC was *** months later she reported a return of poor satiety and an increased appetite.A repeat endoscopy was then *** GJA was approximately 15 mm and was *** was *** day post procedure she had four episodes of *** 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 *** to fibrosis and the depth of ulceration in the area,clips and repeat APC could not be ***,an attempt to inject epinephrine injection was ***,persistent oozing was *** a result,hemostatic powder was applied to the region of the bleeding ***,no more bleeding was *** follow-up,the patient remained hemodynamically stable and a second look endoscopy was not *** 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 *** site bleeding is an infrequent and potentially life-threatening

关键词： Anastomosis Roux-en-Y Argon plasma coagulation

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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

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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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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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Endoscopic ultrasound fine needle aspiration vs fine needle biopsy in solid lesions:A multi-center analysis

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World Journal of Clinical Cases 2021年第34期9卷 10507-10517页

作者： Diogo Turiani Hourneaux Moura Thomas R McCarty Pichamol Jirapinyo igor braga ribeiro Galileu Ferreira Ayala Farias Antonio Coutinho Madruga-Neto Marvin Ryou Christopher C Thompson Gastrointestinal Endoscopy Unit University of Sao Paulo School of MedicineSão PauloSP 05403-010Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States Division of Gastrointestinal Endoscopy University of São Paulo Medical SchoolSão PauloSP 01246-903Brazil

BACKGROUND While endoscopic ultrasound(EUS)-guided fine needle aspiration(FNA)is considered a preferred technique for tissue sampling for solid lesions,fine needle biopsy(FNB)has recently been *** To compare the accuracy of FNB vs FNA in determining the diagnosis of solid *** A retrospective,multi-center study of EUS-guided tissue sampling using FNA vs FNB *** outcomes included diagnostic test characteristics(i.e.,sensitivity,specificity,accuracy),use of rapid on-site evaluation(ROSE),and adverse *** analyses were performed by type of lesion and diagnostic yield with or without ROSE.A multivariable logistic regression was also *** A total of 1168 patients with solid lesions(n=468 FNA;n=700 FNB)underwent EUS-guided *** age was 65.02±12.13 ***,sensitivity,specificity and accuracy were superior for FNB vs FNA(84.70%vs 74.53%;99.29%vs 96.62%;and 87.62%vs 81.55%,respectively;P0.05).Multivariate analysis showed no significant predictor for better *** subgroup analyses,FNB was superior to FNA for non-pancreatic lesions;however,there was no difference between the techniques among pancreatic *** adverse event was reported in each *** FNB is superior to FNA with equivalent diagnostic test characteristics compared to FNA+ROSE in the diagnosis of non-pancreatic solid *** results suggest that EUS-FNB may eliminate the need of ROSE and should be employed as a first-line method in the diagnosis of solid lesions.

关键词： Endoscopic ultrasound-guided tissue acquisition Fine needle aspiration Fine needle biopsy Solid lesions Endoscopic ultrasound Cancer

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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

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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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