Publications by authors named "Alexandre Bestetti"

Background: In the past decades, endoscopic ultrasound has developed from a diagnostic tool to a platform for many therapeutic interventions. Various technological advancements have emerged since the last Brazilian Consensus, demanding a review and update of the recommendations based on the best scientific evidence.

Methods: A group of 32 renowned echoendoscopists selected eight relevant topics to be discussed to generate clinical questions.

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Article Synopsis
  • Endoscopic ultrasound (EUS) is an important tool for evaluating pancreatic lesions, but its accuracy is not very high, prompting the development of a convolutional neural network (CNN) to improve diagnosis of pancreatic cystic neoplasms (PCN) and pancreatic solid lesions (PSL).
  • The CNN was trained on a large dataset from four international centers, comprising over 126,000 images, and successfully distinguished between different types of pancreatic lesions with high accuracy.
  • The results showed the CNN achieved over 99% accuracy for normal pancreatic tissue and PCNs, while distinguishing between pancreatic ductal adenocarcinoma (P-DAC) and neuroendocrine tumors (P-NET) at 94% accuracy, pointing to the
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  • Obesity is expected to impact 17.5% of adults and 400 million children worldwide by 2035, necessitating personalized and multidisciplinary treatment strategies.
  • While lifestyle changes, medications, and bariatric surgery can aid in weight management, long-term success remains low, with surgery being the most effective yet underutilized option.
  • The intragastric balloon (IGB) presents a minimally invasive alternative for weight management, having received approval from major regulatory authorities, and its ongoing development and historical significance are explored in the review.
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Objectives: Endoscopic resection is the preferred approach to treat early Barrett's neoplasia, reducing the need for surgical interventions. However, the best choice between endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) remains unclear. The study aimed to compare the efficacy and safety of EMR vs.

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Background: Successful Crohn's disease (CD) therapy relies on timely and precise management strategies. Endoscopic balloon dilation (EBD) has been applied as a first-line treatment for symptomatic CD-associated strictures due to its minimally invasive nature and the possibility of preserving intestinal length.

Objective: The aim of the present study was to determine patient-related predictive factors associated with the need for surgery for CD-associated ileocolic strictures after technically successful EBD.

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Background: Obesity poses a severe health problem worldwide, with an estimated impact on 17.5% of the adult population by 2035. Among the endoscopic applications for treating this comorbidity, intragastric balloons are the most widely used.

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Ampullary lesions (ALs) can be treated through either an endoscopic approach (EA) or a surgical approach (SA). However, it is important to note that EAs carry a significant risk of incomplete resection, while opting for surgical interventions can result in substantial morbidity. We performed a systematic review and meta-analysis for R0 resection, recurrence, adverse events in general, major adverse events, mortality, and length of hospital stay between SAs and EAs.

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Background: Colorectal cancer is the third most common type of cancer in Brazil, despite the availability of screening methods that reduce its risk. Colonoscopy is the only screening method that also allows therapeutic procedures. The proper screening through colonoscopy is linked to the quality of the exam, which can be evaluated according to quality criteria recommended by various institutions.

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This article provides a comprehensive review of the use of endoscopic vacuum therapy (EVT) in the management of transmural gastrointestinal (GI) defects (TGIDs) and its future perspectives, such as pre-emptive EVT and novel indications, including GI bleeding and large gastroduodenal ulcers management. This review is based on the available literature data and personal experience to demystify the mentioned limitations of EVT as technical difficulties related to the procedure, possible patients' complaints, and institutions' concerns, by sharing several tips and tricks to overcome EVT-related challenges that may discourage endoscopists from using this live-saving technique, and consequently, restricting patients to receive this therapy, which may lead to undesired outcomes. Several factors, such as placement techniques, EVT type selection, management during its use, EVT system exchanges, device removal, type of anesthesia, and how to avoid EVT-related adverse events are described in detail.

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Background: Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract. Current drugs are not effective for treating the primary fibrotic component of CD. Recommended invasive treatments include endoscopic balloon dilation, surgery with resection, or strictureplasty.

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Biliary sphincterotomy is a crucial step in endoscopic retrograde cholangiopancreatography (ERCP), a procedure known to carry a 5% to 10% risk of complications. The relationship between Pure cut, Endocut, post-ERCP pancreatitis (PEP) and bleeding is unclear. This systematic review and meta-analysis compared these two current types and their relationships with adverse events.

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 is a condition related to the extracellular deposition of abnormal fibrillar proteins. Gastric involvement may present as a systemic or localized form of the disease. The endoscopic presentation can vary from nodular, ulcerated, or infiltrative lesions.

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Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment.

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Peroral endoscopic myotomy (POEM) and Heller myotomy with fundoplication (HMF) effectively treat achalasia, an esophageal motor disease. Although a significant number of meta-analyses have compared POEM and HMF, these studies showed discrepant postoperative gastroesophageal reflux disease (GERD) conclusions. This review aimed to objectively compare GERD over time, as well as the efficiency, safety, and adverse events in POEM versus HMF for treating achalasia.

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Article Synopsis
  • Self-expanding metal stents (SEMS) are used to relieve swallowing difficulties in esophageal cancer patients, with valved SEMS (SEMS-V) developed to potentially reduce gastroesophageal reflux disease (GERD) symptoms compared to non-valved SEMS (SEMS-NV).
  • A systematic review and meta-analysis of 10 randomized clinical trials involving 467 patients showed no significant differences in GERD symptoms, dysphagia relief, technical success, or adverse events between the two types of stents.
  • Both SEMS-V and SEMS-NV are deemed safe and effective for palliation in esophageal cancer, with comparable outcomes regarding GERD, dysphagia improvement, and quality of life.
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  • Endoscopic resection (ER) is favored for early gastric cancer (EGC) due to its lower adverse events and shorter hospital stays compared to surgery, although it may result in higher recurrence rates and lower complete resection rates.
  • The systematic review analyzed 29 studies with over 20,000 patients, finding no significant differences in 5-year overall survival and cancer-specific survival between ER and surgical methods.
  • Both treatments are effective and safe, but ER is less invasive and leads to a quicker recovery, yet carries some risks.
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