Discussão de Caso

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<= b>DISCIPLINA DE CIRURGIA DO APARELHO DIGESTIVO

SERVIÇO DE CIRURGIA DO CÓLON E RETO=

<= b>DISCIPLINA DE CIRURGIA DO APARELHO DIGESTIVO

SERVIÇO DE CIRURGIA DO CÓLON E RETO=

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<= /b>

Serviço de Endoscopia Digestiva – HC FMUSP

SESSÃO DE ARTIGOS CIENTÍFICOS

Coordenação: Dr.Paulo Sakai / Dr. Dalton Chaves

Apresentação: Gustavo Luz

29 de Março de 2006

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Content-Type: image/gif R0lGODlhAQIDAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAAD9 AQIAgAAAAG+J9wIejI+py+0Po5y02ouz3rz7D4biSJbmiabqyrbuC4MFADs= ------=_NextPart_01C7649E.14E91B20 Content-Location: file:///C:/C9981CD2/file9266_arquivos/slide0709.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Discussão de Caso

<= /span>Gastroin= testinal Endoscopy

&nbs= p; December 2005 Volume 62 Issue 6 =

Tissue damage of different submucosal injection solutions for EMR

Mitsuhiro Fujishiro, Naohisa Yahagi, = Koji Kashimura, Toyokazu Matsuura, Masanori Nakamura, Naomi Kakushima, Shinya Kodashima, Satoshi Ono, Katsuya Kobayashi, Takuhei Hashimoto et al.
Current affiliations: Department of Gastroenterology, Graduate School of Medicine, University of Tokyo; Product Research Department, Kamakura Resea= rch Laboratories, Chugai Pharmaceutical Co, LTD, Kanagawa; Chugai Research Institute for Medical Science, Inc, Nagano; Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan

= Serviço de Endoscopia Digestiva - HC FMUSP

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Serviço de Endosc= opia Digestiva - HC FMUSP

• Com objetivo de pr= evenir perfuração, injeção de fluidos na <= /span>camada submucosa é comumente realizada durante mucosectomia (EMR)

• Assim como o tempo= em que a lesão se mantém elevada é crucial para o sucesso na EMR, o dano tecidual que a substância injetada provoca deve ser considerado de suma <= /b>importância

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Serviço de Endosc= opia Digestiva - HC FMUSP

=

• Se a solução injetada tem propriedade de causar dano tecidual, a análise histológica da peça ressecada pode ser prejudicada

•

=

• O dano teci= dual na camada muscular pode resultar em sangramento ou perfuração tardia, principalmente no intestino delgado e no cólon, que tê= ;m uma parede menos espessa

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= Serviço de Endoscopia Digestiva - HC FMUSP

•Pouco se conhece sobre o poder d= e dano tecidual das substâncias utilizadas na prática clíni= ca para realização da EMR
<= span style=3D'font-family:Arial;font-size:75%;visibility:hidden'>• =

•
•Este estudo comparou o dano tecidual entre algumas substâncias com diferentes concentrações utilizando estômago de porco <= /span>

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= Serviço de Endoscopia Digestiva - HC FMUSP

• Endoscópios padrão:

   GIF XQ 230; OLYMPUS
   EG 2931 PENTAX

    4 mini porcos (Sus scrofa)
Posicionados em decúbito lateral esquerdo sob anestesia geral

Cateter injetor/ agulha 23 G(NM-200L= -0423; Olympus)

wMaterial e Métodos

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= Serviço de Endoscopia Digestiva - HC FMUSP

        = ;            &n= bsp;            = ;            &n= bsp;            = ;

        = ;

•Soluções avaliadas

<= span style=3D'font-family:Arial;font-size:117%'>• NaCl 0,9% ( Solução = salina normal)

<= span style=3D'font-family:Arial;font-size:117%'>• NaCl 3,75 % ( Solução salina hipertônica)

<= span style=3D'font-family:Arial;font-size:117%'>• Dextrose a 5,10,15,20,30,40 e 50%&= #13;

• Glyceol (Glicerina 10% + NaCl 0,9%= + Frutose 5%)

<= span style=3D'font-family:Arial;font-size:117%'>• Ácido hialurônico 0,25%

<= span style=3D'font-family:Arial;font-size:117%'>• Ácido hialurônico 0,125%

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= Serviço de Endoscopia Digestiva - HC FMUSP

        = ;            &n= bsp;            = ;            &n= bsp;            = ;

        = ;

•Injeção de 2ml de = cada substância na camada submucosa
Endoclipes foram colocados próxima local injetado para localizar a “lesão” posteriormente
<= span style=3D'font-family:Arial;font-size:88%;visibility:hidden'>• =
•Todas as soluções foram misturadas com pequen= o volume de indigo carmin (0,5 ml = por 10 ml de solução) para facilitar a visualização da difusão da substância pela submucosa&= #13;
<= span style=3D'font-family:Arial;font-size:88%;visibility:hidden'>•

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= Serviço de Endoscopia Digestiva - HC FMUSP

        = ;            &n= bsp;            = ;            &n= bsp;            = ;

        = ;

= • Após a injeção permanecia no estômago por cerca de 30 minutos para observar o lo= cal injetado

•

•2 porcos: sacrificados para análise do dano tecidual imediato

•

•2 porcos: nova endoscopia com 24= h e 1 semana = após a injeção       sacrificados: dano tecidual tardio

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= Serviço de Endoscopia Digestiva - HC FMUSP

        = ;            &n= bsp;            = ;            &n= bsp;            = ;

        = ;

<= span style=3D'font-family:Arial;font-size:75%;visibility:hidden'>•

<= span style=3D'font-family:Arial;font-size:75%'>•Os estômagos eram esticados sobre uma

•pra= ncha de cortiça e fixados com formol

•

<= span style=3D'font-family:Arial;font-size:75%'>•As áreas injetadas eram cortadas

•sep= aradamente e embebidas em parafina

•

<= span style=3D'font-family:Arial;font-size:75%'>•Cor= tes histológicos foram corados com

•hem= atoxilina e eosina para proceder a análise

• microscópica

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= Serviço de Endoscopia Digestiva - HC FMUSP

        = ;            &n= bsp;            = ;            &n= bsp;            = ;

        = ;

•RESULTADOS: =

•

=

Observação endoscópica:
• Houve mínima diferença com relação as alterações de mucosa das mesmas substâncias nos diferentes porcos

<= span style=3D'font-family:Arial'>• = Com relação a solução salina normal(NaCl 0,9%), &#= 13;
dextrose a 5 e 10 %,glyceol e as duas soluções de hialoronidase não houve alteração de mucosa vista pela endoscopia
<= span style=3D'font-family:Arial;visibility:hidden'>̶= 6;
• Soluções hipertônicas ,exceto Glyceol e dextrose a 10 %, provocam dano tecidual com diferentes intensidades

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= Serviço de Endoscopia Digestiva - HC FMUSP

        = ;            &n= bsp;            = ;            &n= bsp;            = ;

        = ;

•

<= span style=3D'font-family:Arial;visibility:hidden'>•

NaCl 0,9% (Solução salina normal)

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= Serviço de Endoscopia Digestiva - HC FMUSP

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R= 26;

NaCl 3,75 % (Solução salina hipertônica)

Palidez com hiperemia marginal em toda área infiltrada (20min.)

Hiperemia e erosão central

Erosão de mucosa

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