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Gustavo Maluf,Rogé,rio Jardim Caldas,Eduardo Rodrigues Fregnani,Paulo Sé,rgio da Silva Santos 대한구강악안면외과학회 2020 대한구강악안면외과학회지 Vol.46 No.2
We present a case of osteoradionecrosis treated with leukocyte- and platelet-rich fibrin (LPRF) and surgery and followed up with clinical and tomographic investigations. A 65-year-old woman presented with pain in the posterior region of the right palate. Her medical history included cardiovascular disease and squamous cell carcinoma in the anterior region of the floor of the mouth that had been treated with intensity-modulated radiation therapy. Measurements of isodose curves showed a full dosage of 6,462.6 cGy in the anterior mandibular region, whereas that in the posterior region on the right side of the maxilla reached 5,708.1 cGy. Osteotomy was performed using rotary instruments, and debridement and placement of two LPRF membranes were also carried out. New gum tissue with no bone exposure was noted 14 days postoperatively. Tissue repair was complete, and the patient had no further complaints. During a 39-month follow-up period, the oral mucosa remained intact, and the patient was rehabilitated with a new upper denture. Since there is no consensus regarding the best protocol to treat osteoradionecrosis, LPRF might be an interesting adjuvant to a surgical approach. The use of LPRF is simple and reduces operational costs, time of handling, probability of technical failure, and associated morbidities for patients with osteoradionecrosis.
Endoscopic ultrasound-guided gastroenterostomy (gastroenteric anastomosis)
Joel Fernandez de Oliveira,Matheus Cavalcante Franco,Gustavo Rodela,Fauze Maluf-Filho,Bruno Costa Martins 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.3
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a promising minimally invasive technique for patients with gastric outlet obstruction (GOO), regardless of whether a benign or malignant condition impedes gastric emptying. EUS-GE involves creating a bypass from the stomach to the small bowel distally to the obstruction, which is similar to the surgical gastroenteric anastomosis. In fact, EUS-GE has been reported to have longer stent patency in patients with malignant GOO than conventional self-expandable metal stents deployed across a malignant obstruction. Although surgical treatment is still considered the gold-standard treatment for patients with malignant GOO, the results of recent studies have shown not only similar rates of technical and clinical success with EUS-GE, but also lower rates of adverse events. In this review, we aimed to appraise the current status of EUS-GE, describe the multiple techniques to perform this procedure, compare the outcomes of EUS-GE with those of other therapeutic modalities, and discuss the related adverse events and the future perspectives of EUS-GE.
Endoscopic ultrasound-guided gastroenterostomy (gastroenteric anastomosis)
Joel Fernandez de Oliveira,Matheus Cavalcante Franco,Gustavo Rodela,Fauze Maluf-Filho,Bruno Costa Martins 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.3
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a promising minimally invasive technique for patients with gastric outlet obstruction (GOO), regardless of whether a benign or malignant condition impedes gastric emptying. EUS-GE involves creating a bypass from the stomach to the small bowel distally to the obstruction, which is similar to the surgical gastroenteric anastomosis. In fact, EUS-GE has been reported to have longer stent patency in patients with malignant GOO than conventional self-expandable metal stents deployed across a malignant obstruction. Although surgical treatment is still considered the gold-standard treatment for patients with malignant GOO, the results of recent studies have shown not only similar rates of technical and clinical success with EUS-GE, but also lower rates of adverse events. In this review, we aimed to appraise the current status of EUS-GE, describe the multiple techniques to perform this procedure, compare the outcomes of EUS-GE with those of other therapeutic modalities, and discuss the related adverse events and the future perspectives of EUS-GE.
Iatagan R. Josino,Bruno C. Martins,Andressa A. Machado,Gustavo R. de A. Lima,Martin A. C. Cordero,Amanda A. M. Pombo,Rubens A. A. Sallum,Ulysses Ribeiro Jr,Todd H. Baron,Fauze Maluf-Filho 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.6
Background/Aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malig-nant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients withesophageal cancer. Methods: This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignantesophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study. Results: Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15–5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01–4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR,0.5; 95% CI, 0.26–0.85; p=0.01). No difference was observed in overall survival. Conclusions: The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapyand a 28 mm stent flare were associated with a higher risk of SEMS-ERF.