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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

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A new heparin fragment decreases liver ischemia-reperfusion injury

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Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 190-192页

作者： Enio R Vasques Estela RR Figueira Joel A Rocha-Filho Cinthia Lanchotte Jorge LS Ximenes Helena B Nader Ivarne LS Tersariol Marcelo A Lima Tiago Rodrigues JoséEM Cunha Eleazar Chaib Luiz AC D’Albuquerque Flávio HF Galvão Laboratorio de Investigaçao Medica 37 Departamento de GastroenterologiaHospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de São PauloSão Paulo 01246-903Brazil departamento de gastroenterologia Hospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de São PauloSão PauloBrazil Disciplina de Anestesiologia Hospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de São PauloSão PauloBrazil departamento de Bioquimica Universidade Federal de São PauloSão PauloBrazil Universidade Federal do ABC Santo AndreSão PauloBrazil serviço de Transplante de Figado e orgaos do Aparelho Digestivo Departamento de GastroenterologiaHospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de São PauloSão PauloBrazil

To the Editor:Ischemia-reperfusion injury following surgery and transplantation can lead to irreversible multiorgan *** calcium overload is associated to cellular death during ischemiareperfusion.A recently discovered heparin fragment (HF),trisulfated disaccharide (TD),that acts on sodium-calcium exchanger(NCX) decreasing intracellular Ca^(2+),showed effectiveness on protecting hepatocytes from ischemia-reperfusion injury [1].

关键词： irreversible heparin injury

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Dynamic contrast enhanced ultrasound in differential diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis

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World Journal of Gastrointestinal oncology 2024年第6期16卷 2804-2815页

作者： Giorgio Esposto Paolo Santini Fabrizio Termite Linda Galasso Irene Mignini Maria Elena Ainora Antonio Gasbarrini Maria Assunta Zocco department of CEMAD Digestive Disease Center Fondazione Policlinico Universitario A Gemelli IRCCSCatholic University of RomeRome 00168Italy department of Fondazione Policlinico Universitario Agostino Gemelli IRCCS UniversitàCattolica del Sacro CuoreRome 00168Italy department of Medicina Interna e gastroenterologia CEMAD Digestive Disease CenterFondazione Policlinico Universitario A Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy

BACKGRoUND Non-invasive differential diagnosis between hepatocellular carcinoma(HCC)and other liver cancer(*** or metastasis)is highly challenging and definitive diagnosis still relies on histological *** patterns of enhancement and wash-out of liver nodules can be used to stratify the risk of malignancy only in cirrhotic patients and HCC frequently shows atypical *** contrast-enhanced ultrasound(DCEUS)with standardized software could help to overcome these obstacles,providing functional and quantitative parameters and potentially improving accuracy in the evaluation of tumor *** To explore clinical evidence regarding the application of DCEUS in the differential diagnosis of liver *** A comprehensive literature search of clinical studies was performed to identify the parameters of DCEUS that could relate to histological *** accordance with the study protocol,a qualitative and quantitative analysis of the evidence was *** Rise time was significantly higher in HCC patients with a standardized mean difference(SMD)of 0.83(95%CI:0.48-1.18).Similarly,other statistically significant parameters were mean transit time local with a SMD of 0.73(95%CI:0.20-1.27),peak enhancement with a SMD of 0.37(95%CI:0.03-0.70),area wash-in area under the curve with a SMD of 0.47(95%CI:0.13-0.81),wash-out area under the curve with a SMD of 0.55(95%CI:0.21-0.89)and wash-in and wash-out area under the curve with SMD of 0.51(95%CI:0.17-0.85).SMD resulted not significant in fall time and wash-in rate,but the latter presented a trend towards greater values in HCC compared to intrahepatic *** DCEUS could improve non-invasive diagnosis of HCC,leading to less liver biopsy and early *** quantitative analysis needs to be applied on larger cohorts to confirm these preliminary results.

关键词： Dynamic contrast enhanced ultrasound Hepatocellular carcinoma Intracellular cholangiocarcinoma Quantitative ultrasound Liver cancer Time-intensity curve

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Shear-wave elastography to predict hepatocellular carcinoma after hepatitis C virus eradication:A systematic review and meta-analysis

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World Journal of Gastroenterology 2024年第10期30卷 1450-1460页

作者： Giorgio Esposto Paolo Santini Linda Galasso Irene Mignini Maria Elena Ainora Antonio Gasbarrini Maria Assunta Zocco CEMAD Digestive Disease Center Fondazione Policlinico Universitario“A.Gemelli”IRCCSCatholic University of RomeRome 00168Italy Fondazione Policlinico Universitario Agostino Gemelli IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS-UniversitàCattolica del Sacro CuoreRome 00168Italy Medicina Interna e gastroenterologia CEMAD Digestive Disease CenterUniversitàCattolica del Sacro CuoreFondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

BACKGRoUND Direct-acting antiviral agents(DAAs)are highly effective treatment for chronic hepatitis C(CHC)with a significant rate of sustained virologic response(SVR).The achievement of SVR is crucial to prevent additional liver damage and slow down fibrosis *** assessment of fibrosis degree can be performed with transient elastography,magnetic resonance elastography or shear-wave elastography(SWE).Liver elastography could function as a predictor for hepato-cellular carcinoma(HCC)in CHC patients treated with *** To explore the predictive value of SWE for HCC development after complete clearance of hepatitis C virus(HCV).METHoDS A comprehensive literature search of clinical studies was performed to identify the ability of SWE to predict HCC occurrence after HCV *** accordance with the study protocol,a qualitative and quantitative analysis of the evidence was *** At baseline and after 12 wk of follow-up,a trend was shown towards greater liver stiffness(LS)in those who go on to develop HCC compared to those who do not[baseline LS standardized mean difference(SMD):1.15,95%confidence interval(95%CI):020-2.50;LS SMD after 12 wk:0.83,95%CI:0.33-1.98].The absence of a statistically significant difference between the mean LS in those who developed HCC or not may be related to the inability to correct for confounding factors and the absence of raw source *** was a statist-ically significant LS SMD at 24 wk of follow-up between patients who developed HCC vs not(0.64;95%CI:0.04-1.24).CoNCLUSIoN SWE could be a promising tool for prediction of HCC occurrence in patients treated with *** studies with larger cohorts and standardized timing of elastographic evaluation are needed to confirm these data.

关键词： Shear-wave elastography Hepatocellular carcinoma Hepatitis C virus Sustained virologic response

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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

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The outcomes and safety of patients undergoing endoscopic retrograde cholangiopancreatography combining a single-use cholangioscope and a single-use duodenoscope:A multicenter retrospective international study

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 71-76页

作者： Alessandro Fugazza Matteo Colombo Michel Kahaleh V.Raman Muthusamy Bick Benjamin Wim Laleman Carmelo Barbera Carlo Fabbri Jose Nieto Abed Al-Lehibi Mohan Ramchandani Amy Tyberg Haroon Shahid Avik Sarkar dean Ehrlich Stuart Shermand Cecilia Binda Marco Spadaccini Andrea Iannone Kareem Khalaf Nageshwar Reddy Andrea Anderloni Alessandro Repici Division of Gastroenterology and Digestive Endoscopy Humanitas Research Hospital-IRCCSVia Manzoni 5620089RozzanoMilanoItaly Gastroenterology Rutgers Robert Wood JohnsonNew BrunswickNew JerseyUSA Vatche and Tamar Manoukian Division of Digestive Diseases University of CaliforniaLos Angeles School of Medicine at UCLALos AngelesCaliforniaUSA Division of Digestive and Liver Disorders Indiana University School of MedicineIndianapolisINUSA department of Gastroenterology and Hepatology University Hospitals LeuvenKU Leuven3000 LeuvenBelgium U.o.C.di gastroenterologia ed Endoscopia Digestiva Ospedale Giuseppe MazziniASL TeramoItaly Gastroenterology and Digestive Endoscopy Unit Forlì-Cesena HospitalsAUSL RomagnaForlì-CesenaItaly Borland Groover Clinic JacksonvilleFloridaUSA department of Gastroenterology and Hepatology King Fahad Medical CityRiyadhSaudi Arabia Asian Institute of Gastroenterology HyderabadIndia Section of Gastroenterology Department of Emergency and Organ TransplantationUniversity of BariBari 70124Italy department of Biomedical Sciences Humanitas UniversityVia Rita Levi Montalcini 420090Pieve EmanueleMilanItaly

Background: Duodenoscope-related multidrug-resistant organism(MDRo) infections raise concerns. Disposable duodenoscopes have been recently introduced in the market and approved by regulatory agencies with the aim to reduce the risk of endoscopic retrograde cholangiopancreatography(ERCP) associated infections. The aim of this study was to evaluate the outcome of procedures performed with single-use duodenoscopes in patients with clinical indications to single-operator cholangiopancreatoscopy. Methods: This is a multicenter international, retrospective study combining all patients who underwent complex biliopancreatic interventions using the combination of a single-use duodenoscope and a single-use cholangioscope. The primary outcome was technical success defined as ERCP completion for the intended clinical indication. Secondary outcomes were procedural duration, rate of cross-over to reusable duodenoscope, operator-reported satisfaction score(1 to 10) on performance rating of the single-use duodenoscope, and adverse event(AE) rate. Results: A total of 66 patients(26, 39.4% female) were included in the study. ERCP was categorized according to ASGE ERCP grading system as 47(71.2%) grade 3 and 19(28.8%) grade 4. The technical success rate was 98.5%(65/66). Procedural duration was 64(interquartile range 15-189) min, cross-over rate to reusable duodenoscope was 1/66(1.5%). The satisfaction score of the single-use duodenoscope classified by the operators was 8.6 ± 1.3 points. Four patients(6.1%) experienced AEs not directly related to the single-use duodenoscope, namely 2 post-ERCP pancreatitis(PEP), 1 cholangitis and 1 ***: Single-use duodenoscope is effective, reliable and safe even in technically challenging procedures with a non-inferiority to reusable duodenoscope, making these devices a viable alternative to standard reusable equipment.

关键词： Single-operator cholangioscopy Single-use duodenoscope Endoscopic retrograde cholangiopancreatography Indeterminate biliary stricture Difficult biliary stones

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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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Change in neoadjuvant chemotherapy could alter the prognosis of patients with pancreatic adenocarcinoma: A case report

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World Journal of Clinical Cases 2021年第14期9卷 3418-3423页

作者： Alberto Meyer Bárbara J Carvalho Kayo AA Medeiros Leonardo Z Pipek Fernanda S Nascimento Milena o Suzuki João VT Munhoz Leandro R Iuamoto Luiz A Carneiro-D'Alburquerque Wellington Andraus gastroenterologia Hospital das Clínicas HCFMUSPFaculdade de MedicinaUniversidade de São PauloSão Paulo 01426-010Brazil gastroenterologia Faculdade de Medicinada Universidade de São PauloSão Paulo 05403-000Brazil orthopaedics and Traumatology Faculdade de Medicinada Universidade de São PauloSão Paulo 05403-000Brazil

BACKGRoUND Neoadjuvant treatment has become a standard of care for borderline or locally advanced pancreatic cancer and is increasingly considered even for up-front resectable *** aim of this article is to present the case of a 62-year-old patient with locally advanced pancreatic adenocarcinoma who was successfully treated with gemcitabine plus nab-paclitaxel after the failure of the first line *** SUMMARY Computerized tomography scan and magnetic resonance imaging demonstrated a nodular lesion of ill-defined limits in the body of the pancreas,measuring approximately 4.2 cm×2.7 cm,with an infiltrative *** tumor had contact with the superior mesenteric vein,splenomesenteric junction and the proximal segment of the splenic artery,causing focal reduction of its *** to vascular involvement,neoadjuvant chemotherapy treatment with eight cycles of“folinic acid,5-fluorouracil,irinotecan and oxa-liplatine”(FoLFIRINoX)were *** the end of the cycles,surgery was performed,but the procedure was interrupted due to finding of lesions suspected of *** plus nab-paclitaxel was then successfully used for neoadjuvant treatment with subsequent R0 surgical *** Gemcitabine plus nab-paclitaxel may be effective as an alternative regimen when FoLFIRINoX fails as the first line of treatment,suggesting the need for further studies to identify which patients would benefit from each type of therapeutic approach.

关键词： Neoadjuvant chemotherapy Pancreatic cancer Resectable pancreatic cancer Borderline resectable Neoadjuvant Pancreas Case report

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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 o 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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