MARIANNY NAZARETH SULBARAN NAVA
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- ENDOSCOPIC GASTRIC SUBMUCOSAL DISSECTION: experimental comparative protocol between standard technique and Hybrid-Knife(r)(2016) MENDONÇA, Ernesto Quaresma; ZURETTI, Lucas Snioka; PANZANI, Thiago; SULBARAN, Marianny; SAKAI, Christiano Makoto; SAKAI, PauloABSTRACT Background Endoscopic treatment of superficial gastrointestinal tumors is routinely performed, however the advantages and shortcomings of submucosal pressure-jet dissection is still debated. Objective - Aiming to compare this technique with conventional submucosal dissection, a study was designed in pigs. Methods - Areas of the antral mucosa of the stomach with a diameter of 2 cm2 (6 per animal) were marked, and resected by means of the hybrid-knife (experimental technique), and Flush-knife or IT-knife (controls). An ERBE ICC 300 electrosurgical unit was adopted. End-points were procedural time, complications, and quality of the resected specimen. Results - A total of 27 interventions were conducted in five animals. Time spent with the two options was quite short, and similar: 9.5±3.1 vs 8.0±3.0 minutes (P=0.21). Complications didn't differ (three per group, not significant), and removed specimen looked adequate in both circumstances. Conclusion - The hybrid-knife technique is an acceptable alternative to submucosal dissection, showing no difference compared to the standard technique taking into consideration the procedure, the presence of complications and the quality of the resected specimen.
- Systematic review and meta-analysis of colon capsule endoscopy accuracy for colorectal cancer screening. An alternative during the Covid-19 pandemic?(2022) SULBARAN, Marianny; BUSTAMANTE-LOPEZ, Leonardo; BERNARDO, Wanderley; SAKAI, Christiano M.; SAKAI, Paulo; NAHAS, Sergio; MOURA, Eduardo G. H. deAim To determine the diagnostic accuracy of colon capsule endoscopy for colorectal cancer screening. Methods Studies that compared the diagnostic performance of colonoscopy and second-generation colon capsule endoscopy (CCE-2) for screening of asymptomatic patients aged 50-75 years were included. The primary outcomes were sensitivity, specificity, and positive and negative likelihood ratios for polyps and adenomas measuring at least 6 mm or 10 mm. Results Eight full-text studies that evaluated 1602 patients were included for systematic review. Of these, 840 (52.43%) patients participated in an opportunistic screening program. The pooled outcomes of CCE-2 for polyps at least 6 mm / 10 mm were (CI = confidence interval): sensitivity: 88% (95% CI: 0.84-0.91) / 88% (95% CI: 0.82-0.93), specificity: 94% (95% CI: 0.92-0.95) / 95.5% (95% CI: 0.94-0.97); positive likelihood ratio: 11.86 (95% CI: 5.53-25.46) / 23.07 (95% CI: 6.163-86.36); negative likelihood ratio: 0.14 (95% CI: 0.1-0.21) / 0.14 (95% CI: 0.09-0.21). The area under the summary receiver operating characteristic curve for polyps at least 6 and 10 mm was 96.3% and 96.7%, respectively. The only cancer missed by complete CCE-2 was shown at multiple frames in the unblinded review. In total, 125 (7.8%) patients presented mild adverse events mostly related to bowel preparation. Conclusion CCE-2 is demonstrated to be an effective and safe alternative method for colorectal cancer screening. Diagnostic performance of CCE-2 for polyps of at least 6 and 10 mm was similar. Completion rates still need to be improved.
- Overtube-assisted enteroscopy and capsule endoscopy for the diagnosis of small-bowel polyps and tumors: a systematic review and meta-analysis(2016) SULBARAN, Marianny; MOURA, Eduardo de; BERNARDO, Wanderley; MORAIS, Cintia; OLIVEIRA, Joel; BUSTAMANTE-LOPEZ, Leonardo; SAKAI, Paulo; MOENKEMUELLER, Klaus; SAFATLE-RIBEIRO, AdrianaBackground and study aims: Several studies have evaluated the utility of double-balloon enteroscopy (DBE) and capsule endoscopy (CE) for patients with small-bowel disease showing inconsistent results. The aim of this study was to determine the sensitivity and specificity of overtube-assisted enteroscopy (OAE) as well as the diagnostic concordance between OAE and CE for small-bowel polyps and tumors. Patients and methods: We conducted a systematic review and meta-analysis of studies in which the results of OAE were compared with the results of CE for the evaluation of small-bowel polyps and tumors. When data for surgically resected lesions were available, the histopathological results of OAE and surgical specimens were compared. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the diagnosis of small-bowel polyps and tumors were analyzed. Secondarily, the rates of diagnostic concordance and discordance between OAE and CE were calculated. Results: There were 15 full-length studies with a total of 821 patients that met the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were as follows: 0.89 (95% confidence interval [CI] 0.84-0.93), with heterogeneity chi(2)=41.23 (P = 0.0002) and inconsistency (I-2)=66.0 %; 0.97 (95 % CI 0.95-0.98), with heterogeneity chi(2)=45.27 (P=0.07) and inconsistency (I-2)=69.1 %; 16.61 (95 % CI 3.74-73.82), with heterogeneity Cochrane's Q=225.19 (P<0.01) and inconsistency (I-2)=93.8 %; and 0.14 (95 % CI 0.05-0.35), with heterogeneity Cochrane's Q=81.01 (P<.01) and inconsistency (I-2)=82.7 %, respectively. A summary receiver operating characteristic curve (SROC) curve was constructed, and the area under the curve (AUC) was 0.97. Conclusion: OAE is an accurate test for the detection of small-bowel polyps and tumors. OAE and CE have a high diagnostic concordance rate for small-bowel polyps and tumors. This study was registered in the PROSPERO international database (www.crd.york.ac.uk/prospero/) with the study number CRD42015016000.
conferenceObject SYSTEMATIC REVIEW AND META-ANALYSIS OF COLON CAPSULE ENDOSCOPY ACCURACY FOR COLORECTAL CANCER SCREENING. AN ALTERNATIVE DURING THE COVID ERA?(2021) SULBARAN, Marianny; BERNARDO, Wanderley M.; BUSTAMANTE-LOPEZ, Leonardo A.; SAKAI, Christiano M.; SAKAI, Paulo; NAHAS, Sergio C.; MOURA, Eduardo G. De- Endoscopic colostomy with percutaneous colopexy: an animal feasibility study(2017) BUSTAMANTE-LOPEZ, Leonardo Alfonso; SULBARAN, Marianny; NAHAS, Sergio Carlos; MOURA, Eduardo Guimaraes Horneaux de; NAHAS, Caio Sergio; MARQUES, Carlos Federico; SAKAI, Christiano; CECONELLO, Ivan; SAKAI, PauloBackground: Indications for colostomy in colorectal diseases are obstruction of the large bowel, such as in cancer, diverticular disease in the acute phase, post-radiotherapy enteritis, complex perirectal fistulas, anorectal trauma and severe anal incontinence. Some critically ill patients cannot tolerate an exploratory laparotomy, and laparoscopic assisted colostomy also requires general anesthesia. Objective: To evaluate the feasibility, safety and efficacy of performing colostomy assisted by colonoscopy and percutaneous colopexy. Materials and methods: Five pigs underwent endoscopic assisted colostomy with percutaneous colopexy. Animals were evaluated in post-operative days 1, 2, 5 and 7 for feeding acceptance and colostomy characteristics. On day 7 full colonoscopy was performed on animals followed by exploratory laparotomy. Results: Average procedure time was 27 minutes (2154 min). Postoperative mobility and feeding of animals were immediate after anesthesia recovery. Position of the colostomy, edges color, appearance of periostomal area, as well as its function was satisfactory in four animals. Retraction of colostomy was present in one pig. The colonoscopy and laparotomy control on the seventh day were considered as normal. A bladder perforation that was successfully repaired through the colostomy incision occurred in one pig. The main limitation of this study is its experimental nature. Conclusion: Endoscopic assisted colostomy with percutaneous colopexy proves to be a safe and effective method with low morbidity for performing colostomy in experimental animals, with possible clinical application in humans.