375 results on '"Artifon, Everson L."'
Search Results
152. Perforated Meckel's diverticulum.
- Author
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Gatto J, Takada J, Otoch JP, Kreve F, Loss FS, and Artifon ELA
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- Adult, Humans, Ileal Diseases diagnosis, Intestinal Perforation diagnosis, Male, Meckel Diverticulum complications, Peritonitis diagnosis, Abdomen, Acute etiology, Ileal Diseases etiology, Intestinal Perforation etiology, Meckel Diverticulum diagnosis, Peritonitis etiology
- Abstract
We report a patient with diffuse peritonitis due to perforation of Meckel's diverticulum. This patient was referred to the operating room and underwent bowel resection segment encompassing the area of the diverticulum and terminoterminal primary enteroanastomosis on two levels with good evolution. The diverticulum complications are often related to the presence of ectopic mucosa, specially the gastric and pancreatic type. Since preoperative diagnosis is difficult and infrequent, in most cases this anomaly is confirmed only during surgery. Surgical resection of the affected intestinal segment is the mainstay of treatment in both diverticula diagnosed incidentally, as the complicated by inflammation, bleeding, obstruction or perforation. We conclude that in cases of acute abdomen punctured, the diagnosis of Meckel's diverticulum should be considered.
- Published
- 2017
153. Laparoendoscopic rendez-vous: a safe alternative to the treatment of choledocholithiasis.
- Author
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Kreve F, Takada J, Gatto J, Loss FS, and Artifon ELA
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- Cholangiopancreatography, Endoscopic Retrograde, Cholecystectomy, Laparoscopic, Female, Humans, Middle Aged, Choledocholithiasis surgery, Laparoscopy methods
- Abstract
The choice treatment for choledocholithiasis when associated with lithiasic cholecystitis is endoscopic retrograde cholangiopancreatography (ERCP). However, in some cases this therapeutic fails, which requires an alternative method to extract the stones. The surgical approach tends to be the next step, but it is related to greater complexity of achievement and higher complications rates. In 1993, Deslandres et al. developed the combined treatment called laparoendoscopic rendez-vous, that unites in a single stage the endoscopic treatment of choledocholithiasis and laparoscopic removal of the gallbladder. We report the case of a patient diagnosed with common bile duct (CBD) stones, in which the conventional CPRE was not successful, and was taken to treatment by laparoendoscopic approach. We conclude, based on this case and on other published studies, that this therapeutic modality has advantages for being feasible, presenting low complications rate, shorter hospital stay and acceptable cost.
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- 2017
154. Biliary ileus: case report.
- Author
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Kreve F, Takada J, Gatto J, Loss FS, and Artifon ELA
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- Female, Gallstones complications, Humans, Ileal Diseases diagnosis, Intestinal Fistula complications, Intestinal Obstruction diagnosis, Middle Aged, Gallstones diagnosis, Ileal Diseases etiology, Intestinal Fistula diagnosis, Intestinal Obstruction etiology
- Abstract
Biliary ileusis a uncommon cause of mechanical bowel obstruction, affecting older adult patients who often have other significant medical conditions. It is caused by intestinal impaction of a gallstone that enters the bowel via a cholecysto-enteric fistula. The mortality rate is considerable, ranging between 12 and 27%. Treatment in most cases is surgical, aimed at the resolution of the intestinal obstruction. We report the case of a 55 year old patient diagnosed with biliary ileus, wich evolved without complications after a enterolithotomy. We have concluded, based on the literature that an early diagnosis associated with appropriate therapy can lead to a better prognosis.
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- 2017
155. Endoscopic gastrostomy: critical analysis in a regional referral hospital.
- Author
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Fávaro GM, Filho TF, Coca DS, Cunha MA, Sato Uemura R, Furuya Júnior CK, Aparício D, and Artifon ELA
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Gastroscopy methods, Gastrostomy methods, Humans, Male, Middle Aged, Referral and Consultation, Retrospective Studies, Young Adult, Enteral Nutrition methods, Gastroscopy adverse effects, Gastrostomy adverse effects, Postoperative Complications epidemiology
- Abstract
Introduction: Percutaneous endoscopic gastrostomy (PEG) is a safe and effective endoscopic surgical procedure for enteral access and gastrointestinal decompression, and it is an excellent alternative to surgical gastrostomy. There are various clinical indications and these mainly include the need for prolonged enteral nutritional support due to complications from neurological, geriatric and oncological diseases and decompression of the gastrointestinal tract. Although safe and effective, a number of possible complications relating to the time (early or late complications) and severity (minor or major complications) may occur., Objective: To evaluate the indications and complications relating to PEG among selected patients at the digestive endoscopy service of a regional referral hospital., Materials and Methods: A retrospective study on patients who underwent PEG between May 2013 and April 2015 was conducted. The patients were identified through searching the medical records and using a standardized data form., Results: 53 cases were analyzed. The average age was 70.47 years and 60.37% of the patients werewomen. The main indication identified was the need for enteral nutritional support, and 73.58% of these indications were derived from neurological complications, 15.09% from geriatric complications and 9.43% from oncological complications and 1.88% were due to gastrointestinal decompression. Complications occurred in 24.52% of the cases: 23.07% were major and 76.93% were minor. Regarding the time, there were eight cases of late complications and five of early complications., Conclusion: PEG was shown to be an effective and safe method for enteral access. The indication and complication rates were similar to those reported in the literature.
- Published
- 2017
156. Epidemiological aspects of endoscopic resections of colorectal polyps in patients at an endoscopy training center in the Santos region, Brasil.
- Author
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Filho TF, Fávaro GM, Coca DS, Daniel LB, Guenaga KF, Sato Uemura R, Furuya Junior CK, and Artifon ELA
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- Adenocarcinoma diagnostic imaging, Adenocarcinoma epidemiology, Adenocarcinoma pathology, Adenomatous Polyps diagnostic imaging, Adenomatous Polyps epidemiology, Adenomatous Polyps pathology, Adolescent, Adult, Aged, Aged, 80 and over, Brazil epidemiology, Child, Child, Preschool, Colon diagnostic imaging, Colon pathology, Colon surgery, Colorectal Neoplasms diagnostic imaging, Colorectal Neoplasms epidemiology, Colorectal Neoplasms pathology, Female, Humans, Intestinal Polyps diagnostic imaging, Intestinal Polyps epidemiology, Intestinal Polyps pathology, Male, Middle Aged, Precancerous Conditions diagnostic imaging, Precancerous Conditions epidemiology, Precancerous Conditions pathology, Rectum diagnostic imaging, Rectum pathology, Rectum surgery, Retrospective Studies, Young Adult, Adenocarcinoma surgery, Adenomatous Polyps surgery, Colonoscopy, Colorectal Neoplasms surgery, Intestinal Polyps surgery, Precancerous Conditions surgery
- Abstract
Introduction: Colorectal polyps are structures that project from the surface of the mucosal layer of the large intestine. They are classified as neoplastic or non-neoplastic. Early detection of pre-neoplastic lesions is important for preventing colorectal cancer. These can be resected so as to decrease the morbidity and mortality rates. Colonoscopy is the gold-standard procedure for diagnosing and resecting precursor lesions., Objective: To evaluate the epidemiological, endoscopic and histological aspects of endoscopic resection of lesions of the colon and rectum at a training center., Materials and Method: A search was conducted in the database of our institution covering the period from January 2011 to July 2014. Cases that underwent endoscopic resection of polyps and/or colorectal lesions were selection. The following variables were defined: general data on the patients (age, gender and indication from the examination) and data on the polypoid lesion (number, histological type and topographic distribution)., Results: 678 lesions were identified in 456 examinations. Regarding sex, 242 (53.1%) were female and 214 (46.9%) were male. The mean age was 64.54 years, with extremes of 5 and 94 years. The most frequent locations were the rectum (21%) and sigmoid (20%). Histologically, 34.7% were hyperplastic polyps and 58.9% were adenomatous polyps, of which 74.1% were tubular, 10.6% tubulovillous, 2% villous and 13% indeterminate; and 1.7% were adenocarcinomas. In 65.4% of the cases, the examination showed that only one polyps was present, while 34.6% had two or more lesions., Conclusion: In our clinic, with a mean of 250 examinations/month, the parameters evaluated were compatible with the results reported in the literature.
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- 2017
157. An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery.
- Author
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Chen YI, Levy MJ, Moreels TG, Hajijeva G, Will U, Artifon EL, Hara K, Kitano M, Topazian M, Abu Dayyeh B, Reichel A, Vilela T, Ngamruengphong S, Haito-Chavez Y, Bukhari M, Okolo P 3rd, Kumbhari V, Ismail A, and Khashab MA
- Subjects
- Adult, Aged, Anastomosis, Surgical adverse effects, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Constriction, Pathologic etiology, Constriction, Pathologic therapy, Dilatation, Drainage adverse effects, Endoscopy, Gastrointestinal, Endosonography, Female, Humans, Length of Stay, Male, Middle Aged, Operative Time, Postoperative Complications etiology, Retrospective Studies, Stents, Treatment Outcome, Ultrasonography, Interventional adverse effects, Cholangiopancreatography, Endoscopic Retrograde methods, Drainage methods, Pancreatic Ducts pathology, Pancreatic Ducts surgery, Pancreaticoduodenectomy adverse effects, Postoperative Complications therapy
- Abstract
Background and Aims: Endoscopic management of post-Whipple pancreatic adverse events (AEs) with enteroscopy-assisted endoscopic retrograde pancreatography (e-ERP) is associated with high failure rates. EUS-guided pancreatic duct drainage (EUS-PDD) has shown promising results; however, no comparative data have been done for these 2 modalities. The goal of this study is to compare EUS-PDD with e-ERP in terms of technical success (PDD through dilation/stent), clinical success (improvement/resolution of pancreatic-type symptoms), and AE rates in patients with post-Whipple anatomy., Methods: This is an international multicenter comparative retrospective study at 7 tertiary centers (2 United States, 2 European, 2 Asian, and 1 South American). All consecutive patients who underwent EUS-PDD or e-ERP between January 2010 and August 2015 were included., Results: In total, 66 patients (mean age, 57 years; 48% women) and 75 procedures were identified with 40 in EUS-PDD and 35 in e-ERP. Technical success was achieved in 92.5% of procedures in the EUS-PDD group compared with 20% of procedures in the e-ERP group (OR, 49.3; P < .001). Clinical success (per patient) was attained in 87.5% of procedures in the EUS-PDD group compared with 23.1% in the e-ERP group (OR, 23.3; P < .001). AEs occurred more commonly in the EUS-PDD group (35% vs 2.9%, P < .001). However, all AEs were rated as mild or moderate. Procedure time and length of stay were not significantly different between the 2 groups., Conclusions: EUS-PDD is superior to e-ERP in post-Whipple anatomy in terms of efficacy with acceptable safety. As such, EUS-PDD should be considered as a potential first-line treatment in post-pancreaticoduodenectomy anatomy when necessary expertise is available., (Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
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158. EUS-guided biliary drainage or enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction: an international comparative study.
- Author
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Khashab MA, El Zein MH, Sharzehi K, Marson FP, Haluszka O, Small AJ, Nakai Y, Park DH, Kunda R, Teoh AY, Peñas I, Perez-Miranda M, Kumbhari V, Van der Merwe S, Artifon EL, and Ross AS
- Abstract
Background and study aims: How enteroscopy-assisted ERCP (e-ERCP) and endoscopic ultrasound-guided biliary drainage (EUS-BD) compare in patients with surgically altered upper gastrointestinal anatomy is currently unknown. The aims of this study were to compare efficacy and safety of both techniques and study predictors of these outcomes. Patients and methods: This was an international, multicenter comparative cohort study at 10 tertiary centers. Outcomes data included technical success (biliary access with cholangiography and stent placement [when indicated]), clinical success (resolution of biliary obstruction) and adverse events (AEs) (graded according to the ASGE lexicon). Results: A total of 98 patients underwent EUS-BD (n = 49) or e-ERCP (n = 49). Technical success was achieved in 48 (98 %) patients in the EUS-BD group as compared to 32 (65.3 %) patients in the e-ERCP group (OR 12.48, P = 0.001). Clinical success was attained in 88 % of patients in EUS-BD group as compared to 59.1 % in the e-ERCP group (OR 2.83, P = 0.03). Procedural time was significantly shorter in the EUS-BD group (55 min vs 95 min, P < 0.0001). AEs occurred more commonly in the EUS-BD group (20 % vs. 4 %, P = 0.01). However, the majority (90 %) of AEs were mild/moderate. Length of stay was significantly longer in the EUS-BD group (6.6 d vs. 2.4 d, P < 0.0001). Conclusions: EUS-BD can be performed with a higher degree of clinical efficacy and shorter procedure time than e-ERCP in patients with surgically-altered upper gastrointestinal anatomy. Whether or not this approach should be first-line therapy in this patient population is highly dependent on the indication for the procedure, the patient's anatomy, and local practice and expertise.
- Published
- 2016
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159. AN INNOVATIVE EX-VIVO MODEL FOR RAPID CHANGE OF THE PAPILLA FOR TEACHING ADVANCED ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY PROCEDURES.
- Author
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Artifon EL, Nakadomari TS, Kashiwagui LY, Belmonte EA, Solak CR, Cheng S, Furuya CK Jr, and Otoch JP
- Subjects
- Animals, Models, Animal, Swine, Time Factors, Ampulla of Vater, Cholangiopancreatography, Endoscopic Retrograde methods, Radiology education
- Abstract
Background: Models for endoscopic retrograde cholangiopancreatography training allow practice with an expert feedback and without risks. A method to rapidly exchange the papilla can be time saving and accelerate the learning curve., Aim: To demonstrate a newly method of rapid exchange papilla in ex-vivo models to teach retrograde cholangiopancreatography advanced procedures., Methods: A new model of ex-vivo papilla was developed in order to resemble live conditions of procedures as cannulation, papilotomy or fistula-papilotomy, papiloplasty, biliary dilatation, plastic and metallic stentings., Results: The ex-vivo model of papilla rapid exchange is feasible and imitates with realism conditions of retrograde cholangiopancreatography procedures., Conclusion: This model allows an innovative method of advanced endoscopic training., Competing Interests: none
- Published
- 2016
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160. Recurrent acute pancreatitis caused by pancreatic biliary maljunction due to long common channel.
- Author
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Farias GF, Otoch JP, Guedes HG, and Artifon EL
- Subjects
- Adult, Bile Ducts diagnostic imaging, Digestive System Abnormalities complications, Female, Humans, Pancreatic Ducts diagnostic imaging, Recurrence, Bile Ducts abnormalities, Cholangiopancreatography, Endoscopic Retrograde, Digestive System Abnormalities diagnostic imaging, Pancreatic Ducts abnormalities, Pancreatitis etiology
- Abstract
The pancreatic biliary maljunction is a rare anomaly that affects mainly females, defined as an anatomical maljunction of the pancreatic duct and the biliary duct confluence, and may be a rare cause of recurrent acute pancreatitis. In order to early diagnosis and prompt treatment, ERCP has an important role in it.
- Published
- 2016
161. [Comparison of colon-cleansing methods in preparation for colonoscopy-comparative of solutions of mannitol and sodium picosulfate].
- Author
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de Moura DT, Guedes H, Tortoretto V, Arataque TP, de Moura EG, Román JP, Rodela GL, and Artifon EL
- Subjects
- Cathartics adverse effects, Citrates adverse effects, Double-Blind Method, Female, Humans, Male, Mannitol adverse effects, Middle Aged, Organometallic Compounds adverse effects, Outcome Assessment, Health Care, Picolines adverse effects, Prospective Studies, Cathartics administration & dosage, Citrates administration & dosage, Colonoscopy, Mannitol administration & dosage, Organometallic Compounds administration & dosage, Picolines administration & dosage
- Abstract
Objectives: The purpose of the present study is to compare intestinal preparation with mannitol and sodium picosulphate, assessing patient's acceptance, side effects and cleaning capacity., Material and Methods: This is a prospective, nom randomized, blind study, in which the evaluator had no information about the preparation applied. The sample obtained was divided into two groups according to the bowel preparation applied, with 153 patients prepared with 10% mannitol and 84 patients with sodium picosulfate. The evaluation of colon preparation was done using the Boston Scale (Boston Bowel Preparation Scale - BBP) through a three-point scoring system for each of the three regions of the colon: right, left and transverse colon., Results: Of the 237 patients that were evaluated, 146 (61.60%) were female and 91 (38.4%) were male. Regarding the group that used mannitol, 98 were female (64.05%) and 55 were male (35.95%). Among the patients who used sodium picosulfate, 48 were female (57.14%) and 36 were male (42.86%), with no statistical differences between both groups (p> 0.32). Considering that an adequate preparation scores ≥ 6 in the Boston Scale, the bowel cleansing preparation was satisfactory in both groups. 93% of the patients who used mannitol and 81% of the patients who used sodium picosulfate had adequate preparation (score of ≥ 6). Moreover, we consider that the average score in the preparation with Mannitol was 9, while the sodium picosulfate score was 7. There were no significant differences between the two groups., Conclusion: There is consensus among authors who state that colonoscopy's safety and success are highly related to the cleansing outcome, regardless of the method used. The same can be observed in the present study, on which both preparations were proved safe and effective for bowel cleansing, according to the Boston scale, as well as accepted by patients and free of complications.
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- 2016
162. Guide wire-a sisted cannulation versus conventional contrast to prevent pancreatitis. A systematic review and meta-analysis based on randomized control trials.
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de Moura ET, de Moura EG, Bernardo W, Cheng S, Kondo A, de Moura DT, Bravo J, and Artifon EL
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- Catheterization adverse effects, Catheterization instrumentation, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Contrast Media, Humans, Outcome Assessment, Health Care, Pancreatitis etiology, Randomized Controlled Trials as Topic, Catheterization methods, Cholangiopancreatography, Endoscopic Retrograde methods, Pancreatitis prevention & control
- Abstract
Objective: Through this systematic review and meta-analysis, we aim to clarify the differences between these two techniques, thus improving primary success cannulation and reducing complications during endoscopic retrograde cholangiopancreatography, primarily pancreatitis., Methods: A comprehensive search was conducted to search for data available up until June2015from the most important databases available in the health field: EMBASE, MEDLINE (via PubMed), Cochrane, LILACS and CENTRAL (via BVS), SCOPUS, the CAPES database (Brazil), and gray literature., Results: Nine randomized clinical trialsincluding2583 people were selected from20,198 studies for meta-analysis. Choledocholithiasis had been diagnosed in mostly (63.8%) of the patients, who were aged an average of 63.15 years. In those patients treated using the guide wire-assisted cannulation technique, provided a significantly lower instance of pancreatitis (RD=0.03; 95% CI: 0.01-0.05; I2= 45%) and greater primary success cannulation (RD=0.07; 95% CI: 0.03-0.12; I2=12%) than conventional contrast cannulation., Conclusions: The guide wire-assisted technique, when compared to the conventional contrast technique, reduces the risk of pancreatitis and increases primary success cannulation rate. Thus, guide wire-assisted cannulation appears to be the most appropriate first-line cannulation technique.
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- 2016
163. International collaborative study on EUS-guided gallbladder drainage: Are we ready for prime time?
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Kahaleh M, Perez-Miranda M, Artifon EL, Sharaiha RZ, Kedia P, Peñas I, De la Serna C, Kumta NA, Marson F, Gaidhane M, Boumitri C, Parra V, Rondon Clavo CM, and Giovannini M
- Subjects
- Aged, Aged, 80 and over, Cholecystectomy standards, Drainage adverse effects, Female, Humans, Logistic Models, Male, Multivariate Analysis, Recurrence, Retrospective Studies, Stents, Cholecystitis, Acute surgery, Drainage methods, Endosonography methods, Gallbladder diagnostic imaging
- Abstract
Background: Cholecystectomy remains the gold standard treatment of cholecystitis. Endoscopic treatment of cholecystitis includes transpapillary gallbladder drainage. Recently, endoscopic ultrasound-guided transmural drainage of the gallbladder (EUS-GBD) has been reported. This study reports the cumulative experience of an international group performing EUS-GBD., Methods: Cases of EUS-GBD from January 2012 to November 2013 from 3 tertiary-care institutions were captured in a registry. Patient demographics, disease characteristics, procedural and clinical outcomes were recorded., Results: 35 patients (15 malignant, 20 benign) were included. Median age was 81 years (SD=13.76 years), sixteen (46%) were males. Median follow-up was 91.5 days (SD=157 days). Transmural access was obtained from the stomach (n=17) or duodenum (n=18). Stents placed included plastic (n=6), metal (n=20), or combination (n=7). Technical success was achieved in 91.4% (n=32). Immediate adverse events (14%) included: bleeding, stent migration, cholecystitis and hemoperitoneum. Delayed adverse events (11%) included abscess formation and recurrence of cholecystitis. Long-term clinical success rate was 89%. Stent type and puncture site were not associated with immediate (p=0.88, p=0.62), or long-term (p=0.47, p=0.27) success., Conclusions: EUS-GBD appears to be feasible, safe, and effective. Prospective studies are needed to confirm these findings and identify the best technique to use., Clinical Trial Registration: NCT01522573., (Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
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- 2016
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164. Ex vivo and simulator models teaching therapeutic ERCP and EUS: description of SOBED's first course.
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Artifon EL, Ramirez ME, Ardengh JC, Sartor MC, Favaro GM, Belmonte E, Lobo J, Coelho D, Pereira-Lima J, Lopez CV, Matuguma SE, Furuya CK Jr, Pisani J, Cheng S, Buch MA, Franzini T, Vilela TF, Pessoa R, Bonin E, Lera M, Nakadomari TS, Kashiwagui LY, Gerber MT, and Mascarenhas R
- Subjects
- Animals, Brazil, Chickens, Computer Simulation, Curriculum, Humans, In Vitro Techniques, Models, Anatomic, Swine, Cholangiopancreatography, Endoscopic Retrograde, Endoscopy, Gastrointestinal education, Endosonography, Gastroenterology education, Models, Educational, Simulation Training methods
- Abstract
Teaching models in endoscopy are important tools to minimize risks derived from endoscopic procedures, taking into account that therapeutic endoscopy, also known as surgical endoscopy, has greatly developed during the last decade. This results from the fact that minimally invasive procedures present relevant contributions and promote more comfort to patients. In this context, ex vivo teaching models and virtual simulators are important tools to the safe acquisition of abilities. In this article, the Brazilian Society of Digestive Endoscopy presents and describes its first course of therapeutic ERCP and EUS in models of laboratory teaching.
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- 2016
165. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography.
- Author
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Khashab MA, Van der Merwe S, Kunda R, El Zein MH, Teoh AY, Marson FP, Fabbri C, Tarantino I, Varadarajulu S, Modayil RJ, Stavropoulos SN, Peñas I, Ngamruengphong S, Kumbhari V, Romagnuolo J, Shah R, Kalloo AN, Perez-Miranda M, and Artifon EL
- Abstract
Background and Aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction., Patients and Methods: Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50 % at 2 weeks or to below 3 mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon's severity grading system. Overall survival and duration of stent patency were calculated using Kaplan-Meier analysis., Results: A total of 96 patients (mean age 66 years, female 45 %, pancreatic cancer 55 %) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8 %) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5 %) patients. A total of 10 (10.5 %) adverse events occurred: pneumoperitoneum (n = 2), sheared wire (n = 1), bleeding (n = 1), bile leak (n = 3), cholangitis (n = 2), and unintentional perforation (n = 1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44 %) patients died of disease progression during the study period. The median patient survival was 167 days (95 %CI 112 - 221) days. The 6-month stent patency rate was 95 % (95 %CI 94.94 - 95.06 %) and the 1-year stent patency was 86 % (95 %CI 85.74 - 86.26 %)., Conclusion: This study on EUS-BD demonstrates excellent efficacy and safety of EUS-BD when performed by experts., Study Registration: NCT01889953.
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- 2016
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166. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography in suspected choledocholithiasis: A systematic review.
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De Castro VL, Moura EG, Chaves DM, Bernardo WM, Matuguma SE, and Artifon EL
- Abstract
Background and Objectives: There is a lack of consensus about the optimal noninvasive strategy for patients with suspected choledocholithiasis. Two previous systematic reviews used different methodologies not based on pretest probabilities that demonstrated no statistically significant difference between Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) for the detection of choledocholithiasis. In this article, we made a comparison of the diagnostic ability of EUS and MRCP to detect choledocholithiasis in suspected patients., Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations with all published randomized prospective trials. We performed the systemic review using MedLine, EMBASE, Cochrane, LILACS, and Scopus reviews through May 2015. We identified eight randomized, prospective, blinded trials comparing EUS and MRCP. All the patients were submitted to a gold standard method. We calculated the study-specific variables and performed analyses using aggregated variables such as sensitivity, specificity, prevalence, positive predictive value (PPV) and negative predictive value (NPV), and accuracy., Results: Five hundred and thirty eight patients were included in the analysis. The pretest probability for choledocholithiasis was 38.7. The mean sensitivity of EUS and MRCP for detection of choledocholithiasis was 93.7 and 83.5, respectively; the specificity was 88.5 and 91.5, respectively. Regarding EUS and MRCP, PPV was 89 and 87.8, respectively, and NPV was 96.9 and 87.8, respectively. The accuracy of EUS and MRCP was 93.3 and 89.7, respectively., Conclusions: For the same pretest probability of choledocholithiasis, EUS has higher posttest probability when the result is positive and a lower posttest probability when the result is negative compared with MRCP.
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- 2016
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167. Endoscopic Ultrasound-Guided Biliary Drainage: A Systematic Review and Meta-Analysis.
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Khan MA, Akbar A, Baron TH, Khan S, Kocak M, Alastal Y, Hammad T, Lee WM, Sofi A, Artifon EL, Nawras A, and Ismail MK
- Subjects
- Bile Ducts surgery, Drainage methods, Endosonography methods, Humans, Surgery, Computer-Assisted methods, Choledochostomy methods, Cholestasis surgery, Common Bile Duct surgery
- Abstract
Background and Aims: Variable success and adverse event rates have been reported for endoscopic ultrasound-guided biliary drainage (EUS-BD) utilizing either extrahepatic or intrahepatic approach. We aimed to conduct a proportion meta-analysis to evaluate the cumulative efficacy and safety of EUS-BD and to compare the two approaches and transluminal methods of EUS-BD., Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus from January 2001 through January 5, 2015, to identify studies reporting technical success and adverse events of EUS-BD. A sample size of more than 20 patients was a further criterion. Weighted pooled rate (WPR) for technical success and post-procedure complications was calculated for overall studies and predefined subgroups. Pooled odds ratios were calculated for technical success and adverse events for two approaches and transluminal methods of EUS-BD for distal common bile duct (CBD) strictures., Results: The WPR with 95% confidence interval (CI) for technical success and post-procedure adverse events was 90% (86, 93%) and 17% (13, 22%), respectively, with considerable heterogeneity (I(2) = 77%). For high-quality studies, the WPR for technical success was 94% (91, 96 %), I(2) = 0% and WPR for post-procedure adverse event was 16% (12, 19%), I(2) = 39%. In meta-regression model, distal CBD stricture and transpapillary drainage were associated with higher technical success and intrahepatic access route was associated with higher adverse event rate. There was no difference in technical success using either approach OR 1.27 (0.52, 3.13), I(2) = 0% or transluminal method OR 1.32 (0.51, 3.38), I(2) = 0%. However, the extrahepatic approach appeared significantly safer as compared to the intrahepatic approach OR 0.35 (0.19, 0.67), I(2) = 27%. Likewise, choledochoduodenostomy was found to have less adverse events as compared to hepaticogastrostomy, OR 0.40 (0.18, 0.87), I (2) = 0%., Conclusion: In cases of failure of traditional ERC to achieve biliary drainage, EUS-BD appears to be an emerging therapeutic modality with a cumulative success rate of 90% and cumulative adverse events rate of 17%. Randomized controlled trials are required to further evaluate the efficacy and safety of the procedure along with the comparison to traditional modalities like percutaneous transhepatic biliary drainage.
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- 2016
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168. A very rare postcholecystectomy complication.
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Guedes HG and Artifon EL
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- Cholecystectomy, Laparoscopic methods, Choledocholithiasis surgery, Cutaneous Fistula diagnosis, Cutaneous Fistula etiology, Cutaneous Fistula surgery, Female, Humans, Middle Aged, Reoperation methods, Stents, Treatment Outcome, Biliary Fistula diagnosis, Biliary Fistula etiology, Biliary Fistula surgery, Cholangiopancreatography, Endoscopic Retrograde methods, Cholecystectomy, Laparoscopic adverse effects, Colonic Diseases diagnosis, Colonic Diseases etiology, Colonic Diseases surgery, Intestinal Fistula diagnosis, Intestinal Fistula etiology, Intestinal Fistula surgery, Postoperative Complications diagnosis, Postoperative Complications surgery, Prosthesis Implantation instrumentation, Prosthesis Implantation methods, Sphincterotomy, Endoscopic methods
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- 2016
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169. Estadiaje local del carcinoma rectal: imágenes de ecografía versus resonancia magnética. Revisión sistemática de la literatura y metaanálisis.
- Author
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Guenaga KF, Otoch JP, and Artifon EL
- Subjects
- Humans, Neoplasm Staging, Proctoscopy instrumentation, Proctoscopy methods, Rectal Neoplasms diagnostic imaging, Rectal Neoplasms surgery, Endosonography instrumentation, Endosonography methods, Magnetic Resonance Imaging, Preoperative Care, Rectal Neoplasms pathology
- Abstract
New surgical techniques in the treatment of rectal cancer have improved survival mainly by reducing local recurrences. A preoperative staging method is required to accurately identify tumor stage and planning the appropriate treatment. MRI and ERUS are currently being used for the local staging (T stage). In this review, the accuracy of MRI and ERUS with rigid probe was compared against the gold standard of the pathological findings in the resection specimens. Five studies met the inclusion criteria and were included in this meta-analysis. The accuracy was 91.0% to ERUS and 86.8% to MRI (p=0.27). The result has no statistical significance but with pronounced heterogeneity between the included trials as well as other published reviews. We can conclude that there is a clear need for good quality, larger scale and prospective studies.
- Published
- 2016
170. EUS-guided biliary drainage.
- Author
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Khashab MA, Levy MJ, Itoi T, and Artifon EL
- Subjects
- Bile Duct Diseases diagnostic imaging, Choledochostomy methods, Humans, Stents, Treatment Outcome, Bile Duct Diseases therapy, Drainage methods, Endoscopy, Digestive System methods, Endosonography methods, Ultrasonography, Interventional methods
- Published
- 2015
- Full Text
- View/download PDF
171. Endoscopic-ultrasound versus percutaneous-guided celiac plexus block for chronic pancreatitis pain. A systematic review and meta-analysis.
- Author
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Moura RN, De Moura EG, Bernardo WM, Otoch JP, Bustamante FA, Albers DV, Silva GL, Chaves DM, and Artifon EL
- Subjects
- Abdominal Pain diagnosis, Chronic Pain diagnosis, Fluoroscopy, Humans, Pain Measurement, Radiography, Interventional, Tomography, X-Ray Computed, Abdominal Pain therapy, Autonomic Nerve Block methods, Celiac Plexus diagnostic imaging, Chronic Pain therapy, Endosonography, Pancreatitis, Chronic complications, Ultrasonography, Interventional
- Abstract
Background: Abdominal pain is present in the vast majority of patients with chronic pancreatitis, being frequently debilitating. Celiac plexus block (CPB) is an interventional technique that can be considered to provide a temporary pain relief., Objective: To estimate the effectiveness and safeness of endoscopic-ultrasound (EUS) comparing with percutaneous-guided CBP in patients with pancreatic pain., Methods: A systematic review of English and non-English articles using MEDLINE, EMBASE, LILACS and COCHRANE (via BVS)., Study Selection and Data Extraction: Only randomized control trials (RCT) comparing the beneficial and harmful effects of EUS and percutaneous-guided celiac plexus block for managing pancreatic pain were included. Data was extracted and analyzed on variables including pain relief and related procedure complications., Results: Two RCT met the inclusion criteria. Both studies assessed the primary outcome (reduction on pain score) and evaluated adverse effects. The drugs injected were the same; nevertheless percutaneous technique was guided by fluoroscopy in one study and by computer tomography (CT) in other. The results showed that the EUS-CPB group was more effective to reduce pain score after 4 weeks after the procedure, with risk of bias to do this affirmation. No statistical difference in pain relief at 1, 8 and 12 weeks and in complications rates., Conclusions: Based on this systematic review and meta-analysis, no statistically significant difference was noted in pain relief and complications for EUS and percutaneous - CPB.
- Published
- 2015
172. Surgical or endoscopic management for post-ERCP large transmural duodenal perforations: a randomized prospective trial.
- Author
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Artifon EL, Minata MK, Cunha MA, Otoch JP, Aparicio DP, Furuya CK, and Paione JL
- Subjects
- Adult, Aged, Anastomosis, Surgical, Duodenal Diseases etiology, Duodenal Diseases mortality, Female, Humans, Intestinal Perforation etiology, Intestinal Perforation mortality, Jejunum surgery, Length of Stay statistics & numerical data, Liver surgery, Male, Middle Aged, Prospective Studies, Self Expandable Metallic Stents, Suture Techniques, Treatment Outcome, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Duodenal Diseases therapy, Duodenoscopy instrumentation, Duodenoscopy methods, Intestinal Perforation therapy
- Abstract
Introduction: Duodenal perforations are an uncommon adverse event during ERCP. Patients can develop significant morbidity and mortality. Even though surgery has been used to manage duodenal complications, therapeutic endoscopy has seen significant advances., Objective: To compare endoscopic approach with surgical intervention in patients with duodenal perforations post-ERCP., Material and Methods: prospective randomized study in a tertiary center with 23 patients divided in 2 groups. Within 12 hours after the event, the patients underwent endoscopic or surgical approach. Endoscopic approach included closure of the perforation with endoclips and SEMS. Surgical repair included hepaticojejunostomy, suture of the perforation or duodenal suture. The success was defined as closure of the defect. Secondary outcomes included mortality, adverse events, days of hospitalization and costs., Results: The success was 100% in both groups. There was one death in the endoscopic group secondary to sepsis. There was no statistical difference in mortality or adverse events. We noticed statistical difference in favor of the endoscopic group considering shorter hospitalization (4.1 days versus 15.2 days, with p=0.0123) and lower cost per patient (U$14,700 versus U$19,872, with p=0.0103)., Conclusions: Endoscopic approach with SEMS and endoclips is an alternative to surgery in large transmural duodenal perforations post-ERCP.
- Published
- 2015
173. Guidewire cannulation: Are we moving in the opposite direction from evidence-based medicine?
- Author
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Artifon EL, Oliveira JF, Moura ET, and Moura EG
- Subjects
- Female, Humans, Male, Ampulla of Vater surgery, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Choledocholithiasis surgery, Cholestasis surgery, Common Bile Duct surgery, Pancreatic Ducts surgery, Pancreatic Neoplasms surgery, Pancreatitis etiology
- Published
- 2015
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174. Endoscopic ultrasound: past, present and future.
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Artifon EL
- Subjects
- Endoscopy, Gastrointestinal methods, Endosonography methods, Humans, Endoscopy, Gastrointestinal trends, Endosonography trends, Gastrointestinal Diseases diagnostic imaging
- Published
- 2015
175. Surgery or EUS-guided choledochoduodenostomy for malignant distal biliary obstruction after ERCP failure.
- Author
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Artifon EL, Loureiro JF, Baron TH, Fernandes K, Kahaleh M, and Marson FP
- Abstract
Background and Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) is the method of choice for drainage in patients with distal malignant biliary obstruction, but it fails in up to 10% of cases. Percutaneous transhepatic cholangiography (PTC) and surgical bypass are the traditional drainage alternatives. This study aimed to compare technical and clinical success, quality of life, and survival of surgical biliary bypass or hepaticojejunostomy (HJT) and endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDT) in patients with distal malignant bile duct obstruction and failed ERCP., Patients and Methods: A prospective, randomized trial was conducted. From March 2011 to September 2013, 32 patients with malignant distal biliary obstruction and failed ERCP were studied. The HJT group consisted of 15 patients and the CDT group consisted of 14 patients. Technical and clinical success, quality of life, and survival were assessed prospectively., Results: Technical success was 94% (15/16) in the HJT group and 88% (14/16) in the CDT group (P = 0.598). Clinical success occurred in 14 (93%) patients in the HJT group and in 10 (71%) patients in the CDT group (P = 0.169). During follow-up, a statistically significant difference was seen in mean functional capacity scores, physical health, pain, social functioning, and emotional and mental health aspects in both techniques (P < 0.05). The median survival time in both groups was the same (82 days)., Conclusion: Data relating to technical and clinical success, quality of life, and survival were similar in patients who underwent HJT and CDT drainage after failed ERCP for malignant distal biliary obstruction.
- Published
- 2015
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176. Biliary transpapillary endoscopic balloon dilation for treating choledocholithiasis.
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Daniel LB, Favaro GM, Filho TF, Cunha MA, AparÍcio DS, Uemura RS, Furuya CK Jr, and Artifon EL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Young Adult, Cholangiopancreatography, Endoscopic Retrograde methods, Choledocholithiasis surgery, Dilatation methods, Sphincterotomy, Endoscopic methods
- Abstract
Objective: To evaluate the efficacy and safety of transpapillary papilloplasty in patients with choledocholithiasis., Materials and Methods: All endoscopic retrograde cholangiopancreatography (ERCP) procedures performed at Hospital Ana Costa, in the city of Santos, Brazil, over the last five years were retrospectively evaluated using the hospital's information database. The success of the procedure and complications due to residual calculi, pancreatitis, bleeding and perforation were evaluated., Results: From January 2010 to May 2014, 1860 ERCP procedures were performed. Fifty-five patients were evaluated here. Their ages ranged from 12 to 98 years (mean, 66.3; standard deviation, 19.34; median, 71). Thirty-two patients (58.2%) were women. Sixteen (29.1%) presented giant choledocholithiasis, with calculi larger than 12 mm. Twenty-seven (49.1%) had mul-tiple choledocholithiasis., Conclusion: In view of the therapeutic efficacy and low complication rate among our patients, we can conclude that endoscopic papilloplasty is a safe and effective method for endoscopic treatment of choledocolithiasis in selected cases.
- Published
- 2015
177. Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: is there any difference?
- Author
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Artifon EL, Marson FP, Gaidhane M, Kahaleh M, and Otoch JP
- Subjects
- Adult, Aged, Aged, 80 and over, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Cholangiopancreatography, Endoscopic Retrograde, Cholestasis etiology, Drainage methods, Endosonography, Female, Follow-Up Studies, Humans, Jaundice, Obstructive etiology, Male, Middle Aged, Neoplasms pathology, Prospective Studies, Quality of Life, Self Expandable Metallic Stents, Survival Rate, Treatment Failure, Ultrasonography, Interventional, Choledochostomy adverse effects, Cholestasis surgery, Hepatic Duct, Common surgery, Jaundice, Obstructive surgery, Neoplasms complications, Stomach surgery
- Abstract
Background: EUS-guided biliary drainage (BD) is an evolving alternative technique for patients with malignant biliary obstruction for which ERCP failed., Objective: To compare the outcomes of 2 nonanatomic EUS-guided BD routes: hepaticogastrostomy (HPG) and choledochoduodenostomy (CD)., Design: Prospective, randomized trial., Setting: Tertiary endoscopic referral center., Patients: Forty-nine patients with unresectable distal malignant biliary obstruction and failed ERCP were included. The HPG group had 25 patients and the CD group had 24 patients., Interventions: EUS-guided HPG or CD. In all procedures, a biliary puncture with a 19-gauge needle followed by cholangiography, wire advancement, track dilation, and self-expandable metal stent deployment were performed., Main Outcome Measurements: Technical and clinical success, quality of life, adverse events, and survival., Results: The technical success rate was 96% for HPG and 91% for CD. The clinical success rate was 91% for HPG and 77% for CD. The mean procedural time was 47.8 minutes for HPG and 48.8 minutes for CD. The mean scores of quality of life were similar during follow-up. The overall adverse event rate was 16.3% (20% for the HPG group and 12.5% for the CD group). One patient with a bile leak required percutaneous biloma drainage. There was no statistical difference between the 2 techniques and no difference with regard to survival time between the 2 groups., Limitations: Single-center study., Conclusion: HPG and CD techniques are similar in efficacy and safety. Both HPG and CD seem valid alternative options for BD in patients with distal malignant biliary obstruction after failed ERCP., (Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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178. Percutaneous passage of an extraction balloon to assist recanalization of the common bile duct after surgical transection.
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Artifon EL, Silva GL, Uemura RS, Teran A, and Buch M
- Subjects
- Cholangiopancreatography, Endoscopic Retrograde, Cholecystectomy, Laparoscopic adverse effects, Common Bile Duct injuries, Constriction, Pathologic surgery, Female, Humans, Middle Aged, Stents, Common Bile Duct surgery, Prosthesis Implantation methods
- Published
- 2015
- Full Text
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179. Endoscopic ultrasonography guided drainage: summary of consortium meeting, May 21, 2012, San Diego, California.
- Author
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Kahaleh M, Artifon EL, Perez-Miranda M, Gaidhane M, Rondon C, Itoi T, and Giovannini M
- Subjects
- Biliary Tract Diseases diagnostic imaging, Choledochostomy adverse effects, Choledochostomy standards, Decompression adverse effects, Decompression standards, Drainage adverse effects, Drainage standards, Gastrostomy adverse effects, Gastrostomy standards, Humans, Pancreatic Diseases diagnostic imaging, Practice Guidelines as Topic, Predictive Value of Tests, Treatment Outcome, Biliary Tract Diseases therapy, Choledochostomy methods, Decompression methods, Drainage methods, Endosonography standards, Gastrostomy methods, Pancreatic Diseases therapy, Ultrasonography, Interventional standards
- Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for biliary and pancreatic drainage. While ERCP is successful in about 95% of cases, a small subset of cases are unsuccessful due to altered anatomy, peri-ampullary pathology, or malignant obstruction. Endoscopic ultrasound-guided drainage is a promising technique for biliary, pancreatic and recently gallbladder decompression, which provides multiple advantages over percutaneous or surgical biliary drainage. Multiple retrospective and some prospective studies have shown endoscopic ultrasound-guided drainage to be safe and effective. Based on the currently reported literature, regardless of the approach, the cumulative success rate is 84%-93% with an overall complication rate of 16%-35%. endoscopic ultrasound-guided drainage seems a viable therapeutic modality for failed conventional drainage when performed by highly skilled advanced endoscopists at tertiary centers with expertise in both echo-endoscopy and therapeutic endoscopy.
- Published
- 2015
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180. [Endoscopic dilation of the gastrointestinal tract].
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Artifon EL, Castaño Llano R, Otoch JP, and Tchekmedyian AJ
- Subjects
- Constriction, Pathologic therapy, Contraindications, Dilatation instrumentation, Endoscopy, Digestive System instrumentation, Humans, Treatment Outcome, Digestive System Diseases therapy, Dilatation methods, Endoscopy, Digestive System methods
- Abstract
The endoscopic dilation of the gastrointestinal tract is carried out to relieve either functional or organic disorders, secondary to a variety of both benign and malignant diseases. With the advent of new technologies, virtually all digestive stenosis can be managed in a minimally invasive way. Despite its wide dissemination in actual practice, there are few controlled studies comparing the different forms of endoscopic dilation. In this article, we review this technique and the evidence available for application in different segments of the gastrointestinal tract. The future of the dilations includes the development of dilators to assess dilation during the procedure. These advents and the implementation indications, benefits and risks for each of the existing systems of dilations.
- Published
- 2015
181. Endoscopic stent combined with endovaginal clipping for resolution of rectovaginal fistula after colorectal anastomotic dehiscence.
- Author
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Artifon EL, Silva GL, Furuya CK, Buch M, and Bonini L
- Published
- 2014
- Full Text
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182. [Endoscopy training by using ex vivo and simulators: a new teaching tool].
- Author
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Artifon EL, Tchekmedyian AJ, Fernandes K, Artifon AN, Fonseca A, and Otoch JP
- Subjects
- Clinical Competence, Computer Simulation, Humans, Models, Animal, Models, Educational, South America, User-Computer Interface, Endoscopy, Gastrointestinal education, Simulation Training methods
- Abstract
In recent decades, the traditional teaching model of gastrointestinal endoscopy has been based on the teacher-student tutorial method based on theoretical models. Today, simulators have the advantages of virtual reality. The handling apparatus is similar to that used in clinical practice; it is safe, which allows unlimited use, cost-effective for institutions and with superior performance over other training models. Besides, biological simulators are a viable, accessible and affordable tool to simulate gastrointestinal lesions, allowing training in endoscopy with a high degree of similarity in the endoscopic appearance. In this review, we analyze both models, showing its advantages for the training of the endoscopist of the times.
- Published
- 2014
183. A review on endoscopic palliation of obstructive jaundice before surgery.
- Author
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Artifon EL, Otoch JP, and Tchekmedyian AJ
- Subjects
- Algorithms, Cholangiopancreatography, Endoscopic Retrograde, Humans, Drainage, Jaundice, Obstructive surgery, Preoperative Care methods
- Abstract
Since its development, endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a simple diagnostic technique to an important therapeutic procedure. Obstructive jaundice is often the first and most common complication in patients with malignant disease of the extrahepatic biliary tract. Although preoperative biliary drainage (PBD) may be instituted in many centers, different studies have reported divergent results regarding its benefits in reducing the complications of hepatopancreatobiliary surgery, especially with regard to pancreatoduodenectomy for pancreatic cancer. In this review, we will summarize the current literature of PBD and describe its indications, possible benefits, and, when indicated, the appropriate interval before surgery.
- Published
- 2014
184. [Contributions of endoscopic ultrasound to pancreatic cystic lesions].
- Author
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Artifon EL, Tchekmedyian AJ, Otoch JP, Gutierrez Galiana JP, Canseco S, and Caro LE
- Subjects
- Carcinoembryonic Antigen analysis, Humans, Sensitivity and Specificity, Endosonography, Pancreatic Cyst diagnostic imaging, Pancreatic Neoplasms diagnostic imaging
- Abstract
Cystic lesions of the pancreas are peculiar in relation to their diagnosis and treatment. The use of endoscopic ultrasonography (EUS) has provided better sensitivity and specificity to differentiate benign from malignant cysts, condition that provides an early diagnosis and an effective and definite treatment.
- Published
- 2014
185. Multicenter study on endoscopic ultrasound-guided expandable biliary metal stent placement: choice of access route, direction of stent insertion, and drainage route.
- Author
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Dhir V, Artifon EL, Gupta K, Vila JJ, Maselli R, Frazao M, and Maydeo A
- Subjects
- Adult, Aged, Chi-Square Distribution, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Cholangiopancreatography, Endoscopic Retrograde methods, Cohort Studies, Duodenum, Female, Humans, Liver, Logistic Models, Male, Metals, Middle Aged, Patient Safety, Prosthesis Design, Retrospective Studies, Risk Assessment, Treatment Outcome, Cholestasis diagnostic imaging, Cholestasis surgery, Drainage methods, Endosonography methods, Stents, Ultrasonography, Interventional
- Abstract
Background and Aim: Endoscopic ultrasonography-guided biliary drainage (EUS-BD) using expandable biliary metal stents has emerged as an acceptable alternative in patients with failed endoscopic retrograde cholangiopancreatography for malignant biliary obstruction. However, there is no consensus over the preferred access route (transhepatic or extrahepatic), direction of stent insertion (antegrade or retrograde) or drainage route (transluminal or transpapillary) in patients potentially suitable for multiple methods. The present study compares success and complication rates in patients undergoing EUS-BD via different methods., Methods: This was a multicenter retrospective analysis. Records of patients who underwent EUS-BD for malignant obstructive jaundice at four centers were entered in a standard database. Success and complications were compared for different techniques., Results: Sixty-eight patients were analyzed. EUS-BD was successful in 65 patients (95.6%). There was no significant difference in the success rates of different techniques. Complications were seen in 14 patients (20.6%) and mortality in three patients (4.4%). Complications were significantly higher for the transhepatic route compared to the transduodenal route (30.5% vs 9.3%, P=0.03). There was no significant difference in complication rates among transluminal and transpapillary stent placements, or direct and rendezvous stenting. Logistic regression analysis showed transhepatic access to be the only independent risk factor for complications (P=0.031, t=2.2)., Conclusion: EUS-BD can be carried out with high success rates regardless of the choice of access route, stent direction or drainage route. However, complications are significantly higher with transhepatic access. The transduodenal route should be chosen for EUS-guided and rendezvous stent placements, when both routes are available., (© 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.)
- Published
- 2014
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186. Metastasis of breast cancer to major duodenal papilla.
- Author
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Bastos T, Souza TF, Otoch JP, Grecco E, Àvila F, and Artifon EL
- Subjects
- Female, Humans, Middle Aged, Ampulla of Vater, Breast Neoplasms pathology, Carcinoma, Lobular secondary, Duodenal Neoplasms secondary
- Abstract
Metastasis is an infrequent cause of tumor involvement of the major duodenal papilla and of cholestasis. We report a case of obstructive jaundice due to a metastatic breast carcinoma to the major duodenal papilla, and assess curative and palliative treatment that interventional endoscopy can offer.
- Published
- 2014
187. Double pylorus in the era of proton pump inhibitors.
- Author
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Mansur Reimão S, Ferreira De Souza T, Otoch JP, Makoto Sakai C, Yance Hurtado RM, Menezes Marques L, Guimarães Hourneaux De Moura E, and Artifon EL
- Subjects
- Humans, Male, Middle Aged, Gastric Fistula drug therapy, Omeprazole therapeutic use, Proton Pump Inhibitors therapeutic use, Pylorus abnormalities
- Abstract
Double pylorus and gastroduodenal fistula are rare conditions and can be either congenital or acquired. We report a case of a 58-year-old man with epigastric pain and dyspepsia in which the upper gastrointestinal endoscopy revealed an acquired double pylorus, probably caused by a gastric ulcer.
- Published
- 2014
188. Endoscopic ultrasound hemostasis techniques.
- Author
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Artifon EL, Aparicio DP, Otoch JP, Carvalho PB, Marson FP, Fernandes K, and Tchekmedyian AJ
- Subjects
- Aneurysm, Ruptured complications, Esophageal and Gastric Varices complications, Gastrointestinal Hemorrhage etiology, Humans, Endosonography, Gastrointestinal Hemorrhage diagnostic imaging, Gastrointestinal Hemorrhage therapy, Hemostatic Techniques
- Abstract
Since its development, endoscopic ultrasound (EUS) has evolved from a simple diagnostic technique to an important therapeutic tool for interventional endoscopy. EUS analysis provides real-time imaging of most major thoracic and abdominal vessels, and the possibility to use needle puncture with a curved linear array echoendoscope as a vascular intervention. In this review, we describe the endoscopic ultrasound approach to vascular therapy outside of the gastrointestinal wall.
- Published
- 2014
189. Difficult cannulation: what should I do before EUS guided access?
- Author
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Artifon EL, Moura RN, and Otoch JP
- Subjects
- Endosonography, Humans, Catheterization methods, Cholangiopancreatography, Endoscopic Retrograde methods, Common Bile Duct
- Abstract
Selective cannulation of the common bile duct can be difficult, so multiple strategies have been developed to overcome the situation. In this review we analize the different strategies that can be used like different papillotome instead of the standard catheter, precut papillotomy using precut needle knives or precut papillotome, transpancreatic papillary septotomy, and stenting of the pancreatic duct. Bile duct cannulation remains an important benchmark of successful ERCP. Alternative biliary access indication and its use is very important If biliary cannulation remains unsuccessful.The suprapapillary puncture is a promissory technique. It's important to have in mind that the goal of all techniques is to provide acute pancreatitis decrease.
- Published
- 2014
190. [Endoscopic retrograde cholangiopancreatography: a technique in permanent evolution].
- Author
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Artifon EL, Tchekmedyian AJ, and Aguirre PA
- Subjects
- Bile Duct Diseases surgery, Bile Ducts anatomy & histology, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Cholangiopancreatography, Endoscopic Retrograde trends, Humans, Cholangiopancreatography, Endoscopic Retrograde methods
- Abstract
In this article we will review all the anatomic aspects, technics, indications, contraindications and complications of ERCP.
- Published
- 2013
191. endoscopic papillary large-balloon dilatation in patients with Billroth II gastrectomy.
- Author
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Vila JJ and Artifon EL
- Subjects
- Female, Humans, Male, Cholangiopancreatography, Endoscopic Retrograde methods, Choledocholithiasis surgery, Gastroenterostomy, Postoperative Complications surgery
- Published
- 2013
- Full Text
- View/download PDF
192. Role of EUS-FNA in Recurrent Lung Cancer: Maximum Results with Minimum (minimally invasive) Effort.
- Author
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Ioncica AM, Bektas M, Suzuki R, Saftoiu A, Artifon EL, and Bhutani MS
- Abstract
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an excellent method for primary lung cancer staging. We describe a 66-year-old male who underwent EUS-FNA for the diagnosis of recurrent lung cancer. Two years after initial radiation therapy followed by complete remission, routine follow-up imaging study revealed a mass in the right hilum. Trans-esophageal EUS revealed a 1.3-cm mass and the result of EUS-FNA was consistent with non-small lung cancer. EUS-FNA can play an important role in diagnosis of recurrent lung cancer as well as primary staging avoiding the more invasive diagnostic technique.
- Published
- 2013
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193. Endoscopic ultrasound-guided biliary drainage.
- Author
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Artifon EL
- Published
- 2013
- Full Text
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194. Endoscopic ultrasonography guided biliary drainage: summary of consortium meeting, May 7th, 2011, Chicago.
- Author
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Kahaleh M, Artifon EL, Perez-Miranda M, Gupta K, Itoi T, Binmoeller KF, and Giovannini M
- Subjects
- Bile Ducts diagnostic imaging, Biliary Tract Neoplasms complications, Certification, Cholangiopancreatography, Endoscopic Retrograde economics, Cholangiopancreatography, Endoscopic Retrograde instrumentation, Cholangiopancreatography, Endoscopic Retrograde standards, Cholestasis diagnostic imaging, Cholestasis etiology, Clinical Competence, Drainage economics, Drainage instrumentation, Drainage standards, Education, Medical, Health Care Costs, Humans, Insurance, Health, Reimbursement, Pancreatic Neoplasms complications, Stents, Terminology as Topic, Treatment Outcome, Bile Ducts surgery, Cholangiopancreatography, Endoscopic Retrograde methods, Cholestasis surgery, Drainage methods, Endosonography economics, Endosonography standards, Ultrasonography, Interventional economics, Ultrasonography, Interventional standards
- Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred procedure for biliary or pancreatic drainage in various pancreatico-biliary disorders. With a success rate of more than 90%, ERCP may not achieve biliary or pancreatic drainage in cases with altered anatomy or with tumors obstructing access to the duodenum. In the past those failures were typically managed exclusively by percutaneous approaches by interventional radiologists or surgical intervention. The morbidity associated was significant especially in those patients with advanced malignancy, seeking minimally invasive interventions and improved quality of life. With the advent of biliary drainage via endoscopic ultrasound (EUS) guidance, EUS guided biliary drainage has been used more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that encompasses various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS guided biliary and pancreatic drainage techniques. This diversity has resulted in variations and improvements in EUS Guided biliary and pancreatic drainage; and over the years has led to an extensive nomenclature. The diversity of techniques, nomenclature and recent progress in our intrumentation has led to a dedicated meeting on May 7(th), 2011 during Digestive Disease Week 2011. More than 40 advanced endoscopists from United States, Brazil, Mexico, Venezuela, Colombia, Italy, France, Austria, Germany, Spain, Japan, China, South Korea and India attended this pivotal meeting. The meeting covered improved EUS guided biliary access and drainage procedures, terminology, nomenclature, training and credentialing; as well as emerging devices for EUS guided biliary drainage. This paper summarizes the meeting's agenda and the conclusions generated by the creation of this consortium group.
- Published
- 2013
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195. A One-step Procedure by Using Linear Echoendoscope to Perform EUS-guided Choledochoduodenostomy and Duodenal Stenting in Patients with Irresectable Periampullary Cancer.
- Author
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Rebello C, Bordini A, Yoshida A, Viana B, Ramos PE, Otoch JP, Cirino LM, and Artifon EL
- Abstract
Objective: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) has become an alternative method after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP) treatment. We present a case series study and its feasibility by using only a linear therapeutic channel echoendoscope to create both a biliary-enteral fistula and anatomic enteral recanalization., Methods: We presented seven cases of unresectable periampullary cancer with both biliary and duodenal obstruction. In these cases, the EUS-guided technique might be an alternative to double stenting (biliary and enteral) in the same procedure and equipment., Results: In all cases, the location of the biliary obstruction was in the distal common bile duct (CBD) and the grade of proximal dilation diameter varied from 15 mm to 20 mm. Two patients had type I (28.6%) and five had type II (71.4%) duodenal obstruction. Technical success of EUS-CD, by the stent placement, occurred in 100% of the cases. There were no early complications. Biliary drainage was effective clinically as well as in laboratory in 6 cases (6/7), by relieving obstructive jaundice and decreasing bilirubin levels., Conclusion: EUS equipment may offer an alternative to double stenting in the same procedure and with palliative propose.
- Published
- 2012
- Full Text
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196. Extrahepatic anterograde covered self-expandable metallic stent placement across malignant biliary obstruction passed by endoscopic ultrasound guidance access: a challenging technique.
- Author
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Artifon EL, Ferreira F, Benevides G, Marcaccio FH, Otoch JP, Takada J, Carnevale FC, Mota AM, Moura E, Rasslan S, de Figueiredo LP, and Sakai P
- Subjects
- Acute Disease, Aged, Bile Duct Neoplasms complications, Drainage instrumentation, Female, Humans, Jaundice, Obstructive etiology, Medical Illustration, Treatment Outcome, Ultrasonography, Interventional methods, Bile Duct Neoplasms therapy, Endosonography methods, Jaundice, Obstructive therapy, Stents
- Abstract
The authors report the case of a female patient submitted to endoscopic cholangiography intending to drain the biliary tree due to jaundice. The patient had gastrointestinal deviation due to an advanced gastric cancer that evolved with a distal extrahepatic mass. Abdominal CT scan demonstrated a distal mass, extrahepatic biliary dilation and a normal intra-hepatic tree. In this condition and after a multidisciplinary discussion, an endoscopic ultrasound guided extrahepatic access with the deployment of a partially covered self-expandable metallic stent was performed. The patient normalized her bilirubin levels after a successful procedure.
- Published
- 2012
197. [EUS-guided access to dorsal pancreatic duct in a patient with pancreas divisum].
- Author
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A Artifon EL, V Frazã O MS, Coelho Ferreira F, and P Otoch J
- Subjects
- Acute Disease, Adult, Drainage instrumentation, Humans, Male, Pancreatic Ducts diagnostic imaging, Pancreatitis diagnostic imaging, Pancreatitis therapy, Recurrence, Stents, Drainage methods, Endosonography, Pancreatic Ducts abnormalities, Pancreatitis etiology, Ultrasonography, Interventional
- Abstract
Case report of pancreas divisum dorsal pancreatic duct access with endoscopic ultrasonography help to relief pain in a patient with not possible access by PCRE.
- Published
- 2012
198. Post-endoscopic retrograde cholangiopancreatography complications: How can they be avoided?
- Author
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Vila JJ, Artifon EL, and Otoch JP
- Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has a significant complication rate which can be lowered by adopting technical variations of proven beneficial effect and prophylactic maneuvers such as pancreatic stenting during ERCP or periprocedural non-steroidal anti-inflammatory drug administration. However, adoption of these prophylactic maneuvers by endoscopists is not uniform. In this editorial we discuss the beneficial effects of the aforementioned maneuvers.
- Published
- 2012
- Full Text
- View/download PDF
199. EUS-guided choledochoduodenostomy for malignant distal biliary obstruction palliation: an article review.
- Author
-
Artifon EL and Perez-Miranda M
- Abstract
The EUS-guided biliary drainage is a new tool for the palliation of distal obstructive biliary lesions. The EUS-guided access, which creates a fistulization between the duodenal bulb and distal common biliary duct, is an effective method to relieve jaundice and has low morbidity and mortality, in patients with distal biliary obstruction (pancreatic mass or papillary câncer). This technique is called choledochoduodenostomy and is presented promptly in this article. The EUS-guided biliary drainage should be made within protocol conditions and done by very experienced endosonographers.
- Published
- 2012
- Full Text
- View/download PDF
200. EUS-guided fistulization of postoperative colorectal stenosis in an infant with Hirschsprung's disease: a new technique.
- Author
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Artifon EL, Ferreira F, Baracat R, Okawa L, Gupta K, Sakai P, and Bhutani MS
- Subjects
- Anastomosis, Surgical adverse effects, Child, Preschool, Constriction, Pathologic therapy, Endosonography, Humans, Male, Stents, Ultrasonography, Interventional, Colon surgery, Colonic Diseases therapy, Colonoscopy methods, Hirschsprung Disease surgery, Postoperative Complications therapy, Rectum surgery
- Published
- 2012
- Full Text
- View/download PDF
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