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| 1 | Acute abdominal obstruction:Colon stent or emergency surgery? An evidence-based review显示文摘According to the American Cancer Society and Colorectal Cancer Statistics 2017,colorectal cancer(CRC) is one of the most common malignancies in the United States and the second leading cause of cancer death in the world in 2018.Previous studies demonstrated that 8%-29% of patients with primary CRC present malignant colonic obstruction(MCO). In the past, emergency surgery has been the primary treatment for MCO, although morbidity and surgical mortality rates are higher in these settings than in elective procedures. In the 1990 s, selfexpanding metal stents appeared and was a watershed in the treatment of patients in gastrointestinal surgical emergencies. The studies led to high expectations because the use of stents could prevent surgical intervention, such as colostomy, leading to lower morbidity and mortality, possibly resulting in higher quality of life. This review was designed to provide present evidence of the indication, technique, outcomes, benefits, and risks of these treatments in acute MCO through the analysis of previously published studies and current guidelines. | Igor Braga Ribeiro Diogo Turiani Hourneaux de Moura Christopher C Thompson Eduardo Guimaraes Hourneaux de Moura | 2019 | World Journal of Gastrointestinal Endoscopy2019，11，3： | 15 |
| 2 | Endoscopy vs surgery in the treatment of early gastric cancer:Systematic review显示文摘AIM: To report a systematic review,establishing the available data to an unpublished 2a strength of evidence,better handling clinical practice.METHODS: A systematic review was performed using MEDLINE,EMBASE,Cochrane,LILACS,Scopus and CINAHL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 compiled.RESULTS: 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 < 0.05),demonstrating better results with endoscopy. Mortality data were obtained in four studies(n = 1107). There was no difference between the groups(RD =-0.01,95%CI:-0.02-0.00,P = 0.22).CONCLUSION: Three-,5-year survival,recurrence and mortality are similar for both groups. Considering complication,endoscopy is better and,analyzing complete resection data,it is worse than surgery. | 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 | 2015 | World Journal of Gastroenterology2015，21，46： | 12 |
| 3 | Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding:A systematic review and metaanalysis显示文摘AIM To compare the diagnostic accuracy of video capsule endoscopy(VCE) and double-balloon enteroscopy(DBE) in cases of obscure gastrointestinal bleeding(OGIB) of vascular origin.METHODS MEDLINE(via PubMed), LILACS(via BVS) and Cochrane/CENTRAL virtual databases were searched for studies dated before 2017. We identified prospective and retrospective studies, including observational, cohort, single-blinded and multicenter studies, comparing VCE and DBE for the diagnosis of OGIB, and data of all the vascular sources of bleeding were collected. All patients were subjected to the same gold standard method. Relevant data were then extracted from each included study using a standardized extraction form. We calculated study variables(sensitivity, specificity, prevalence, positive and negative predictive values and accuracy) and performed a meta-analysis using Meta-Disc software.RESULTS In the per-patient analysis, 17 studies(1477 lesions) were included. We identified3150 exams(1722 VCE and 1428 DBE) in 2043 patients and identified 2248 sources of bleeding, 1467 of which were from vascular lesions. Of these lesions, 864(58.5%) were diagnosed by VCE, and 613(41.5%) were diagnosed by DBE. The pretest probability for bleeding of vascular origin was 54.34%. The sensitivity of DBE was 84%(95%CI: 0.82-0.86; heterogeneity: 78.00%), and the specificity was92%(95%CI: 0.89-0.94; heterogeneity: 92.0%). For DBE, the positive likelihood ratio was 11.29(95%CI: 4.83-26.40; heterogeneity: 91.6%), and the negative likelihood ratio was 0.20(95%CI: 0.15-0.27; heterogeneity: 67.3%). Performing DBE after CE increased the diagnostic yield of vascular lesion by 7%, from 83% to90%.CONCLUSION The diagnostic accuracy of detecting small bowel bleeding from a vascular source is increased with the use of an isolated video capsule endoscope compared with isolated DBE. However, concomitant use increases the detection rate of the bleeding source. | Hélcio Pedrosa Brito Igor Braga Ribeiro Diogo Turiani Hourneaux de Moura Wanderley Marques Bernardo Dalton Marques Chaves Rogério Kuga Ethan Dwane Maahs Robson Kiyoshi Ishida Eduardo Turiani Hourneaux de Moura Eduardo Guimaraes Hourneaux de Moura | 2018 | World Journal of Gastrointestinal Endoscopy2018，10，12： | 10 |
| 4 | Comparison between endoscopic sphincterotomy vs endoscopic sphincterotomy associated with balloon dilation for removal of bile duct stones:A systematic review and meta-analysis based on randomized controlled trials显示文摘AIM To compare gallstones removal rate and incidence of bleeding, pancreatitis, use of mechanical lithotripsy, cholangitis and perforation between isolated sphincterotomy vs sphincterotomy associated with balloon dilation of papilla in choledocholithiasis through the meta-analysis of randomized clinical trials. METHODS We conducted a systematic review according to the PRISMA guidelines. Literature search was restricted to randomized controlled trials(RCTs) on Med Line, Cochrane Library, LILACS, and EMBASE database platforms in July 2017. The manual search included references of retrieved articles. We extracted data focusing on outcomes: The primary endpoint was the stones removal rate; Secondary endpoints were rates of pancreatitis, bleeding, use of mechanical lithotripsy(ML), perforation and cholangitis. RESULTS Eleven RCTs with 1824 patients were included. EST was associated with more post-endoscopic retrograde cholangiopancreatography(ERCP) bleeding [FE RD-0.02, CI(-0.03,-0.00), I2 = 33%, P = 0.05] and more need of mechanical lithotripsy in general [RE RD-0.16, CI(-0.25,-0.06), I2 = 90%, P = 0.002] and in subgroup analysis of stones greater than 15 mm [RE RD-0.20, CI(-0.38,-0.02), I2 = 82%, P = 0.003]. Incidence of pancreatitis [FE RD-0.01, CI(-0.03, 0.01), I2 = 0, P = 0.36], cholangitis [FE RD-0.00, CI(-0.01, 0.01), I2 =0, P = 0.97] and perforation [FE RD-0.01, CI(-0.01, 0.00), I2 = 0, P = 0.23] was similar between the groups as well as similar stone removal rates in general [FE RD-0.01, CI(-0.01, 0.04), I2 = 0, P = 0.23] and pooled analysis of stones greater than 15 mm [FE RD-0.02, CI(-0.02, 0.07), I2 = 11%, P = 0.31]. CONCLUSION Through meta-analysis of randomized clinical trials we found that isolated sphincterotomy was associated with more post-ERCP bleeding and more need for mechanical lithotripsy. However, there was no statistical difference in the stone removal rate between isolated sphincterotomy and sphincterotomy associated with balloon dilation in the approach to remove gallstones. | Cesar Capel de Clemente Junior Wanderley Marques Bernardo Tomazo Prince Franzini Gustavo Oliveira Luz Marcos Eduardo Lera dos Santos Jonah Maxwell Cohen Diogo Turiani Hourneaux de Moura Fábio Ramalho Tavares Marinho Martin Coronel Paulo Sakai Eduardo Guimaraes Hourneaux de Moura | 2018 | World Journal of Gastrointestinal Endoscopy2018，10，8： | 8 |
| 5 | Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects显示文摘A gastrointestinal(GI) transmural defect is defined as total rupture of the GI wall,and these defects can be divided into three categories: perforations,leaks,and fistulas. Surgical management of these defects is usually challenging and may be associated with high morbidity and mortality rates. Recently,several novel endoscopic techniques have been developed,and endoscopy has become a firstline approach for therapy of these conditions. The use of endoscopic vacuum therapy(EVT) is increasing with favorable results. This technique involves endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. This promotes healing via five mechanisms,including macrodeformation,microdeformation,changes in perfusion,exudate control,and bacterial clearance,which is similar to the mechanisms in which skin wounds are treated with commonly employed wound vacuums. EVT can be used in the upper GI tract,small bowel,biliopancreatic regions,and lower GI tract,with variable success rates and a satisfactory safety profile. In this article,we review and discuss the mechanism of action,materials,techniques,efficacy,and safety of EVT in the management of patients with GI transmural defects. | Diogo Turiani Hourneaux de Moura Bruna Furia Buzetti Hourneaux de Moura Michael A Manfredi Kelly E Hathorn Ahmad N Bazarbashi Igor Braga Ribeiro Eduardo Guimaraes Hourneaux de Moura Christopher C Thompson | 2019 | World Journal of Gastrointestinal Endoscopy2019，11，5： | 6 |
| 6 | Propofol vs traditional sedatives for sedation in endoscopy:A systematic review and meta-analysis显示文摘BACKGROUND Propofol is commonly used for sedation during endoscopic procedures.Data suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of action and improved postprocedure recovery times for patients.However,Propofol requires administration by trained healthcare providers,has a narrow therapeutic index,lacks an antidote and increases risks of cardio-pulmonary complications.AIM To compare,through a systematic review of the literature and meta-analysis,sedation with propofol to traditional sedatives with or without propofol during endoscopic procedures.METHODS A literature search was performed using MEDLINE,Scopus,EMBASE,the Cochrane Library,Scopus,LILACS,BVS,Cochrane Central Register of Controlled Trials,and The Cumulative Index to Nursing and Allied Health Literature databases.The last search in the literature was performed on March,2019 with no restriction regarding the idiom or the year of publication.Only randomized clinical trials with full texts published were included.We divided sedation therapies to the following groups:(1)Propofol versus benzodiazepines and/or opiate sedatives;(2)Propofol versus Propofol with benzodiazepine and/or opioids;and(3)Propofol with adjunctive benzodiazepine and opioid versus benzodiazepine and opioid.The following outcomes were addressed:Adverse events,patient satisfaction with type of sedation,endoscopists satisfaction with sedation administered,dose of propofol administered and time to recovery post procedure.Meta-analysis was performed using RevMan5 software version 5.39.RESULTS A total of 23 clinical trials were included(n=3854)from the initial search of 6410 articles.For Group I(Propofol vs benzodiazepine and/or opioids):The incidence of bradycardia was not statistically different between both sedation arms(RD:-0.01,95%CI:-0.03–+0.01,I2:22%).In 10 studies,the incidence of hypotension was not statistically difference between sedation arms(RD:0.01,95%CI:-0.02–+0.04,I2:0%).Oxygen desaturation was higher in the propofol group but not statistically different between groups(RD:-0.03,95%CI:-0.06–+0.00,I2:25%).Patients were more satisfied with their sedation in the benzodiazepine+opioid group compared to those with monotherapy propofol sedation(MD:+0.89,95%CI:+0.62–+1.17,I2:39%).The recovery time after the procedure showed high heterogeneity even after outlier withdrawal,there was no statistical difference between both arms(MD:-15.15,95%CI:-31.85–+1.56,I2:99%).For Group II(Propofol vs propofol with benzodiazepine and/or opioids):Bradycardia had a tendency to occur in the Propofol group with benzodiazepine and/or opioidassociated(RD:-0.08,95%CI:-0.13–-0.02,I2:59%).There was no statistical difference in the incidence of bradycardia(RD:-0.00,95%CI:-0.08–+0.08,I2:85%),desaturation(RD:-0.00,95%CI:-0.03–+0.02,I2:44%)or recovery time(MD:-2.04,95%CI:-6.96–+2.88,I2:97%)between sedation arms.The total dose of propofol was higher in the propofol group with benzodiazepine and/or opiates but with high heterogeneity.(MD:70.36,95%CI:+53.11–+87.60,I2:61%).For Group III(Propofol with benzodiazepine and opioid vs benzodiazepine and opioid):Bradycardia and hypotension was not statistically significant between groups(RD:-0.00,95%CI:-0.002–+0.02,I2:3%;RD:0.04,95%CI:-0.05–+0.13,I2:77%).Desaturation was evaluated in two articles and was higher in the propofol+benzodiazepine+opioid group,but with high heterogeneity(RD:0.15,95%CI:0.08–+0.22,I2:95%).CONCLUSION This meta-analysis suggests that the use of propofol alone or in combination with traditional adjunctive sedatives is safe and does not result in an increase in negative outcomes in patients undergoing endoscopic procedures. | Aureo Augusto de Almeida Delgado Diogo Turiani Hourneaux de Moura Igor Braga Ribeiro Ahmad Najdat Bazarbashi Marcos Eduardo Lera dos Santos Wanderley Marques Bernardo Eduardo Guimaraes Hourneaux de Moura | 2019 | World Journal of Gastrointestinal Endoscopy2019，11，12： | 6 |
| 7 | Pancreatitis after endoscopic retrograde cholangiopancreatography:A narrative review显示文摘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 patients.Pre-examination measures,during the examination and after the examination are the key to technical and clinical success with a decrease in adverse events.Several studies have debated on the subject,however,numerous topics remain controversial,such as the effectiveness of prophylactic medications and the amylase dosage time.This review was designed to provide an update on the current scientific evidence regarding PEP available in the literature. | 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 | 2021 | World Journal of Gastroenterology2021，27，20： | 5 |
| 8 | Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis:A systematic review and meta-analysis of randomized controlled trials显示文摘BACKGROUND Patients with cirrhosis frequently require sedation for elective endoscopic procedures.Several sedation protocols are available,but choosing an appropriate sedative in patients with cirrhosis is challenging.AIM To conduct a systematic review and meta-analysis to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best approach.METHODS This systematic review and meta-analysis was conducted using the PRISMA guidelines.Electronic searches were performed using MEDLINE,EMBASE,Central Cochrane,LILACS databases.Only randomized control trials(RCTs)were included.The outcomes studied were procedure time,recovery time,discharge time,and adverse events(bradycardia,hypotension,and hypoxemia).The risk of bias assessment was performed using the Revised Cochrane Risk-of-Bias tool for randomized trials(RoB-2).Quality of evidence was evaluated by GRADEpro.The meta-analysis was performed using Review Manager.RESULTS The search yielded 3,576 records.Out of these,8 RCTs with a total of 596 patients(302 in the propofol group and 294 in the midazolam group)were included for the final analysis.Procedure time was similar between midazolam and propofol groups(MD:0.25,95%CI:-0.64 to 1.13,P=0.59).Recovery time(MD:-8.19,95%CI:-10.59 to-5.79,P<0.00001).and discharge time were significantly less in the propofol group(MD:-12.98,95%CI:-18.46 to-7.50,P<0.00001).Adverse events were similar in both groups(RD:0.02,95%CI:0-0.04,P=0.58).Moreover,no significant difference was found for bradycardia(RD:0.03,95%CI:-0.01 to 0.07,P=0.16),hypotension(RD:0.03,95%CI:-0.01 to 0.07,P=0.17),and hypoxemia(RD:0.00,95%CI:-0.04 to 0.04,P=0.93).Five studies had low risk of bias,two demonstrated some concerns,and one presented high risk.The quality of the evidence was very low for procedure time,recovery time,and adverse events;while low for discharge time.CONCLUSION This systematic review and meta-analysis based on RCTs show that propofol has shorter recovery and patient discharge time as compared to midazolam with a similar rate of adverse events.These results suggest that propofol should be the preferred agent for sedation in patients with cirrhosis. | John Alexander Lata Guacho Diogo Turiani Hourneaux de Moura Igor Braga Ribeiro Alberto Machado da Ponte Neto Shailendra Singh Marina Gammaro Baldavira Tucci Wanderley Marques Bernardo Eduardo Guimarães Hourneaux de Moura | 2020 | World Journal of Gastrointestinal Endoscopy2020，12，8： | 4 |
| 9 | Role of pancreatography in the endoscopic management of encapsulated pancreatic collections-review and new proposed classification显示文摘Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or complicated.Within 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 drainage.Proper 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 syndrome.Additionally,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 stents.Pancreatography to adequately assess the main pancreatic duct may be performed by two methods:Either non-invasively using magnetic resonance cholangiopancreatography or endoscopically via retrograde cholangiopancreatography.Despite 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 literature.Therefore,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. | 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 | 2020 | World Journal of Gastroenterology2020，26，45： | 3 |
| 10 | Treatment of high-grade dysplasia and intramucosal carcinoma using radiofrequency ablation or endoscopic mucosal resection + radiofrequency ablation: Meta-analysis and systematic review显示文摘BACKGROUND The progression of Barrett's esophagus(BE) to early esophageal carcinoma occurs sequentially; the metaplastic epithelium develops from a low-grade dysplasia to a high-grade dysplasia(HGD), resulting in early esophageal carcinoma and,eventually, invasive carcinoma. Endoscopic approaches including resection and ablation can be used in the treatment of this condition.AIM To compare the effectiveness of radiofrequency ablation(RFA) vs endoscopic mucosal resection(EMR) + RFA in the endoscopic treatment of HGD and intramucosal carcinoma.METHODS In accordance with PRISMA guidelines, this systematic review included studies comparing the two endoscopic techniques(EMR + RFA and RFA alone) in the treatment of HGD and intramucosal carcinoma in patients with BE. Our analysis included studies involving adult patients of any age with BE with HGD or intramucosal carcinoma. The studies compared RFA and EMR + RFA methods were included regardless of randomization status.RESULTS The seven studies included in this review represent a total of 1950 patients, with742 in the EMR + RFA group and 1208 in the RFA alone group. The use of EMR +RFA was significantly more effective in the treatment of HGD [RD 0.35(0.15,0.56)] than was the use of RFA alone. The evaluated complications(stenosis,bleeding, and thoracic pain) were not significantly different between the two groups.CONCLUSION Endoscopic resection in combination with RFA is a safe and effective method in the treatment of HGD and intramucosal carcinoma, with higher rates of remission and no significant differences in complication rates when compared to the use of RFA alone. | Mileine Valente de Matos Alberto Machado da Ponte-Neto Diogo Turiani Hourneaux de Moura Ethan Dwane Maahs Dalton Marques Chaves Elisa Ryoka Baba Edson Ide Rubens Sallum Wanderley Marques Bernardo Eduardo Guimar?es Hourneaux de Moura | 2019 | World Journal of Gastrointestinal Endoscopy2019，11，3： | 2 |
| 11 | 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显示文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)originate from interstitial cells of Cajal.GISTs can occur anywhere along the gastrointestinal tract.Large lesions have traditionally been removed surgically.However,with recent innovations in advanced endoscopy,GISTs located within the stomach are now removed endoscopically.We describe a new innovative endoscopic technique to close large and hard to access defects after endoscopic full-thickness resection of gastric GISTs.CASE SUMMARY We present a series of three patients who were diagnosed with a gastric GIST.All patients underwent full-thickness endoscopic resection.In all cases,for closure of the surgical bed,conventional endoscopic techniques including hemoclips,endoloop and suturing were unsuccessful.We performed a new technique in which we pulled omental fat into the gastric lumen and completely closed the defect using endoscopic devices.All patients performed well post-procedure and computed tomography was carried out one day after the procedures which showed no extravasation of contrast.CONCLUSION The omental plug technique may be used as an alternative to surgery in selected cases of gastric perforation. | Amit H Sachdev Shahzad Iqbal Igor Braga Ribeiro Diogo Turiani Hourneaux de Moura | 2020 | World Journal of Clinical Cases2020，8，1： | 2 |
| 12 | Acute bleeding after argon plasma coagulation for weight regain after gastric bypass: A case report显示文摘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 complication.CASE 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 GJA.Coagulation 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 vessel.Subsequently,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 later.CONCLUSION 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 infrequent and potentially life-threatening complication associated with this therapy.Endoscopic management is the first line therapy used to achieve hemostasis in these cases. | Diogo Turiani Hourneaux de Moura Amit H Sachdev Po-Wen Lu Igor Braga Ribeiro Christopher C Thompson | 2019 | World Journal of Clinical Cases2019，7，15： | 1 |
| 13 | Antibiotic prophylaxis to prevent complications in endoscopic retrograde cholangiopancreatography:A systematic review and meta-analysis of randomized controlled trials显示文摘BACKGROUND The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography(ERCP)is still controversial.AIM To assess whether antibiotic prophylaxis reduces the rates of complications in patients undergoing elective ERCP.METHODS 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 performed.Only randomized controlled trials were included.The outcomes analyzed included bacteremia,cholangitis,sepsis,pancreatitis,and mortality.The risk of bias was assessed by the Cochrane revised Risk-of-Bias tool for randomized controlled trials.The quality of evidence was assessed by the Grading of Recommendation Assessment,Development,and Evaluation.Meta-analysis was performed using the Review Manager 5.4 software.RESULTS 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 included.There 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. | 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 | 2022 | World Journal of Gastrointestinal Endoscopy2022，14，11： | 1 |
| 14 | Endoscopic retrograde cholangiopancreatography drainage for palliation of malignant hilar biliary obstruction——stent-in-stent or side-by-side?A systematic review and meta-analysis显示文摘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 advantages.AIM To compare both techniques regarding their efficacy and safety in achieving drainage of MHBO.METHODS 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 English.The included studies compared SIS and SBS techniques through endoscopic retrograde cholangiopancreatography.Outcomes analyzed included technical and clinical success,early and late adverse events(AEs),stent patency,reintervention,and procedure-related mortality.RESULTS 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 study.There 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 MHBO.Both techniques are equivalent in terms of technical success,clinical success,rates of both early and late AEs,reintervention,and procedure-related mortality. | 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 | 2021 | World Journal of Hepatology2021，13，5： | 1 |
| 15 | Sodium picosulphate or polyethylene glycol before elective colonoscopy in outpatients?A systematic review and meta-analysis显示文摘AIM To determine the best option for bowel preparation [sodium picosulphate or polyethylene glycol(PEG)] for elective colonoscopy in adult outpatients.METHODS A systematic review of the literature following the PRISMA guidelines was performed using Medline, Scopus, EMBASE, Central, Cinahl and Lilacs. No restrictions were placed for country, year of publication or language. The last search in the literature was performed on November 20th, 2017. Only randomized clinical trials with full texts published were included. The subjects included were adult outpatients who underwent bowel cleansing for elective colonoscopy. The included studies compared sodium picosulphate with magnesium citrate(SPMC)and PEG for bowel preparation. Exclusion criteria were the inclusion of inpatients or groups with specific conditions, failure to mention patient status(outpatient or inpatient) or dietary restrictions, and permission to have unrestricted diet on the day prior to the exam. Primary outcomes were bowel cleaning success and/or tolerability of colon preparation. Secondary outcomes were adverse events, polyp and adenoma detection rates. Data on intention-totreat were extracted by two independent authors and risk of bias assessed through the Jadad scale. Funnel plots, Egger's test, Higgins' test(I2) and sensitivity analyses were used to assess reporting bias and heterogeneity. The meta-analysis was performed by computing risk difference(RD) using MantelHaenszel(MH) method with fixed-effects(FE) and random-effects(RE) models.Review Manager 5(RevMan 5) version 6.1(The Cochrane Collaboration) was the software chosen to perform the meta-analysis.RESULTS662 records were identified but only 16 trials with 6200 subjects were included for the meta-analysis. High heterogeneity among studies was found and sensitivity analysis was needed and performed to interpret data. In the pooled analysis,SPMC was better for bowel cleaning [MH FE, RD 0.03, IC(0.01, 0.05), P = 0.003, I2= 33%, NNT 34], for tolerability [MH RE, RD 0.08, IC(0.03, 0.13), P = 0.002, I2 =88%, NNT 13] and for adverse events [MH RE, RD 0.13, IC(0.05, 0.22), P = 0.002,I2 = 88%, NNT 7]. There was no difference in regard to polyp and adenoma detection rates. Additional analyses were made by subgroups(type of regimen,volume of PEG solution and dietary recommendations). SPMC demonstrated better tolerability levels when compared to PEG in the following subgroups:'day-before preparation' [MH FE, RD 0.17, IC(0.13, 0.21), P < 0.0001, I2 = 0%,NNT 6], 'preparation in accordance with time interval for colonoscopy' [MH RE,RD 0.08, IC(0.01, 0.15), P = 0.02, I2 = 54%, NNT 13], when compared to 'highvolume PEG solutions' [MH RE, RD 0.08, IC(0.01, 0.14), I2 = 89%, P = 0.02, NNT13] and in the subgroup 'liquid diet on day before' [MH RE, RD 0.14, IC(0.06,0.22), P = 0.0006, I2 = 81%, NNT 8]. SPMC was also found to cause fewer adverse events than PEG in the 'high-volume PEG solutions' [MH RE, RD-0.18,IC(-0.30,-0.07), P = 0.002, I2 = 79%, NNT 6] and PEG in the 'low-residue diet'subgroup [MH RE, RD-0.17, IC(-0.27, 0.07), P = 0.0008, I2 = 86%, NNT 6].CONCLUSION SPMC seems to be better than PEG for bowel preparation, with a similar bowel cleaning success rate, better tolerability and lower prevalence of adverse events. | Rodrigo Silva de Paula Rocha Igor Braga Ribeiro Diogo Turiani Hourneaux de Moura Wanderley Marques Bernardo Maurício Kazuyoshi Minata Flávio Hiroshi Ananias Morita Júlio Cesar Martins Aquino Elisa Ryoka Baba Nelson Tomio Miyajima Eduardo Guimaraes Hourneaux de Moura | 2018 | World Journal of Gastrointestinal Endoscopy2018，10，12： | 1 |
| 16 | Gallbladder perforation due to endoscopic sleeve gastroplasty: A case report and review of literature显示文摘BACKGROUND The healthcare impact of obesity is enormous,and there have been calls for new approaches to containing the epidemic worldwide.Minimally invasive procedures have become more popular,with one of the most widely used being endoscopic sleeve gastroplasty(ESG).Although major adverse events after ESG are rare,some can cause considerable mortality.To our knowledge,there has been no previous report of biliary ascites after ESG.CASE SUMMARY A 48-year-old female with obesity refractory to lifestyle changes and prior gastric balloon placement underwent uncomplicated ESG and was discharged on the following day.On postoperative day 3,she developed abdominal pain,which led to an emergency department visit the following day.She was readmitted to the hospital,with poor general health status and signs of peritoneal irritation.Computed tomography imaging showed fluid in the abdominal cavity.Laparoscopy revealed biliary ascites and showed that the gallbladder was sutured to the gastric wall.The patient underwent cholecystectomy and lavage of the abdominal cavity and was admitted to the intensive care unit postoperatively.After 7 d of antibiotic therapy and 20 d of hospitalization,she was discharged.Fortunately,6 mo later,she presented in excellent general condition and with a 20.2%weight loss.CONCLUSION ESG is a safe procedure.However,adverse events can still occur,and precautions should be taken by the endoscopist.In general,patient position,depth of tissue acquisition,location of stitch placement,and endoscopist experience are all important factors to consider to mitigate procedural risk. | João de Siqueira Neto Diogo Turiani Hourneaux de Moura Igor Braga Ribeiro Sérgio Alexandre Barrichello Kelly E Harthorn Christopher C Thompson | 2020 | World Journal of Gastrointestinal Endoscopy2020，12，3： | 1 |
| 17 | Endoscopic vs radiologic gastrostomy for enteral feeding:A systematic review and meta-analysis显示文摘BACKGROUND Percutaneous endoscopic gastrostomy(PEG)and percutaneous radiological gastrostomy(PRG)are minimally invasive techniques commonly used for prolonged enteral nutrition.Despite safe,both techniques may lead to complications,such as bleeding,infection,pain,peritonitis,and tube-related complications.The literature is unclear on which technique is the safest.AIM To establish which approach has the lowest complication rate.METHODS A database search was performed from inception through November 2022,and comparative studies of PEG and PRG were selected following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.All included studies compared the two techniques directly and provided absolute values of the number of complications.Studies with pediatric populations were excluded.The primary outcome of this study was infection and bleeding.Pneumonia,peritonitis,pain,and mechanical complications were secondary outcomes.The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials(RoB2)and we used The Risk of Bias in Nonrandomized Studies(ROBINS-I)to analyze the retrospective studies.We also performed GRADE analysis to assess the quality of evidence.Data on risk differences and 95%confidence intervals were obtained using the Mantel-Haenszel test.RESULTS Seventeen studies were included,including two randomized controlled trials and fifteen retrospective cohort studies.The total population was 465218 individuals,with 273493 having undergone PEG and 191725 PRG.The only outcome that showed a significant difference was tube related complications in retrospective studies favoring PEG(95%CI:0.03 to 0.08;P<0.00001),although this outcome did not show significant difference in randomized studies(95%CI:-0.07 to 0.04;P=0.13).There was no difference in the analyses of the following outcomes:infection in retrospective(95%CI:-0.01 to 0.00;P<0.00001)or randomized(95%CI:-0.06 to 0.04;P=0.44)studies;bleeding in retrospective(95%CI:-0.00 to 0.00;P<0.00001)or randomized(95%CI:-0.06 to 0.02;P=0.43)studies;pneumonia in retrospective(95%CI:-0.04 to 0.00;P=0.28)or randomized(95%CI:-0.09 to 0.11;P=0.39)studies;pain in retrospective(95%CI:-0.05 to 0.02;P<0.00001)studies;peritonitis in retrospective(95%CI:-0.02 to 0.01;P<0.0001)studies.CONCLUSION PEG has lower levels of tube-related complications(such as dislocation,leak,obstruction,or breakdown)when compared to PRG. | Evellin Souza Valentim dos Santos Guilherme Henrique Peixoto de Oliveira Diogo Turiani Hourneaux de Moura Bruno Salomão Hirsch Roberto Paolo Trasolini Wanderley Marques Bernardo Eduardo GuimarãesHourneaux de Moura | 2023 | World Journal of Meta-Analysis2023，11，6： | 0 |
| 18 | Effects of intragastric balloon placement in metabolic dysfunctionassociated fatty liver disease: A systematic review and metaanalysis显示文摘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 dysregulation.AIM 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 markers.METHODS A comprehensive search was done of multiple electronic databases(MEDLINE,EMBASE,LILACS,Cochrane and Google Scholar)and grey literature from their inception until February 2021.Inclusion criteria involved patients with a body mass index>25 kg/m2 with evidence or previous diagnosis of hepatic steatosis.Outcomes 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 included.After 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. | 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 | 2021 | World Journal of Hepatology2021，13，7： | 0 |
| 19 | Gastrointestinal symptoms in patients with COVID-19: Is there a relationship with mortality and new variations of SARS-CoV-2?显示文摘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 symptoms.The gastrointestinal symptoms of COVID-19 include diarrhea,abdominal pain,anorexia,and nausea among other symptoms.Some 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? | Igor Braga Ribeiro Diogo Turiani Hourneaux de Moura Eduardo Guimarães Hourneaux de Moura | 2021 | World Journal of Gastroenterology2021，27，37： | 0 |
| 20 | Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas:Basic principles and recommendations显示文摘Post-surgical leaks and fistulas are the most feared complication of bariatric surgery.They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat.These two related conditions must be distinguished and characterized to guide the appropriate treatment.Leak 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 surfaces.Traditionally,surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates.However,with the development of novel devices and techniques,endoscopic therapy plays an increasingly essential role in managing these conditions.Early 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 fistulas.Several endoscopic techniques are available with different mechanisms of action,including direct closure,covering/diverting or draining.The treatment should be individualized by considering the characteristics of both the patient and the defect.Although 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. | Victor Lira de Oliveira Alexandre Moraes Bestetti Roberto Paolo Trasolini Eduardo Guimaraes Hourneaux de Moura Diogo Turiani Hourneaux de Moura | 2023 | World Journal of Gastroenterology2023，29，7： | 0 |
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