Robson Ishida - Academia.edu (original) (raw)
Papers by Robson Ishida
... Dra. Miyoko Jakabe; Ana MR Paula; Christiane A. Risttori; Sabrina N. Silva; Elaine S. Gomes .... more ... Dra. Miyoko Jakabe; Ana MR Paula; Christiane A. Risttori; Sabrina N. Silva; Elaine S. Gomes ... Fuji Photo Optical Co Aos pacientes que participaram dessa pesquisa Meus pais Yuiti e Yvone, minha irmã Solange e em especial, Ana Paula Page 5. ...
GED gastroenterol. …, 2006
... experimental, Documentos relacionados. Id: 504015. Autor: Safatle-Ribeiro, Adriana Vaz; Kuga,... more ... experimental, Documentos relacionados. Id: 504015. Autor: Safatle-Ribeiro, Adriana Vaz; Kuga, Rogério; Mendes, Daniel Chaves; Ishida, Robson Kiyoshi; Franzine, Tomazo Antônio Prince; Baba, Elisa Ryoka; Artifon, Everson Luiz de Almeida; Sakai, Paulo; Ishioka, Shinichi. ...
Data Revues 00165107 V63i5 S0016510706009588, Aug 19, 2011
Revista do Hospital das Clínicas
Sixty fresh adult livers were obtained from cadavers together with celiac trunk, head of the panc... more Sixty fresh adult livers were obtained from cadavers together with celiac trunk, head of the pancreas and superior mesenteric artery. The right portal vein, left portal vein and their respective branches were dissected as well as the hepatic veins. There was only one right hepatic vein in 59 cases. The median hepatic vein was present in 53 (88.3%) cases and the left hepatic vein only in 46(76.3%). In 59(98.3%) cases, there were right and left portal vein but in one (1.6%) case no portal bifurcation has been found. The median portal vein has been found only in 9(15.2%) cases.
GED - Gastrenterologia Endoscopia Digestiva
Brazilian Journal of Medical and Biological Research
It is possible to obtain two good-quality hepatic transplants from a single cadaveric liver by se... more It is possible to obtain two good-quality hepatic transplants from a single cadaveric liver by separation of the right and left lobes of the liver. We attempted to define a relationship based only on donor body weight for predicting donor total liver weight as well as donor right (segments V-VIII) and left (segments II-IV) hepatic lobe weight. Segment I (caudate lobe) is resected and thus lost in this procedure. The study was performed on 60 human cadaveric livers. We correlated cadaveric body weight (mean +/- SD), 72.43 +/- 9.54 kg, with total liver weight, 1.54 +/- 0.36 kg, and right and left lobe weight, 0.88 +/- 0.23 kg and 0.65 +/- 0.17 kg, respectively, with total liver weight. A formula was obtained by linear regression which provided the following relationships: total liver weight (g) = [245.57 + 17.92 x (body weight, kg)]; right lobe weight (g) = [67.58 + 0.52 x (total liver weight, g)]; left lobe weight (g) = [-63.38 + 0.47 x (total liver weight, g)]. The selection of the ...
GED - Gastrenterologia Endoscopia Digestiva
Resumo: A síndrome de Peutz-jeghers é uma doença autossômica dominante caracterizada por polipose... more Resumo: A síndrome de Peutz-jeghers é uma doença autossômica dominante caracterizada por polipose gastrointestinal (hamartomas), pigmentação mucocutânea e risco aumentado de neoplasias gastrointestinais (adenocarcinoma do cólon, duodeno, ...
Surgical Endoscopy, 2007
The aim of this study was to analyze the contribution of the double-balloon enteroscopy (DBE) for... more The aim of this study was to analyze the contribution of the double-balloon enteroscopy (DBE) for diagnosis of the small bowel disorders. Forty-four patients (20 women, 24 men; mean age 53.5 years-old, range 21-89 years) with chronic gastrointestinal bleeding, diarrhea, polyposis, weight-loss, Roux-en-Y surgery, and other indications underwent DBE. Twenty patients had occult or obscure gastrointestinal bleeding. The source of bleeding was identified in 15/20 (75%): multiple angiodysplasias in four, arterial-venous malformation beyond the ligament of Treitz in two that could be treated with injection successfully. Other diagnoses included: duodenal adenocarcinoma, jejunal tuberculosis, erosions and ulcer of the jejunum. Of 24 patients with other indications, the diagnosis could be achieved in 18 of them (75%), including: two lymphomas, plasmocytoma, Gardner's syndrome, Peutz-Jeghers' syndrome, familial adenomatous polyposis, Behçet's disease, jejunal submucosal lesion, lymphangiectasia due to blastomycosis and unspecific chronic jejunitis. Of three cases with Roux-en-Y reconstruction, two underwent DBE in order to perform biopsies of the excluded duodenum. Additionally, two patients underwent DBE to exclude Crohn's disease and lymphoma of the small bowel. The mean length of small bowel examination was 240 +/- 50 cm during a single approach. The diagnostic yield was 75% (33/44 cases) and therapeutic yield was 63.6%. No major complications were observed, only minor complication such as sore throat in 4/44 (9.1%). 1. DBE is a safe and and accurate method to diagnose small bowel disorders; 2. this method permits chromoscopy, biopsies and treatment of the lesions.
Obesity Surgery, 2014
Patients with postbariatric bacterial overgrowth were reinvestigated after a follow-up of 15 year... more Patients with postbariatric bacterial overgrowth were reinvestigated after a follow-up of 15 years. It was hypothesized that systemic associations analogous to those reported for whole gut microbiome would be revealed. Patients (n = 37, 70.3 % females, 42.4 ± 9.9 years old, preoperative BMI 53.5 ± 10.6 kg/m(2), current BMI 32.8 ± 10.8 kg/m(2)), all submitted to RYGB on account of morbid obesity, were followed during 176.8 ± 25.7 months. Blood tests included fasting blood glucose, HbA1c, liver and pancreatic enzymes, and lipid fractions. Bacterial overgrowth was diagnosed by quantitative culture of gastric fluid in both the excluded remnant and the gastric pouch, with the help of double-balloon enteroscopy. Absolute counts of aerobes and anaerobes in both gastric reservoirs were correlated with nutritional and biochemical measurements, aiming to identify clinically meaningful associations. Patients denied diarrhea, abdominal pain, weight loss, or other symptoms related to bacterial overgrowth. Biochemical profile including enzymes was also acceptable, indicating a stable condition. Positive correlation of bacterial count in either segment of the stomach was demonstrated for BMI and gamma-glutamyl transferase, whereas negative correlation occurred regarding fasting blood glucose. An antidiabetic role along with deleterious consequences for weight loss and liver function are possible in such circumstances. Such phenotype is broadly consistent with reported effects for the whole gut microbiome. Prospective controlled studies including molecular analysis of gastrointestinal fluid, and simultaneous profiling of the entire microbiome, are necessary to shed more light on these findings.
Obesity Surgery, 2007
Morbidly obese patients frequently display asymptomatic chronic activation of acute phase respons... more Morbidly obese patients frequently display asymptomatic chronic activation of acute phase response, with potentially adverse metabolic and cardiovascular consequences. Nutritional preparations to improve this phenomenon have rarely been administered. Aiming to investigate the supplementation of flaxseed flour, a source of omega-3 fatty acids, a prospective randomized double-blind cross-over study was designed. Outpatient obese subjects (n=41) were clinically and biochemically screened, and results for 24 randomized subjects are shown. Age was 40.8 +/- 11.6 years (83.3% females) and body mass index (BMI) was 47.1 +/- 7.2 kg/m2. Flaxseed flour (Farinha de Linhaca Dourada LinoLive, Cisbra, Brazil) in the amount of 30 g/day (5 g of alpha-linolenic acid - omega-3) and an equal mass of placebo (manioc flour) were administered for 2 weeks each. Variables included general biochemical investigation, white blood cell count (WBC), C-reactive protein (CRP), serum amyloid A (SAA) and fibronectin. No intolerance was registered. Body weight and general biochemical indices remained stable. Initial CRP and SAA were elevated (13.7 +/- 9.9 and 17.4 +/- 8.0 ). WBC (8100 +/- 2100/mm3) and fibronectin (463.2 +/- 61.3 mg/dL) were acceptable but in the upper normal range. Corresponding findings after supplementation of flaxseed were 10.6 +/- 6.2 mg/L, 14.3 +/- 9.2 mg/L, 7300 +/- 1800/mm3 and 412.8 +/- 38.6 respectively (P<0.05). No change during the control period regarding baseline occurred when placebo was randomized to be given first; however, when it followed omega-3 supplementation, CRP and SAA recovered, whereas WBC and fibronection remained depressed during those 2 weeks (7500 +/- 2100/mm3 and 393.2 +/- 75.8 mg/dL, P<0.05). 1) Various inflammatory markers were elevated in the studied population, although not necessarily exceeding the normal range; 2) Significant reduction could be demonstrated; 3) Some persistent effects of flaxseed supplement 2 weeks after discontinuation were observed.
Obesity Surgery, 2007
Methods: Bariatric subjects (n=37) were submitted to endoscopic examination of both gastric reser... more Methods: Bariatric subjects (n=37) were submitted to endoscopic examination of both gastric reservoirs via FUJINON enteroscope model EN-450P5, 7.3 ± 1.4 years after RYGBP. Age was 42.4 ± 9.9 years (70.2% females), preoperative BMI was 53.5 ± 10.6, and current BMI was 32.6 ± 7.8 kg/m 2 . Methods included quantitative culture of gastric secretion along with gastric pH and lactulose/hydrogen breath test.
Obesity Surgery, 2013
Mucosal alterations after Roux-en-Y gastric bypass for morbid obesity have not been clearly evalu... more Mucosal alterations after Roux-en-Y gastric bypass for morbid obesity have not been clearly evaluated. This study aims to analyze the mucosal alterations (proliferative status (Ki-67); apoptosis (caspase-3 and BCL-2); hormonal function (gastrin)) in the excluded stomach. Double-balloon enteroscopy was performed in 35 patients who underwent Roux-en-Y gastric bypass longer than 36 months. Multiple biopsies of the proximal pouch and the excluded gastric mucosa were collected. Gastric biopsies from 32 non-operated obese patients were utilized as controls. Endoscopic biopsies were cut from tissue blocks fixed in formalin and embedded in paraffin. Sections 4 μm thick were examined for immunoexpression using the streptavidin-biotin-peroxidase method. The two groups were comparable for age, gender, gastritis, intestinal metaplasia, and Helicobacter pylori. The mean number of positive gastrin cells was 55.5 (standard deviation (SD) = 11.7) in the control group and 29.6 (SD = 7.9) in the cases, p = 0.0003. Ki-67 proliferative index in cases (body = 24.7%, antrum = 24.9%) was significantly higher compared to controls (body = 15.0% and antrum = 17.7%), p = 0.002 and 0.01, respectively. Caspase-3 immunoexpression was higher in the controls compared to the excluded stomach (46 vs. 31%), p = 0.02. There was no statistical difference between CD3, CD8, and Bcl-2 immunoexpressions in the control and cases. Cell proliferation is increased and apoptosis is downregulated in the excluded gastric mucosa compared to the non-operated obese controls. Alterations in cell turnover and in hormonal secretions in these conditions may be of relevance in long-term follow-up.
Journal of Gastrointestinal Surgery, 2008
Gastrointestinal Endoscopy, 2006
Background: The development of capsule endoscopy (CE) has revolutionized imaging of the small bow... more Background: The development of capsule endoscopy (CE) has revolutionized imaging of the small bowel. However, there are few published reports on the sensitivity of CE, especially for small lesions. Probably the best controlled data of sensitivity of CE for small lesions is the canine bead study by Appleyard (2000). In this study CE had a sensitivity of 53% within the range of enteroscopy, as compared to a 94% sensitivity of standard enteroscopy. In a 2005 abstract, Wong reported that CE significantly underestimates the number of small bowel polyps compared with enteroscopy in patients with familial adenomatous poliposis (FAP). It has been our observation that the ampulla is uncommonly seen on CE studies. Further literature review showed that this has never been formally studied. Methods: Between May 2002 and November 2005, 178 CE studies were performed and recorded on compact discs. All the consecutive studies were reviewed by an experienced capsular endoscopist (greater than 150 studies). Forty studies were excluded for following reasons: gastric retention-13, technical difficulties-11, endoscopic placement-12, surgically altered anatomy-3, and poor visualization-1. Indication for CE in the remaining 138 studies (male: female Z 1:1.2) were; gastrointestinal bleeding-62, anemia-26, abdominal pain and diarrhea-15, abdominal pain-9, diarrhea-2, probable Crohn's-8, Crohn's disease-2, probable graft versus host disease-4, FAP-4, Peutz-Jegher-2, celiac disease-2, probable celiac disease-1, rule out intestinal polyp-1, probable carcinoid-1. Results: Ampulla was identified only 9 (6%) out of 138 studies. Four patients had repeated CEs. No ampulla was detected even on repeated examinations. All the visualized ampulla had normal morphology, and not visualized with FAP patients. Discussion: To our knowledge this is the first study to formally document this low rate of visualization of ampulla. This finding strongly supports that the CE does not replace standard/side viewing endoscopy of duodenum, especially in FAP where ampullary pathology is of central importance. Because of its unique anatomy and position in the duodenal C-loop, the generalization of this results to a high miss rate of other small lesions in the small intestine is uncertain. The release of a new capsule with the twice frame rate may improve its sensitivity. Conclusion:CE infrequently detects the ampulla of vater, and it should not replace standard/side-viewing endoscopy in the proximal small bowel especially in FAP.
Gastrointestinal Endoscopy, 2006
Gastrointestinal Endoscopy, 2011
Endoscopy, 2005
Endoscopic evaluation of the excluded stomach after Roux-en-Y gastric bypass surgery for morbid o... more Endoscopic evaluation of the excluded stomach after Roux-en-Y gastric bypass surgery for morbid obesity is a challenge, and the pathological changes that take place in the bypassed stomach are unclear. A new double-balloon method of evaluating the bypassed stomach after Roux-en-Y gastric bypass surgery for morbid obesity is described here. This new enteroscope uses two balloons, one attached to the tip of the endoscope and the other to the distal end of the soft overtube. The procedures were carried out in six patients using the retrograde route, through the end-to-side jejunal anastomosis via the duodenobiliopancreatic limb up to the bypassed stomach. The bypassed stomach was reached in five of six patients (83.3 %). An endoscopic appearance of atrophic gastritis was found in three patients, mild in two cases and severe in one case with intestinal metaplasia. Erosive and hemorrhagic gastritis was found in two patients. Endoscopic evaluation of the bypassed stomach via the retrograde route after Roux-en-Y gastric bypass for morbid obesity is feasible using the double-balloon enteroscope.
Digestive Diseases, 2008
Double-balloon enteroscopy (DBE) allows evaluation and therapy for various small bowel diseases. ... more Double-balloon enteroscopy (DBE) allows evaluation and therapy for various small bowel diseases. In this series the outcome of a 4-year experience in a tertiary hospital school in Brazil is reported. A total of 457 consecutive DBE were performed in 418 patients from August 2004 to August 2008. 93 patients with several indications, whose aim was not the evaluation of suspected diseases of the small bowel mucosa, were excluded, therefore leaving 364 DBE in 325 patients for analysis. Data were retrospectively collected with regard to clinical, endoscopic findings, therapy and complications. Among the 364 DBE performed in 325 patients, 143/325 were males (44%) and 182/325 females (56%) with a mean age of 48.6 +/- 15.7 years (range 17-89). Mean investigation time was 64 +/- 22 min (range 35-135). The depth of insertion beyond the ligament of Treitz was 230 +/- 85 cm (range 30-500) by the antegrade approach and 140 +/- 75 cm (range 0-320) by the retrograde approach. Total enteroscopy was achieved in 41.66% of the attempts (30 of 72 patients). Overall diagnostic yield was 54.95% (200 of 364 procedures) ranging from 0 to 100% in this series, depending on the indication. Angiodysplasia was the main diagnosis in 24.5% (49 of 200 procedures) and endoscopic treatment, including biopsies, hemostasis, tattooing and polypectomy were performed in 65.38% (238 of 364 procedures). No major complications were reported. DBE is a feasible, safe and well-tolerated procedure allowing endoscopic therapy. Selection of indications increases its diagnostic yield.
... Dra. Miyoko Jakabe; Ana MR Paula; Christiane A. Risttori; Sabrina N. Silva; Elaine S. Gomes .... more ... Dra. Miyoko Jakabe; Ana MR Paula; Christiane A. Risttori; Sabrina N. Silva; Elaine S. Gomes ... Fuji Photo Optical Co Aos pacientes que participaram dessa pesquisa Meus pais Yuiti e Yvone, minha irmã Solange e em especial, Ana Paula Page 5. ...
GED gastroenterol. …, 2006
... experimental, Documentos relacionados. Id: 504015. Autor: Safatle-Ribeiro, Adriana Vaz; Kuga,... more ... experimental, Documentos relacionados. Id: 504015. Autor: Safatle-Ribeiro, Adriana Vaz; Kuga, Rogério; Mendes, Daniel Chaves; Ishida, Robson Kiyoshi; Franzine, Tomazo Antônio Prince; Baba, Elisa Ryoka; Artifon, Everson Luiz de Almeida; Sakai, Paulo; Ishioka, Shinichi. ...
Data Revues 00165107 V63i5 S0016510706009588, Aug 19, 2011
Revista do Hospital das Clínicas
Sixty fresh adult livers were obtained from cadavers together with celiac trunk, head of the panc... more Sixty fresh adult livers were obtained from cadavers together with celiac trunk, head of the pancreas and superior mesenteric artery. The right portal vein, left portal vein and their respective branches were dissected as well as the hepatic veins. There was only one right hepatic vein in 59 cases. The median hepatic vein was present in 53 (88.3%) cases and the left hepatic vein only in 46(76.3%). In 59(98.3%) cases, there were right and left portal vein but in one (1.6%) case no portal bifurcation has been found. The median portal vein has been found only in 9(15.2%) cases.
GED - Gastrenterologia Endoscopia Digestiva
Brazilian Journal of Medical and Biological Research
It is possible to obtain two good-quality hepatic transplants from a single cadaveric liver by se... more It is possible to obtain two good-quality hepatic transplants from a single cadaveric liver by separation of the right and left lobes of the liver. We attempted to define a relationship based only on donor body weight for predicting donor total liver weight as well as donor right (segments V-VIII) and left (segments II-IV) hepatic lobe weight. Segment I (caudate lobe) is resected and thus lost in this procedure. The study was performed on 60 human cadaveric livers. We correlated cadaveric body weight (mean +/- SD), 72.43 +/- 9.54 kg, with total liver weight, 1.54 +/- 0.36 kg, and right and left lobe weight, 0.88 +/- 0.23 kg and 0.65 +/- 0.17 kg, respectively, with total liver weight. A formula was obtained by linear regression which provided the following relationships: total liver weight (g) = [245.57 + 17.92 x (body weight, kg)]; right lobe weight (g) = [67.58 + 0.52 x (total liver weight, g)]; left lobe weight (g) = [-63.38 + 0.47 x (total liver weight, g)]. The selection of the ...
GED - Gastrenterologia Endoscopia Digestiva
Resumo: A síndrome de Peutz-jeghers é uma doença autossômica dominante caracterizada por polipose... more Resumo: A síndrome de Peutz-jeghers é uma doença autossômica dominante caracterizada por polipose gastrointestinal (hamartomas), pigmentação mucocutânea e risco aumentado de neoplasias gastrointestinais (adenocarcinoma do cólon, duodeno, ...
Surgical Endoscopy, 2007
The aim of this study was to analyze the contribution of the double-balloon enteroscopy (DBE) for... more The aim of this study was to analyze the contribution of the double-balloon enteroscopy (DBE) for diagnosis of the small bowel disorders. Forty-four patients (20 women, 24 men; mean age 53.5 years-old, range 21-89 years) with chronic gastrointestinal bleeding, diarrhea, polyposis, weight-loss, Roux-en-Y surgery, and other indications underwent DBE. Twenty patients had occult or obscure gastrointestinal bleeding. The source of bleeding was identified in 15/20 (75%): multiple angiodysplasias in four, arterial-venous malformation beyond the ligament of Treitz in two that could be treated with injection successfully. Other diagnoses included: duodenal adenocarcinoma, jejunal tuberculosis, erosions and ulcer of the jejunum. Of 24 patients with other indications, the diagnosis could be achieved in 18 of them (75%), including: two lymphomas, plasmocytoma, Gardner's syndrome, Peutz-Jeghers' syndrome, familial adenomatous polyposis, Behçet's disease, jejunal submucosal lesion, lymphangiectasia due to blastomycosis and unspecific chronic jejunitis. Of three cases with Roux-en-Y reconstruction, two underwent DBE in order to perform biopsies of the excluded duodenum. Additionally, two patients underwent DBE to exclude Crohn's disease and lymphoma of the small bowel. The mean length of small bowel examination was 240 +/- 50 cm during a single approach. The diagnostic yield was 75% (33/44 cases) and therapeutic yield was 63.6%. No major complications were observed, only minor complication such as sore throat in 4/44 (9.1%). 1. DBE is a safe and and accurate method to diagnose small bowel disorders; 2. this method permits chromoscopy, biopsies and treatment of the lesions.
Obesity Surgery, 2014
Patients with postbariatric bacterial overgrowth were reinvestigated after a follow-up of 15 year... more Patients with postbariatric bacterial overgrowth were reinvestigated after a follow-up of 15 years. It was hypothesized that systemic associations analogous to those reported for whole gut microbiome would be revealed. Patients (n = 37, 70.3 % females, 42.4 ± 9.9 years old, preoperative BMI 53.5 ± 10.6 kg/m(2), current BMI 32.8 ± 10.8 kg/m(2)), all submitted to RYGB on account of morbid obesity, were followed during 176.8 ± 25.7 months. Blood tests included fasting blood glucose, HbA1c, liver and pancreatic enzymes, and lipid fractions. Bacterial overgrowth was diagnosed by quantitative culture of gastric fluid in both the excluded remnant and the gastric pouch, with the help of double-balloon enteroscopy. Absolute counts of aerobes and anaerobes in both gastric reservoirs were correlated with nutritional and biochemical measurements, aiming to identify clinically meaningful associations. Patients denied diarrhea, abdominal pain, weight loss, or other symptoms related to bacterial overgrowth. Biochemical profile including enzymes was also acceptable, indicating a stable condition. Positive correlation of bacterial count in either segment of the stomach was demonstrated for BMI and gamma-glutamyl transferase, whereas negative correlation occurred regarding fasting blood glucose. An antidiabetic role along with deleterious consequences for weight loss and liver function are possible in such circumstances. Such phenotype is broadly consistent with reported effects for the whole gut microbiome. Prospective controlled studies including molecular analysis of gastrointestinal fluid, and simultaneous profiling of the entire microbiome, are necessary to shed more light on these findings.
Obesity Surgery, 2007
Morbidly obese patients frequently display asymptomatic chronic activation of acute phase respons... more Morbidly obese patients frequently display asymptomatic chronic activation of acute phase response, with potentially adverse metabolic and cardiovascular consequences. Nutritional preparations to improve this phenomenon have rarely been administered. Aiming to investigate the supplementation of flaxseed flour, a source of omega-3 fatty acids, a prospective randomized double-blind cross-over study was designed. Outpatient obese subjects (n=41) were clinically and biochemically screened, and results for 24 randomized subjects are shown. Age was 40.8 +/- 11.6 years (83.3% females) and body mass index (BMI) was 47.1 +/- 7.2 kg/m2. Flaxseed flour (Farinha de Linhaca Dourada LinoLive, Cisbra, Brazil) in the amount of 30 g/day (5 g of alpha-linolenic acid - omega-3) and an equal mass of placebo (manioc flour) were administered for 2 weeks each. Variables included general biochemical investigation, white blood cell count (WBC), C-reactive protein (CRP), serum amyloid A (SAA) and fibronectin. No intolerance was registered. Body weight and general biochemical indices remained stable. Initial CRP and SAA were elevated (13.7 +/- 9.9 and 17.4 +/- 8.0 ). WBC (8100 +/- 2100/mm3) and fibronectin (463.2 +/- 61.3 mg/dL) were acceptable but in the upper normal range. Corresponding findings after supplementation of flaxseed were 10.6 +/- 6.2 mg/L, 14.3 +/- 9.2 mg/L, 7300 +/- 1800/mm3 and 412.8 +/- 38.6 respectively (P<0.05). No change during the control period regarding baseline occurred when placebo was randomized to be given first; however, when it followed omega-3 supplementation, CRP and SAA recovered, whereas WBC and fibronection remained depressed during those 2 weeks (7500 +/- 2100/mm3 and 393.2 +/- 75.8 mg/dL, P<0.05). 1) Various inflammatory markers were elevated in the studied population, although not necessarily exceeding the normal range; 2) Significant reduction could be demonstrated; 3) Some persistent effects of flaxseed supplement 2 weeks after discontinuation were observed.
Obesity Surgery, 2007
Methods: Bariatric subjects (n=37) were submitted to endoscopic examination of both gastric reser... more Methods: Bariatric subjects (n=37) were submitted to endoscopic examination of both gastric reservoirs via FUJINON enteroscope model EN-450P5, 7.3 ± 1.4 years after RYGBP. Age was 42.4 ± 9.9 years (70.2% females), preoperative BMI was 53.5 ± 10.6, and current BMI was 32.6 ± 7.8 kg/m 2 . Methods included quantitative culture of gastric secretion along with gastric pH and lactulose/hydrogen breath test.
Obesity Surgery, 2013
Mucosal alterations after Roux-en-Y gastric bypass for morbid obesity have not been clearly evalu... more Mucosal alterations after Roux-en-Y gastric bypass for morbid obesity have not been clearly evaluated. This study aims to analyze the mucosal alterations (proliferative status (Ki-67); apoptosis (caspase-3 and BCL-2); hormonal function (gastrin)) in the excluded stomach. Double-balloon enteroscopy was performed in 35 patients who underwent Roux-en-Y gastric bypass longer than 36 months. Multiple biopsies of the proximal pouch and the excluded gastric mucosa were collected. Gastric biopsies from 32 non-operated obese patients were utilized as controls. Endoscopic biopsies were cut from tissue blocks fixed in formalin and embedded in paraffin. Sections 4 μm thick were examined for immunoexpression using the streptavidin-biotin-peroxidase method. The two groups were comparable for age, gender, gastritis, intestinal metaplasia, and Helicobacter pylori. The mean number of positive gastrin cells was 55.5 (standard deviation (SD) = 11.7) in the control group and 29.6 (SD = 7.9) in the cases, p = 0.0003. Ki-67 proliferative index in cases (body = 24.7%, antrum = 24.9%) was significantly higher compared to controls (body = 15.0% and antrum = 17.7%), p = 0.002 and 0.01, respectively. Caspase-3 immunoexpression was higher in the controls compared to the excluded stomach (46 vs. 31%), p = 0.02. There was no statistical difference between CD3, CD8, and Bcl-2 immunoexpressions in the control and cases. Cell proliferation is increased and apoptosis is downregulated in the excluded gastric mucosa compared to the non-operated obese controls. Alterations in cell turnover and in hormonal secretions in these conditions may be of relevance in long-term follow-up.
Journal of Gastrointestinal Surgery, 2008
Gastrointestinal Endoscopy, 2006
Background: The development of capsule endoscopy (CE) has revolutionized imaging of the small bow... more Background: The development of capsule endoscopy (CE) has revolutionized imaging of the small bowel. However, there are few published reports on the sensitivity of CE, especially for small lesions. Probably the best controlled data of sensitivity of CE for small lesions is the canine bead study by Appleyard (2000). In this study CE had a sensitivity of 53% within the range of enteroscopy, as compared to a 94% sensitivity of standard enteroscopy. In a 2005 abstract, Wong reported that CE significantly underestimates the number of small bowel polyps compared with enteroscopy in patients with familial adenomatous poliposis (FAP). It has been our observation that the ampulla is uncommonly seen on CE studies. Further literature review showed that this has never been formally studied. Methods: Between May 2002 and November 2005, 178 CE studies were performed and recorded on compact discs. All the consecutive studies were reviewed by an experienced capsular endoscopist (greater than 150 studies). Forty studies were excluded for following reasons: gastric retention-13, technical difficulties-11, endoscopic placement-12, surgically altered anatomy-3, and poor visualization-1. Indication for CE in the remaining 138 studies (male: female Z 1:1.2) were; gastrointestinal bleeding-62, anemia-26, abdominal pain and diarrhea-15, abdominal pain-9, diarrhea-2, probable Crohn's-8, Crohn's disease-2, probable graft versus host disease-4, FAP-4, Peutz-Jegher-2, celiac disease-2, probable celiac disease-1, rule out intestinal polyp-1, probable carcinoid-1. Results: Ampulla was identified only 9 (6%) out of 138 studies. Four patients had repeated CEs. No ampulla was detected even on repeated examinations. All the visualized ampulla had normal morphology, and not visualized with FAP patients. Discussion: To our knowledge this is the first study to formally document this low rate of visualization of ampulla. This finding strongly supports that the CE does not replace standard/side viewing endoscopy of duodenum, especially in FAP where ampullary pathology is of central importance. Because of its unique anatomy and position in the duodenal C-loop, the generalization of this results to a high miss rate of other small lesions in the small intestine is uncertain. The release of a new capsule with the twice frame rate may improve its sensitivity. Conclusion:CE infrequently detects the ampulla of vater, and it should not replace standard/side-viewing endoscopy in the proximal small bowel especially in FAP.
Gastrointestinal Endoscopy, 2006
Gastrointestinal Endoscopy, 2011
Endoscopy, 2005
Endoscopic evaluation of the excluded stomach after Roux-en-Y gastric bypass surgery for morbid o... more Endoscopic evaluation of the excluded stomach after Roux-en-Y gastric bypass surgery for morbid obesity is a challenge, and the pathological changes that take place in the bypassed stomach are unclear. A new double-balloon method of evaluating the bypassed stomach after Roux-en-Y gastric bypass surgery for morbid obesity is described here. This new enteroscope uses two balloons, one attached to the tip of the endoscope and the other to the distal end of the soft overtube. The procedures were carried out in six patients using the retrograde route, through the end-to-side jejunal anastomosis via the duodenobiliopancreatic limb up to the bypassed stomach. The bypassed stomach was reached in five of six patients (83.3 %). An endoscopic appearance of atrophic gastritis was found in three patients, mild in two cases and severe in one case with intestinal metaplasia. Erosive and hemorrhagic gastritis was found in two patients. Endoscopic evaluation of the bypassed stomach via the retrograde route after Roux-en-Y gastric bypass for morbid obesity is feasible using the double-balloon enteroscope.
Digestive Diseases, 2008
Double-balloon enteroscopy (DBE) allows evaluation and therapy for various small bowel diseases. ... more Double-balloon enteroscopy (DBE) allows evaluation and therapy for various small bowel diseases. In this series the outcome of a 4-year experience in a tertiary hospital school in Brazil is reported. A total of 457 consecutive DBE were performed in 418 patients from August 2004 to August 2008. 93 patients with several indications, whose aim was not the evaluation of suspected diseases of the small bowel mucosa, were excluded, therefore leaving 364 DBE in 325 patients for analysis. Data were retrospectively collected with regard to clinical, endoscopic findings, therapy and complications. Among the 364 DBE performed in 325 patients, 143/325 were males (44%) and 182/325 females (56%) with a mean age of 48.6 +/- 15.7 years (range 17-89). Mean investigation time was 64 +/- 22 min (range 35-135). The depth of insertion beyond the ligament of Treitz was 230 +/- 85 cm (range 30-500) by the antegrade approach and 140 +/- 75 cm (range 0-320) by the retrograde approach. Total enteroscopy was achieved in 41.66% of the attempts (30 of 72 patients). Overall diagnostic yield was 54.95% (200 of 364 procedures) ranging from 0 to 100% in this series, depending on the indication. Angiodysplasia was the main diagnosis in 24.5% (49 of 200 procedures) and endoscopic treatment, including biopsies, hemostasis, tattooing and polypectomy were performed in 65.38% (238 of 364 procedures). No major complications were reported. DBE is a feasible, safe and well-tolerated procedure allowing endoscopic therapy. Selection of indications increases its diagnostic yield.