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Background and study aims Esophageal squamous cell carcinoma (ESCC) is the most common secondary tumor in patients with head and neck squamous cell cancer (HNSCC). Currently, endoscopic submucosal dissection (ESD) is the preferred approach to manage superficial ESCC, however, it remains to be elucidated whether patients with HNSCC and early ESCC managed by ESD have different outcomes. Patients and methods We retrospectively analyzed esophageal ESD for early ESCC from September 2009 to September 2017 and the following variables: demographics, tumor and specimen size, Paris classification, location, en bloc and R0 resection rates, overall survival (OS) and adverse events (AEs). To reduce selection bias, propensity score matching was applied to compare the results. Results Eighty-nine ESDs were performed in 81 consecutive patients (47 with HNSCC and 34 without HNSCC). Patients with HNSCC who developed superficial ESCC were found to be younger and to refer a more frequent history of alcohol ingestion and smoking. There was no difference in lesion size, number of lesions, procedure time, en bloc resection rate, R0 resection rate, local recurrence and adverse event rate between the two groups. The histological depth of invasion for patients with HNSCC was significantly shallower before (P = 0.016) and after (P = 0.047) matching. The overall survival rate was similar in both groups. Conclusions Patients with HNSCC have earlier detection of ESCC, probably due to endoscopic screening. Previous history of chemoradiation and surgery for HNSCC does not affect procedure time, AEs and OS.

SUMMARY INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Our aim was to evaluate the outcomes of this technique in our initial experience. METHODS: Patients with GOO from our institute were included. Technical success was defined as the successful creation of a gastroenterostomy. Clinical success was defined as the ability to tolerate a soft diet after the procedure. We assessed adverse events and diet tolerance 1 month after the procedure. RESULTS: Three patients were included. Technical and clinical success was achieved in all cases. There were no adverse events and good diet tolerance was observed 1 month after the procedure in the included patients. CONCLUSION: EUS-GE is a promising treatment for patients with GOO. RESUMO INTRODUÇÃO: A gastroenterostomia ecoguiada é um novo procedimento para paliação da obstrução maligna gastroduodenal. Nosso objetivo foi avaliar os resultados dessa técnica em nossa experiência inicial. MÉTODOS: Foram incluídos pacientes com obstrução maligna gastroduodenal de nossa instituição. O sucesso técnico foi definido como a realização adequada de uma gastroenterostomia. O sucesso clínico foi definido como boa aceitação de dieta pastosa durante a internação. Os eventos adversos e a aceitação alimentar foram avaliados um mês após o procedimento. RESULTADOS: Três pacientes foram incluídos. Os sucessos técnico e clínico foram alcançados em todos os casos. Não houve eventos adversos e a aceitação alimentar permaneceu adequada um mês após o procedimento nos pacientes incluídos. CONCLUSÃO: O EUS-GE é um tratamento promissor para pacientes com obstrução maligna gastroduodenal.

Overweight and obesity are a global epidemic and a major public health problem in the world, and many methods are currently used to reduce this disease. The aim of this chapter is to perform an overview of intragastric balloons on an evidence-based perspective. In the literature review, the intragastric balloon associated with diet is more effective than sham/diet when comparing body mass index (BMI), weight loss (WL), and percent of excess weight loss (%EWL). The use of intragastric balloons for obesity treatment, in addition to lifestyle modification, is an effective short-term modality for weight loss in selected patients.

OBJECTIVE: Our aim was to evaluate the Japan Gastroenterological Endoscopy Society criteria for endoscopic submucosal resection of early gastric cancer (EGC) based on the experience in a Brazilian cancer center. METHODS: We included all patients who underwent endoscopic submucosal resection for gastric lesions between February 2009 and October 2016. Demographic data and information regarding the endoscopic resection, pathological report and follow-up were obtained. Statistical calculations were performed with Fisher’s exact test and chi-square tests, with 95% confidence intervals. RESULTS: In total, 76% of the 51 lesions were adenocarcinomas, 16% were adenomas, and 8% had other diagnoses. The average size was 19.9 mm (±11.7). The average procedure length was 113.9 minutes (±71.4). The complication rate was 21.3%, with only one patient who needed surgical treatment (transmural perforation). Among the adenocarcinomas, 39.5% met the classic criteria for curability, 31.6% met the expanded criteria and 28.9% met the criteria for noncurative resection. Analysis of the indication criteria and curability revealed differences among cases with “only-by-size” expanded criteria (64.28%), other expanded criteria (40%) and classic criteria (89.47%), with a p-value of 0.049. During follow-up (15.8 months; ±14.3), 86.1% of the EGC patients had no recurrence. When well-differentiated and poorly differentiated lesions or lesions included in the classic and expanded criteria were compared, there were no differences in recurrence. The noncurative group presented a higher recurrence rate than the classic group (p=0.014). CONCLUSION: These results suggest that the Japanese endoscopic submucosal resection criteria might be useful for endoscopic treatment of EGC in Western countries.

Upper gastrointestinal bleeding (UGIB) is one of the most common causes of emergency department visits worldwide and represents a significant public health problem in many countries. Endoscopy plays a major role in the diagnosis and treatment of UGIB. Endoscopic hemostasis of peptic ulcer bleeding is preferably achieved by the combination of injection with contact thermal methods or mechanical methods. Argon plasma coagulation (APC) is a noncontact thermal method of hemostasis that has been employed to treat bleeding angioectasia. The use of APC in this situation presents satisfactory results with a low adverse event rate. APC presents the possibility to treat large bleeding areas in a single session. There is also a limited experience with the use of APC for peptic ulcer bleeding and bleeding from gastrointestinal neoplasia. More recently, radiofrequency ablation has been employed for the treatment of diffuse UGIB caused by angioectasias with promising results.

Background Obesity has become a worldwide epidemic, and many methods are currently used to reduce obesity. This systematic review shows the effectiveness of the intragastric balloon (IGB) method compared to the sham/diet (s/d) method. Objective To demonstrate the effectiveness of the IGB method compared to the s/d method. Setting Hospital das Clinicas da Universidade de Sao Paulo, Brazil, Public Hospital. Methods After searching MEDLINE, Embase, Cochrane, Lilacs, Scopus, and CINAHL, only enrolled randomized control trials comparing IGB/diet with s/d were analyzed. For qualitative analysis, 12 studies were selected, and 9 of these were acceptable for quantitative analysis. Results The IGB/diet is more effective than s/d when comparing body mass index (BMI) loss with a mean difference of 1.1 kg/m 2 by the Student's t test and 1.41 kg/m 2 by the meta-analysis, with significant differences in both. It is also more effective in weight loss (WL), with a mean difference of 2 kg by the Student's t test and 3.55 kg by the meta-analysis. In the qualitative analysis of % excess WL (%EWL), the mean %EWL is 14.0% in favor of the IGB group compared to the s/d group by the Student's t test; however, no significant difference was found between these groups by quantitative analysis. Conclusion Based on randomized control trial data alone, IGB>400 mL is more effective than sham/diet in achieving BMI loss, WL, and %EWL.

Background and study aims: Several studies have evaluated the utility of double-balloon enteroscopy (DBE) and capsule endoscopy (CE) for patients with small-bowel disease showing inconsistent results. The aim of this study was to determine the sensitivity and specificity of overtube-assisted enteroscopy (OAE) as well as the diagnostic concordance between OAE and CE for small-bowel polyps and tumors. Patients and methods: We conducted a systematic review and meta-analysis of studies in which the results of OAE were compared with the results of CE for the evaluation of small-bowel polyps and tumors. When data for surgically resected lesions were available, the histopathological results of OAE and surgical specimens were compared. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the diagnosis of small-bowel polyps and tumors were analyzed. Secondarily, the rates of diagnostic concordance and discordance between OAE and CE were calculated. Results: There were 15 full-length studies with a total of 821 patients that met the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were as follows: 0.89 (95 % confidence interval [CI] 0.84 – 0.93), with heterogeneity χ2 = 41.23 (P = 0.0002) and inconsistency (I 2) = 66.0 %; 0.97 (95 %CI 0.95 – 0.98), with heterogeneity χ2 = 45.27 (P = 0.07) and inconsistency (I 2) = 69.1 %; 16.61 (95 %CI 3.74 – 73.82), with heterogeneity Cochrane’s Q = 225.19 (P

Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review. A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD. We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies, n = 85), the preventive therapy decreased the risk of stenosis (risk difference = −0.36, 95 % CI −0.55 to −0.18, P = 0.0001). Two studies (one randomized and one non-randomized, n = 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = −8.57, 95 % CI −13.88 to −3.25, P

Introdução: A dissecção endoscópica submucosa (ESD) de neoplasias superficiais extensas de esôfago pode evoluir com altas taxas de estenose pós operatória, resultando em uma importante piora na qualidade de vida. Diversas terapias estão disponíveis para prevenir essa complicação. Entretanto, até o momento, nenhuma revisão sistemática e metanálise foram realizadas para avaliar esses resultados. Métodos: Uma revisão sistemática e metanálise foram realizadas utilizando as bases de dados eletrônicas Medline, Embase, Cochrane, LILACS, Scopus e CINAHL. Ensaios clínicos e estudos observacionais foram pesquisados de março de 2014 a fevereiro de 2015. Os termos pesquisados foram: endoscopy, ESD, esophageal stenosis, e esophageal stricture. Três estudos retrospectivos e quatro prospectivos (três randomizados) foram selecionados. Um total de 249 pacientes com diagnóstico de neoplasia superficial de esôfago, submetidos a ESD de pelo menos dois terços da circunferência do órgão foram incluídos. Foram selecionados estudos comparando diversas técnicas para prevenir a estenose de esôfago após extensa ESD. Resultados: Foram realizadas diferentes metanálises com ensaios clínicos randomizados (RCT), ensaios clínicos não randomizados (non- RCT) e uma análise global. Nos RCT (três estudos, n=85), a terapia preventiva diminuiu o risco de estenose (diferença de risco = - 0,36, IC 95% - 0,55 a - 0,18, p = 0,0001). Dois estudos (um randomizado e um não randomizado, n = 55) demonstraram que a terapia preventiva diminui o número médio de dilatações (diferença média = - 8,57, IC 95% - 13,88 a - 3,25, p < 0,002). Não houve diferenças significativas em três RCT em relação à taxa de complicações entre pacientes submetidos à terapia preventiva e aqueles não submetidos (diferença de risco = 0,002, IC 95% -0,09 a 0,14, p = 0,68). Conclusão: O uso da terapia preventiva após extensa ESD no esôfago, reduz o risco de estenose e o número de dilatações endoscópicas para resolução da estenose, sem aumentar o número de complicações Background: Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significant decrease in quality of life. Several therapies are performed to prevent this complication. However, they have not yet been compared in a systematic review. Methods: A systematic review of the literature and meta-analysis were performed using the Medline, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, endoscopic submucosal dissection, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (3 randomized) cohort studies were selected. They involved 249 patients with superficial esophageal neoplasia who underwent ESD of at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophageal stenosis post-ESD. Results: Were realized different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (3 studies, n=85), preventive therapies decreased the risk of stenosis (risk difference = -0.36, 95% CI= -0.55 to -0.18, p = 0.0001). Two studies (1 randomized, 1 non-randomized, n = 55) showed that preventive therapies lowered the average number of endoscopy dilatations (mean difference = -8.57, 95% CI = -13.88 to -3.25, p < 0,002). There were no significant differences in the 3 RCT studies (n=85) with regards to complication rates between patients with preventive therapies and those without (risk difference = 0.02, 95% CI = -0.09 to 0.14, p = 0.68). Conclusion: The use of preventive therapies after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications

Endoscopic ultrasound (EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangiography, but nowadays it emerges as a powerful therapeutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage (EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retrograde cholangiopancreatography (ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or transpapillary, which, again, can be antegrade or retrograde [rendezvous (EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology.

Background and Objectives: At the time of its introduction in the early 80s, endoscopic ultrasonography (EUS) was indicated for diagnostic purposes. Recently, EUS has been employed to assist or to be the main platform of complex therapeutic interventions. Methods: From a series of relevant new topics in the literature and based on the need to complement the I Brazilian consensus on EUS, twenty experienced endosonographers identified and reviewed the pertinent literature in databases. The quality of evidence, strength of recommendations, and level of consensus were graded and voted on. Results: Consensus was reached for eight relevant topics: treatment of gastric varices, staging of nonsmall cell lung cancer, biliary drainage, tissue sampling of subepithelial lesions (SELs), treatment of pancreatic fluid collections, tissue sampling of pancreatic solid lesions, celiac neurolysis, and evaluation of the incidental pancreatic cysts. Conclusions: There is a high level of evidence for staging of nonsmall cell lung cancer; biopsy of SELs as the safest method; unilateral and bilateral injection techniques are equivalent for EUS-guided celiac neurolysis, and in patients with visible ganglia, celiac ganglia neurolysis appears to lead to better results. There is a moderate level of evidence for: yield of tissue sampling of pancreatic solid lesions is not influenced by the needle shape, gauge, or employed aspiration technique; EUS-guided and percutaneous biliary drainage present similar clinical success and adverse event rates; plastic and metallic stents are equivalent in the EUS-guided treatment of pancreatic pseudocyst. There is a low level of evidence in the routine use of EUS-guided treatment of gastric varices.