SPENCER CHENG
Projetos de Pesquisa
Unidades Organizacionais
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
conferenceObject EUS-FNA OF PANCREATIC SOLID MASSES: A PROSPECTIVE RANDOMIZED TRIAL COMPARING SUCTION WITH SLOW PULL(2018) CHENG, Spencer; DANIELLE, Chacon A.; ARTIFON, Everson L.; MATUGUMA, Sergio E.; SANTOS, Marcos E. dos; SAKAI, Christiano M.; CHAVES, Dalton; MOURA, Diogo T. De; MOURA, Eduardo T.- A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis(2018) GUEDES, Hugo Goncalo; MOURA, Diogo Turiani Hourneaux de; DUARTE, Ralph Braga; CORDERO, Martin Andres Coronel; SANTOS, Marcos Eduardo Lera dos; CHENG, Spencer; MATUGUMA, Sergio Eiji; CHAVES, Dalton Marques; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deOur aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.
- Papillary fistulotomy vs conventional cannulation for endoscopic biliary access: A prospective randomized trial(2018) FURUYA, Carlos Kiyoshi; SAKAI, Paulo; MARINHO, Fabio Ramalho Tavares; OTOCH, Jose Pinhata; CHENG, Spencer; PRUDENCIO, Livia Lemes; MOURA, Eduardo Guimaraes Hourneaux de; ARTIFON, Everson Luiz de AlmeidaAIM To compare the cannulation success, biochemical profile, and complications of the papillary fistulotomy technique vs catheter and guidewire standard access. METHODS From July 2010 to May 2017, patients were prospectively randomized into two groups: Cannulation with a catheter and guidewire (Group.) and papillary fistulotomy (Group.). Amylase, lipase and C-reactive protein at T0, as well as 12 h and 24 h after endoscopic retrograde cholangiopancreatography, and complications (pancreatitis, bleeding, perforation) were recorded. RESULTS We included 102 patients (66 females and 36 males, mean age 59.11 +/- 18.7 years). Group. and Group. had 51 patients each. The successful cannulation rates were 76.5% and 100%, respectively (P = 0.0002). Twelve patients (23.5%) in Group. had a difficult cannulation and underwent fistulotomy, which led to successful secondary biliary access (Failure Group). The complication rate was 13.7% (2 perforations and 5 mild pancreatitis) vs 2.0% (1 patient with perforation and pancreatitis) in Groups. and., respectively (P = 0.0597). CONCLUSION Papillary fistulotomy was more effective than guidewire cannulation, and it was associated with a lower profile of amylase and lipase. Complications were similar in both groups.
- EUS-FNA versus ERCP for tissue diagnosis of suspect malignant biliary strictures: a prospective comparative study(2018) MOURA, Diogo Turiani Hourneaux; GUIDAMARAES, Eduardo; MOURA, Hourneaux de; MATUGUMA, Sergio Eiji; SANTOS, Marcos Eduardo dos; MOURA, Eduardo Turiani Hourneaux; BARACAT, Felipe Iankelevich; ARTIFON, Everson L. A.; CHENG, Spencer; BERNARDO, Wanderley Marque; CHACON, Danielle; TANIGAWA, Ryan; JUKEMURA, JoseBackground and study aims Biliary strictures are frequently a challenging clinical scenario and the anatomopathological diagnosis is essential in the therapeutic management, whether for curative or palliative purposes. The acquisition of specimens is necessary since many benign diseases mimic biliopancreatic neoplasms. Endscopic retrograde cholangiopancreatography (ERCP) is the traditionally used method despite the low sensitivity of biliary brush cytology and forceps biopsy. On the other hand, several studies reported good accuracy rates using endoscopic ultrasound- guided fine-needle aspiration (EUS-FNA). The aim of this prospective study was to compare, the accuracy of EUS-FNA and ERCP for tissue sampling of biliary strictures. Patients and methods After performing the sample size calculation, 50 consecutive patients with indeterminate biliary strictures were included to undergo ERCP and EUS on the same sedation. The gold-standard was surgery or 6 months' follow-up. Evaluation of the diagnostic indices (sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio), concordance and adverse events among the methods were performed. Also, subtype analyses of the techniques, anatomical localization and size of the lesion were included. Results The final diagnoses reported in 50 patients were 47 malignant, 1 suspicious and 2 benign lesions. 31 lesions were extraductal and 19 intraductal, 35 were distal and 15 proximal strictures. In the intention-to-treat analysis, the sensitivity and accuracy of EUS-FNA were superior than ERCP tissue sampling (93,8%, 94% vs. 60,4%, 62%, respectively) (P = 0.034), with similar adverse events. There was no concordance between the methods and combining both methods improved the sensitivity and accuracy for 97.9% and 98%, respectively. In the subtype analyses, the EUS-FNA was superior, with a higher accuracy than ERCP tissue sampling in evaluating extraductal lesions (100% vs. 54.8 %, P = 0.019) and in those larger than 1.5 cm (95.8% vs. 61.9%, P = 0.031), but were similar in evaluating intraductal lesions and lesions smaller than 1.5 cm. There was no significant difference between the methods in the analyzes of proximal, distal and pancreatic lesions. Conclusion EUS-FNA is better than ERCP with brush cytology and intraductal forceps biopsy in diagnosing malignant biliary strictures, mainly in the assessment of extraductal lesions and in those larger than 1.5 cm. Combining ERCP with tissue sampling and EUS-FNA is feasible, the techniques have similar complication rates, and the combination greatly improves diagnostic accuracy.
conferenceObject CONVENTIONAL CANNULATION OR PAPILLARY FISTULOTOMY: A PROSPECTIVE RANDOMIZED TRIAL(2018) FURUYA, Carlos K.; MARINHO, Fabio R.; CHENG, Spencer; SAKAI, Paulo; ARTIFON, Everson L.article 4 Citação(ões) na Scopus Ex Vivos Models to Teaching Therapeutic Endoscopic Ultrasound (T-EUS)(2018) L.A. ARTIFON, Everson; CHENG, Spencer; NAKADOMARI, Thaisa; KASHIWAGI, Leandro; ARDENGH, Jose Celso; BELMONTE, Emilio; P. OTOCH, JoseBackground: Endoscopic ultrasound training has a learning curve greater than the other endoscopic therapeutic techniques. One of the preclinical teaching methods is the use of ex vivo porcine models. Aim: To describe five ex vivo porcine models for training in therapeutic echoendoscopic procedures. Materials and methods: Using porcine digestive tract containing esophagus, stomach, duodenum, spleen, liver and gallbladder, five models for therapeutic echoendoscopy training were described. With other segments of the porcine pieces (such as the bladder, spleen segment and omentum segment) and with easily accessible materials (such as grape and ultrasound gel), lesions were simulated to be treated. These models were applied in the Hands on course at the IRCAD (Institut de recherche contre les cancers de l'appareil digestif) Barretos of 2017. Endoscopic equipment and instruments are the same as those used in clinical practice. Result: The models are easily reproducible and do not require exchange during the hands on course period. Endoscopic and echographic imaging and tactile sensitivity are similar to the real one. Conclusion: The models described in this study demonstrated to be realistic, easy to reproduce and allow repetition during the same session. However, comparative studies are necessary to verify the real impact on teaching