10 results on '"Moura EGH"'
Search Results
2. Laparoscopic total fundoplication is superior to medical treatment for reducing the cancer risk in Barrett's esophagus: a long-term analysis.
- Author
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Szachnowicz S, Duarte AF, Nasi A, da Rocha JRM, Seguro FB, Bianchi ET, Tustumi F, de Moura EGH, Sallum RAA, and Cecconello I
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- Humans, Fundoplication, Prospective Studies, Omeprazole, Barrett Esophagus complications, Barrett Esophagus drug therapy, Barrett Esophagus surgery, Esophageal Neoplasms etiology, Esophageal Neoplasms prevention & control, Esophageal Neoplasms diagnosis, Adenocarcinoma etiology, Adenocarcinoma prevention & control, Adenocarcinoma surgery, Laparoscopy
- Abstract
The present study aims to compare the effectiveness of surgical and medical therapy in reducing the risk of cancer in Barrett's esophagus in a long-term evaluation. A prospective cohort was designed that compared Barrett's esophagus patients submitted to medical treatment with omeprazole or laparoscopic Nissen fundoplication. The groups were compared using propensity score matching paired by Barrett's esophagus length. A total of 398 patients met inclusion criteria. There were 207 patients in the omeprazole group (Group A) and 191 in the total fundoplication group (Group B). After applying the propensity score matching paired by Barrett's esophagus length, the groups were 180 (Group A) and 190 (Group B). Median follow-up was 80 months. Group B was significantly superior for controlling GERD symptoms. Group B was more efficient than Group A in promoting Barrett's esophagus regression or blocking its progression. Group B was more efficient than Group A in preventing the development of dysplasia and cancer. Logistic regression was performed for the outcomes of adenocarcinoma and dysplasia. Age and body mass index were used as covariates in the logistic regression models. Even after regression analysis, Group B was still superior to Group A to prevent esophageal adenocarcinoma or dysplasia transformation (odds ratio [OR]: 0.51; 95% confidence interval [CI]: 0.27-0.97, for adenocarcinoma or any dysplasia; and OR: 0.26; 95% CI: 0.08-0.81, for adenocarcinoma or high-grade dysplasia). Surgical treatment is superior to medical management, allowing for better symptom control, less need for reflux medication use, higher regression rate of the columnar epithelium and intestinal metaplasia, and lower risk for progression to dysplasia and cancer., (© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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3. Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial.
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de Moura ETH, Jukemura J, Ribeiro IB, Farias GFA, de Almeida Delgado AA, Coutinho LMA, de Moura DTH, Aissar Sallum RA, Nasi A, Sánchez-Luna SA, Sakai P, and de Moura EGH
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- Adult, Barium, Esophageal Sphincter, Lower surgery, Esophagoscopy adverse effects, Esophagoscopy methods, Fundoplication adverse effects, Fundoplication methods, Humans, Quality of Life, Treatment Outcome, Esophageal Achalasia diagnosis, Esophageal Achalasia etiology, Esophageal Achalasia surgery, Esophagitis, Peptic etiology, Gastroesophageal Reflux etiology, Laparoscopy adverse effects, Laparoscopy methods, Myotomy adverse effects, Myotomy methods, Natural Orifice Endoscopic Surgery adverse effects, Natural Orifice Endoscopic Surgery methods
- Abstract
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 condition., Aim: To compare POEM and laparoscopic myotomy and partial fundoplication (LM-PF) regarding their efficacy and outcomes for the treatment of achalasia., Methods: 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 vs 296.75 ± 56.13 and 218.75 ± 50.88 min, respectively; P = 0.001 for both). In the POEM group, there were improvements in all domains of the QoL questionnaire, whereas there were improvements in only three domains in the LM-PF group., Conclusion: POEM and LM-PF appear to be equally effective in controlling the symptoms of achalasia, shortening LOS, and minimizing AEs. Nevertheless, POEM has the advantage of improving all domains of QoL, and shortening anesthesia and procedure times but with a significantly higher rate of gastroesophageal reflux., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)
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- 2022
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4. Endoscopic management of acute leak after sleeve gastrectomy: principles and techniques.
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de Moura DTH, de Freitas Júnior JR, de Souza GMV, de Oliveira GHP, McCarty TR, Thompson CC, and de Moura EGH
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- Anastomotic Leak diagnostic imaging, Anastomotic Leak etiology, Anastomotic Leak surgery, Gastrectomy adverse effects, Gastrectomy methods, Humans, Treatment Outcome, Laparoscopy methods, Obesity, Morbid surgery
- Abstract
Competing Interests: The authors declare that they have no conflict of interest.
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- 2022
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5. Bigger is not always better for the endoscopic treatment of sleeve gastrectomy (SG) leaks using fully covered stents.
- Author
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Sánchez-Luna SA, De Moura EGH, and De Moura DTH
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- Anastomotic Leak surgery, Endoscopy, Gastrectomy, Humans, Retrospective Studies, Stents, Treatment Outcome, Laparoscopy, Obesity, Morbid surgery
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- 2022
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6. Endoscopic approach to complex gastric tube stricture after laparoscopic sleeve gastroplasty: a case report.
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Funari MP, Miranda Neto AA, Sagae VMT, de Souza TF, Minata MK, Cheng S, and de Moura EGH
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- Constriction, Pathologic etiology, Constriction, Pathologic surgery, Gastrectomy, Humans, Treatment Outcome, Gastroplasty adverse effects, Laparoscopy, Obesity, Morbid surgery
- Abstract
Competing Interests: The authors declare that they have no conflict of interest.
- Published
- 2021
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7. Endoscopic sleeve gastroplasty in the management of weight regain after sleeve gastrectomy.
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de Moura DTH, Barrichello S Jr, de Moura EGH, de Souza TF, Dos Passos Galvão Neto M, Grecco E, Sander B, Hoff AC, Matz F, Ramos F, de Lima JHF, Teixeira L, Dib V, Falcão M, Potti H, Baretta G, Jirapinyo P, and Thompson CC
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- Body Mass Index, Gastrectomy, Humans, Retrospective Studies, Treatment Outcome, Weight Gain, Gastroplasty methods, Laparoscopy, Obesity, Morbid surgery
- Abstract
Background: Sleeve gastrectomy is a well-standardized surgical treatment for obesity. However, rates of weight regain after sleeve gastrectomy in long-term follow-up are relatively high. This multicenter study is the first to evaluate the use of an endoscopic sleeve gastroplasty (ESG) technique for the management of this population., Methods: This was a multicenter retrospective study, including patients with weight regain following sleeve gastrectomy who underwent ESG for weight loss. Primary outcomes included absolute weight loss, percent total weight loss (%TWL), change in body mass index (BMI), percent excess weight loss (%EWL) at 6 and 12 months, and safety profile. Clinical success was defined as achieving ≥ 25 % EWL at 1 year, ≤ 5 % serious adverse event (SAE) rate following society-recommended thresholds, and %TWL ≥ 10 %., Results: 34 patients underwent ESG after sleeve gastrectomy. Technical success was 100 %. At 1 year, 82.4 % and 100 % of patients achieved ≥ 10 %TWL and ≥ 25 % EWL, respectively. Mean (SD) %TWL was 13.2 % (3.9) and 18.3 % (5.5), and %EWL was 51.9 % (19.1) and 69.9 % (29.9) at 6 months and 1 year, respectively. Mean (SD) %TWL was 14.2 % (12.5), 19.3 % (5.3), 17.5 % (5.2), and 20.4 % (3.3), and %EWL was 88.5 % (52.8), 84.4 % (22.4), 55.4 % (14.8), and 47.8 % (11.2) for BMI categories of overweight and obesity class I, II, and III, respectively, at 1 year. No predictors of success were identified in the multivariable regression analysis. No SAEs were reported., Conclusion: ESG appears to be safe and effective in the management of weight regain following sleeve gastrectomy., Competing Interests: Dr. E. G. H. de Moura is a consultant (with nonfinancial support) for Boston Scientific and Olympus. Dr. Galvão Neto has received grants and personal fees from Fractyl Labs, GI dynamics, GI windows, Apollo Endosurgery, Olympus, Medtronic, and M.I. Tech. Dr. Thompson has received grants from Apollo Endosurgery and Olympus, and personal fees from Medtronic, Boston Scientific, Apollo Endosurgery, and Olympus., (© Georg Thieme Verlag KG Stuttgart · New York.)
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- 2020
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8. Pneumatic dilation versus laparoscopic Heller's myotomy in the treatment of achalasia: systematic review and meta-analysis based on randomized controlled trials.
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Bonifácio P, de Moura DTH, Bernardo WM, de Moura ETH, Farias GFA, Neto ACM, Lordello M, Korkischko N, Sallum R, and de Moura EGH
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- Adult, Esophageal Sphincter, Lower surgery, Female, Humans, Male, Middle Aged, Randomized Controlled Trials as Topic, Treatment Outcome, Dilatation methods, Esophageal Achalasia surgery, Heller Myotomy methods, Laparoscopy methods
- Abstract
Achalasia is a primary esophageal motor disorder with a variety of causes. It is most common in Central and South America, where Chagas disease is endemic. In addition to the infectious etiology, achalasia can be idiopathic, autoimmune, or drug induced. It is an incurable, progressive condition that destroys the intramural nerve plexus, causing aperistalsis of the esophageal body and impaired relaxation of the lower esophageal sphincter. The literature on the treatment of achalasia comparing pneumatic dilation (PD) and laparoscopic Heller's myotomy (LHM) shows conflicting results. Therefore, a systemic review and meta-analysis are needed. A systematic review and meta-analysis of randomized controlled trials of PD and LHM, based on the preferred reporting items for systematic reviews and meta-analyses recommendations, was presented. The primary outcome was symptom remission based on the Eckardt score. Secondary outcomes were lower esophageal sphincter pressure (LESP), gastroesophageal reflux (GER), and perforation. A total of four studies were included in this analysis. The total number of patients was 404. Posttreatment symptom remission rates did not differ significantly between LHM and PD at 2 years (RD = 0.03, 95% CI [-0.05, 0.12], P = 0.62), or 5 years (RD = 0.13, 95% CI [-0.12, 0.39], P = 0.32). The posttreatment perforation rate was lower for LHM (RD = 0.04, 95% CI [-0.08, -0.01], P = 0.03). There was no significant difference in terms of LESP or GER. For the treatment of esophageal achalasia, LHM and PD were found to be similar in terms of their long-term efficacy, as well as in terms of the posttreatment GER rates. However, the perforation rate appears to be lower when LHM is employed.
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- 2019
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9. Comparison between Enteroscopy-Based and Laparoscopy-Assisted ERCP for Accessing the Biliary Tree in Patients with Roux-en-Y Gastric Bypass: Systematic Review and Meta-analysis.
- Author
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da Ponte-Neto AM, Bernardo WM, de A Coutinho LM, Josino IR, Brunaldi VO, Moura DTH, Sakai P, Kuga R, and de Moura EGH
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- Balloon Enteroscopy adverse effects, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Humans, Laparoscopy adverse effects, Outcome Assessment, Health Care, Balloon Enteroscopy methods, Biliary Tract diagnostic imaging, Cholangiopancreatography, Endoscopic Retrograde methods, Gastric Bypass, Laparoscopy methods
- Abstract
Although balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography (BAE-ERCP) is a well-described means of accessing the duodenal papilla in patients with Roux-en-Y gastric bypass (RYGB), it is associated with modest clinical success rates. Laparoscopy-assisted ERCP (LA-ERCP)-performed by advancing a standard duodenoscope through a gastrostomy into the excluded stomach and duodenum-has emerged as a viable alternative to BAE-ERCP, with apparently higher success rates. In this systematic review, we compare LA-ERCP with enteroscopy-based techniques in post-RYGB patients, including 22 case series that provided data on papilla identification, papilla cannulation, and complications. We found that LA-ERCP was superior to the enteroscopy-based techniques in its capacity to reach the duodenal papilla, although complication rates were lower for the latter. Comparative studies are needed in order to corroborate our findings.
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- 2018
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10. Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass.
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Abbas AM, Strong AT, Diehl DL, Brauer BC, Lee IH, Burbridge R, Zivny J, Higa JT, Falcão M, El Hajj II, Tarnasky P, Enestvedt BK, Ende AR, Thaker AM, Pawa R, Jamidar P, Sampath K, de Moura EGH, Kwon RS, Suarez AL, Aburajab M, Wang AY, Shakhatreh MH, Kaul V, Kang L, Kowalski TE, Pannala R, Tokar J, Aadam AA, Tzimas D, Wagh MS, and Draganov PV
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- Adult, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Female, Gastric Bypass, Humans, Length of Stay, Male, Middle Aged, Operative Time, Retrospective Studies, Cholangiopancreatography, Endoscopic Retrograde methods, Laparoscopy adverse effects
- Abstract
Background and Aims: The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases, yet standard ERCP is not possible because of surgically altered gastroduodenal anatomy. Laparoscopy-assisted ERCP (LA-ERCP) has been proposed as an option, but supporting data are derived from single-center small case series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP., Methods: This is a retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all the following were achieved: reaching the papilla, cannulating the desired duct, and providing endoscopic therapy as clinically indicated., Results: A total of 579 patients (median age, 51; 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (interquartile range [IQR], 109-210), with a median ERCP time of 40 minutes (IQR, 28-56). Median hospital stay was 2 days (IQR, 1-3). Adverse events were 18% (laparoscopy related, 10%; ERCP related, 7%; both, 1%) with the clear majority (92%) classified as mild/moderate, whereas 8% were severe and 1 death occurred., Conclusions: Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. The ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher because of the added laparoscopy-related events., (Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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