Percorrer por autor "Pinto-Marques, Pedro"
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- Age-related decline in intestinal villus length : a cross-sectional study on the human gutPublication . Vara-Luiz, Francisco; Palma, Carolina; Mendes, Ivo; Piçarra, Francisco; Teles, Ana Elisa; Nogueira, Filipe; Costa-Santos, Inês; Nunes, Gonçalo; Patita, Marta; Mocanu, Irina; Pires, Sara; Meira, Tânia; Vieira, Ana; Pinto-Marques, Pedro; Mascarenhas, Paulo; Leskiv, Iryna; Gomes-Pinto, Daniel; Fonseca, JorgeBackground/Objectives: There is widespread agreement that age is a significant predictor of impaired response to nutritional support. This is generally attributed to anabolic resistance, with impaired absorption considered irrelevant/non-existent. However, animal models demonstrate age-related structural changes in the intestinal mucosa that may reduce absorptive capacity. We aimed to evaluate potential histological changes in the duodenal mucosa associated with aging. Methods: We conducted a single-center observational cross-sectional study. Ambulatory younger (18–45 years) and older (≥70 years) adults referred for upper endoscopy were included and underwent duodenal biopsies. Those biopsies were analyzed and compared for histological/histomorphometric changes, including villus length. Clinical and laboratory data were also recorded. Results: One hundred patients were included (46 men/54 women), 50 aged 18–45 years and 50 aged ≥70 years. There were no duodenal endoscopic changes. The median villus length was 0.35 mm (IQR 0.32–0.41 mm) in older people, lower than in younger adults (0.57 mm; IQR 0.47–0.68 mm) (p < 0.001). In a multivariable regression model including age, sex, and Charlson comorbidity index, age remained inversely associated with villus length (p < 0.001). Older participants also exhibited lower hemoglobin, iron, folate, vitamin B12, albumin and vitamin D levels, despite normal inflammatory markers. Conclusions: Aging is associated with histological changes in the intestinal mucosa, including villus shortening. These findings support the concept of mucosal aging as a distinct biological process. Villus shortening may reflect reduced absorptive surface area and could contribute to age-related nutritional vulnerability, although its functional implications remain to be determined.
- A challenging case of recurrent cholangitis caused by isolated bile duct metastasis of colorectal adenocarcinoma : rescue therapy through endoscopic ultrasound-guided hepaticoesophagostomyPublication . Vara-Luiz, Francisco; Mendes, Ivo; Nunes, Gonçalo; Palma, Carolina; Patita, Marta; Pinto-Marques, PedroA 64-year-old male was admitted with fever, abdominal pain, and jaundice. Medical history was relevant for colorectal adenocarcinoma 11 years before and right hepatectomy due to liver metastasis. MRCP revealed left hepatic duct stenosis without liver nodules. ERCP was performed for biliary drainage with plastic stents. After inconclusive brush cytology, cholangioscopy (SpyGlass™ DS2) was performed showing villous mucosa surrounded by irregular vessels suggestive of tumor neovascularization. SpyBite™ biopsies confirmed biliary metastasis of colorectal origin. The patient started palliative chemotherapy being readmitted 6 months later with acute cholangitis. Diffuse infiltrating intrabiliary lesion with 120 mm was detected in control MRCP. Given its intraductal extension and gastric compression by the hypertrophied liver leading to duodenoscope mispositioning, transpapilar stents could not be deployed. Multiorgan dysfunction developed despite broad-spectrum antibiotics, and EUS-guided biliary drainage was proposed. Although EUS access was limited by gastric bulging, puncture of a dilated intrahepatic duct was accomplished with a 19G needle. PCSEMS (GIOBOR™ 8 × 100 mm) placement was only possible above the gastroesophageal junction with the proximal flare being incidentally deployed in a 3-cm intraparietal esophageal tract. The misplaced stent was immediately recanalized, and a stent-in-stent FCSEMS (WallFlex™ 80 × 10 mm) allowed the hepaticoesophagostomy creation. Since the stent opening was orally oriented in esophageal lumen, parenteral nutrition was started to avoid contamination. Sepsis recovering and liver test normalization were observed. Before hospital discharge, stent reposition was planned to resume oral feeding. After placement of a third stent-in-stent NCSEMS (WallFlex™ 120 × 10 mm) in the hepaticoesophagostomy to prevent migration, the proximal flare was oriented to the stomach gently pushing with the endoscope aiding by an inflated biliary balloon. The patient resumed chemotherapy but died 8 months after due to disease progression. Isolated bile duct metastasis is an uncommon complication of colorectal cancer. EUS-guided hepaticoesophagostomy is feasible when puncture through the esophagus was inevitable, especially in patients with liver hypertrophy.
- Clinical, endoscopic and histologic differences in gastric mucosa between younger and older adults : an observational study on the aging stomachPublication . Vara-Luiz, Francisco; Mendes, Ivo; Palma, Carolina; Mascarenhas, Paulo; Teles, Ana Elisa; Santos, Inês Costa; Nunes, Gonçalo; Patita, Marta; Mocanu, Irina; Pires, Sara; Meira, Tânia; Vieira, Ana; Pinto-Marques, Pedro; Gomes-Pinto, Daniel; Fonseca, JorgeBackground/Objectives: Age-related changes in the gastric mucosa remain incompletely understood. We aimed to assess and compare clinical, endoscopic and histologic changes in the gastric mucosa associated with aging, and to explore whether gastric aging is associated with a distinct histological pattern. Methods: Single-center observational study. Younger (18–45 years) and older (≥70 years) adults undergoing elective upper endoscopy were included and underwent gastric biopsies. The clinical, endoscopic and histologic features were analyzed and compared. Results: A total of 100 patients were included (45 men/55 women), 50 with 18–45 years and 50 with ≥70 years. Dyspepsia, gastro-esophageal reflux disease and peptic ulcer disease were the most common indications for upper endoscopy. Gastric lesions (erythema, erosions, ulceration and polyps) were more common in older patients (80% vs. 50%, p = 0.003), as well as histologic changes such as chronic gastritis (56% vs. 38%, p = 0.004), chronic atrophic gastritis (CAG; 28% vs. 4%, p < 0.001) and intestinal metaplasia (28% vs. 4%, p < 0.001). These findings persisted after adjusting for Helicobacter pylori (H. pylori) status and proton pump inhibitor intake on the multivariate analysis. Prevalence of H. pylori was similar between both groups (28% vs. 32%, p = 0.189). Conclusions: Aging is associated with clinical, endoscopic and histologic changes in the gastric mucosa including CAG and metaplasia, independent of the presence of H. pylori. These findings may result from several aging-related pathophysiological processes and decades of cumulative gastric injury and support the hypothesis of an aging stomach phenotype, underscoring the need for an age-adjusted interpretation of gastric biopsies.
- Duodenal angiolipoma : a rare tumor causing recurrent upper gastrointestinal bleedingPublication . Vara-Luiz, Francisco; Nunes, Gonçalo; Oliveira, Carla; Mendes, Ivo; Dahlstedt-Ferreira, Catrine; Currais, Pedro; Pinto-Marques, Pedro; Fonseca, JorgeDuodenal angiolipoma is a rare adipocytic tumor, with non-specific symptoms precluding an early diagnosis. We present a case of a 67-year-old female admitted due to upper gastrointestinal bleeding. The upper endoscopy and endoscopic ultrasound evaluation showed a subepithelial lesion in the third portion of the duodenum. Endoscopic excision was performed using a standard polypectomy technique after endoloop placement. Histopathology was compatible with duodenal angiolipoma. The authors highlight duodenal angiolipoma as a rare adipocytic tumor potentially causing gastrointestinal bleeding, which can be safely treated with endoscopic excision.
- Endoscopic treatment of bile duct stones after bariatric Roux-en-Y gastric bypass through endoscopic ultrasound-directed transgastric ERCPPublication . Vara-Luiz, Francisco; Nunes, Gonçalo; Pinto-Marques, Pedro; Oliveira, Carla; Mendes, Ivo; Patita, Marta; Fonseca, JorgeEndoscopic retrograde cholangiopancreatography (ERCP) is technically challenging after Roux-en-Y gastric bypass (RYGB) [1]. Standard approaches include enteroscopy-assisted and laparoscopy-assisted ERCP, which present difficult implementation in clinical practice [2]. The authors report endoscopic ultrasound-directed transgastric ERCP (EDGE) for the treatment of bile duct stones in RYGB patients ([Video 1]).
- Endoscopic ultrasound-guided cholecystoduodenostomy followed by stone clearance using electrohydraulic and mechanical lithotripsy in a frail patient with acute cholecystitisPublication . Vara-Luiz, Francisco; Mendes, Ivo; Nunes, Gonçalo; Palma, Carolina; Patita, Marta; Fonseca, Jorge; Pinto-Marques, Pedro
- Endoscopic vacuum therapy of a refractory esophagopleural fistula in a patient with Boerhaave syndrome, using an innovative hybrid stentPublication . Mendes, Ivo; Nunes, Gonçalo; Vara-Luiz, Francisco; Vaz, João; Luz, Carlos; Fonseca, Jorge; Pinto-Marques, Pedro
- First case report of pancreatic angiomyolipoma diagnosed by EUS-guided fine-needle biopsyPublication . Vara-Luiz, Francisco; Patita, Marta; Pinto-Marques, Pedro; Mendes, Ivo; Canastra, Ana Ramos
- First case report of pancreatic angiomyolipoma diagnosed by EUS-guided fine-needle biopsyPublication . Vara-Luiz, Francisco; Patita, Marta; Pinto-Marques, Pedro; Mendes, Ivo; Canastra, Ana Ramos
- Portuguese Pancreatic Club perspective on the surveillance strategy for intraductal papillary mucinous neoplasms : when and how to do it?Publication . Vara-Luiz, Francisco; Fernandes, Alexandra; Bispo, Miguel; Vilas-Boas, Filipe; Cúrdia-Gonçalves, Tiago; Rodrigues-Pinto, Eduardo; Pinto-Marques, Pedro; Portuguese Pancreatic Club, specialized section of the Portuguese Society of GastroenterologyBackground: Pancreatic cysts are increasingly recognized nowadays, with estimated prevalence that may reach 50% in aging populations. Most cysts are of benign origin, and only a small proportion has malignant potential, including intraductal papillary mucinous neoplasms (IPMNs). Since pancreatic cysts are common, the most important goal was to identify the small percentage at high risk of developing malignancy. The increased detection and awareness of IPMNs led to the development of several consensus and guidelines, with only the most recent being evidence-based. Summary: Current consensus guidelines recommend risk assessment to prioritize high-risk patients for malignancy. In the Fukuoka/Kyoto guidelines, the predictive factors of malignancy are called “high-risk stigmata” and “worrisome features.” Conversely, other guidelines consider the terms “absolute indication” and “relative indication” for surgery, as well as criteria for referral to multidisciplinary groups. In case of non-resected IPMNs, criteria for surveillance depend on cyst size, with magnetic resonance imaging pointed as the most consensual modality for follow-up, although the recommended imaging modality varies among consensus. In some situations, namely, older age, frailty/comorbidities, or stability of cyst size, follow-up discontinuation may be considered. Key Message: Performance of surveillance guidelines is measured by the ability to identify patients with high-grade dysplasia/early stage-invasive cancer. Guidelines with more intense protocols will likely lead to fewer missed cancers, balanced by a greater number of benign resections. Multidisciplinary management preferably in reference centers is of utmost importance given the indolent and complex nature of the disease, and a global evidence-based guideline that combines the several guidelines’ groups is mandatory to uniformize care. In this review, the Portuguese Pancreatic Club summarizes the risk assessment and surveillance strategy of a patient with an IPMN according to different guidelines in order to create an updated perspective and to guide clinical care.