SPENCER CHENG
Projetos de Pesquisa
Unidades Organizacionais
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Suction versus slow-pull for endoscopic ultrasound-guided fine-needle aspiration of pancreatic tumors: a prospective randomized trial(2020) CHENG, Spencer; BRUNALDI, Vitor O.; MINATA, Mauricio K.; CHACON, Danielle A.; SILVEIRA, Eduardo B.; MOURA, Diogo T. H. de; SANTOS, Marcos E. L. Dos; MATUGUMA, Sergio E.; CHAVES, Dalton M.; FRANCA, Raony F.; JACOMO, Alfredo L.; ARTIFON, Everson L. A.Background: Suction (S) is commonly used to improve cell acquisition during endoscopic ultrasoundguided fine-needle aspiration (EUS-FNA). Slow-pull (SP) sampling is another technique that might procure good quality specimens with less bloodiness. We aimed to determine if SP improves the diagnostic yield of EUS-FNA of pancreatic masses. Methods: Patients with pancreatic solid masses were randomized to four needle passes with both techniques in an alternate fashion. Sensitivity, specificity, positive, and negative predictive values were calculated. Cellularity and bloodiness of cytological samples were assessed and compared according to the technique. Results: Sensitivity, specificity, and accuracy of suction vs. SP were 95.2% vs. 92.3%; 100% vs. 100; 95.7% vs. 93%, respectively. As to the association of methods, they were 95.6, 100 and 96%, respectively. Positive predictive values for S and SP were 100%. There was no difference in diagnostic yield between S and SP (p = 0.344). Cellularity of samples obtained with SP and Suction were equivalent in both smear evaluation (p = 0.119) and cell-block (0.980). Bloodiness of SP and suction techniques were similar as well. Conclusions: S and SP techniques provide equivalent sensitivity, specificity, and accuracy. Association of methods seems to improve diagnostic yield. Suction does not increase the bloodiness of samples compared to slow-pull.
- The feared postdilation complication in caustic esophageal stenosis: combined endoscopic and surgical treatment(2021) SAGAE, Vitor Massaro Takamatsu; RIBEIRO, Igor Braga; PONTE NETO, Alberto Machado da; MATUGUMA, Sergio Eiji; CHENG, Spencer; SANTOS, Marcos Eduardo Lera dos; MOURA, Eduardo Guimaraes Hourneaux de
- Anti-reflux versus conventional self-expanding metal stents in the palliation of esophageal cancer: A systematic review and meta-analysis(2022) SASSO, Joao Guilherme Ribeiro Jordao; MOURA, Diogo Turiani Hourneaux de; PROENCA, Igor Mendonca; MONTE JUNIOR, Epifanio Silvino do; RIBEIRO, Igor Braga; SANCHEZ-LUNA, Sergio A.; CHENG, Spencer; BESTETTI, Alexandre Moraes; KUM, Angelo So Taa; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBackground and study aims Self-expanding metal stents (SEMS) are an effective palliative endoscopic therapy to reduce dysphagia in esophageal cancer. Gastroesophageal reflux disease (GERD) is a relatively common complaint after non-valved conventional SEMS placement. Therefore, valved self-expanding metal stents (SEMS-V) were designed to reduce the rate of GERD symptoms. We aimed to perform a systematic review and meta-analysis comparing the two stents. Material and methods This was a systematic review and meta-analysis including only randomized clinical trials (RCT) comparing the outcomes between SEMS-V and non-valved self-expanding metal stents (SEMS-NV) following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were analyzed with Review Manager Software. Quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation guidelines. Results Ten randomized clinical trials including a total of 467 patients, 234 in the SEMS-V group and 233 in the SEMS-NV group, were included. There were no statistically significant differences regarding GERD qualitative analysis (RD -0.17; 95% CI -0.67, 0.33; P= 0.5) and quantitative analysis (SMD -0.22; 95% CI -0.53, 0.08; P=0.15) technical success (RD -0.03; 95% CI -0.07, 0.01; P= 0.16), dysphagia improvement (RD -0.07; 95% CI -0.19, 0.06; P=0.30), and adverse events (RD 0.07; 95% CI -0.07, 0.20; P= 0.32). Conclusions Both SEMS-V and SEMS-NV are safe and effective in the palliation of esophageal cancer with similar rates of GERD, dysphagia relief, technical success, adverse events, stent migration, stent obstruction, bleeding, and improvement of the quality of life.
- AN INNOVATIVE EX-VIVO MODEL FOR RAPID CHANGE OF THE PAPILLA FOR TEACHING ADVANCED ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY PROCEDURES(2016) ARTIFON, Everson L.A.; NAKADOMARI, Thaisa S.; KASHIWAGUI, Leandro Y.; BELMONTE, Emilio A.; SOLAK, Cláudio R.; CHENG, Spencer; FURUYA JR, Carlos K.; OTOCH, Jose P.ABSTRACT Background: Models for endoscopic retrograde cholangiopancreatography training allow practice with an expert feedback and without risks. A method to rapidly exchange the papilla can be time saving and accelerate the learning curve. Aim: To demonstrate a newly method of rapid exchange papilla in ex-vivo models to teach retrograde cholangiopancreatography advanced procedures. Methods: A new model of ex-vivo papilla was developed in order to resemble live conditions of procedures as cannulation, papilotomy or fistula-papilotomy, papiloplasty, biliary dilatation, plastic and metallic stentings. Results: The ex-vivo model of papilla rapid exchange is feasible and imitates with realism conditions of retrograde cholangiopancreatography procedures. Conclusion: This model allows an innovative method of advanced endoscopic training.
- Endoscopic approach to complex gastric tube stricture after laparoscopic sleeve gastroplasty: a case report(2021) FUNARI, Mateus Pereira; MIRANDA NETO, Antonio Afonso; SAGAE, Vitor Massaro Takamatsu; SOUZA, Thiago Ferreira de; MINATA, Mauricio Kazuyoshi; CHENG, Spencer; MOURA, Eduardo Guimaraes Hourneaux de
- Endoscopic-ultrasound evaluation and fine needle aspiration with a linear echoendoscope in the cecum: it is possible(2019) CHENG, Spencer; BRUNALDI, Vitor Ottoboni; SILVA, Gustavo Luis Rodela; FURUYA, Carlos Kiyoshi; MINATA, Mauricio Kazuyoshi; MATUGUMA, Sergio Eiji; ARTIFON, Everson Luiz de Almeida
- Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis(2016) OLIVEIRA, J. F.; MOURA, E. G. H.; BERNARDO, W. M.; IDE, E.; CHENG, S.; SULBARAN, M.; SANTOS, C. M. L.; SAKAI, P.Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review. A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD. We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies, n = 85), the preventive therapy decreased the risk of stenosis (risk difference = -0.36, 95 % CI -0.55 to -0.18, P = 0.0001). Two studies (one randomized and one non-randomized, n = 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = -8.57, 95 % CI -13.88 to -3.25, P < 0.002). There were no significant differences in the three RCT studies (n = 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI -0.09 to 0.14, P = 0.68). The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.
- Tips and tricks in the endoscopic management of a complex biliary stone in Billroth II gastrectomy(2022) OLIVEIRA, Guilherme Henrique Peixoto de; MOURA, Diogo Turiani Hourneaux de; MCCARTY, Thomas R.; OLIVEIRA, Pedro Victor Aniz Gomes de; FUNARI, Mateus Pereira; CHENG, Spencer; MOURA, Eduardo Guimaraes Hourneaux de
- Colonoscopic Ultrasound-Guided Fine-Needle Aspiration Using a Curvilinear Array Transducer: A Single-Center Retrospective Cohort Study(2022) CHENG, Spencer; MATUGUMA, Sergio E.; OLIVEIRA, Guilherme H. P. de; SILVA, Gustavo L. R.; CHENG, Henrique; SANCHEZ-LUNA, Sergio A.; MINATA, Mauricio K.BACKGROUND: Curvilinear array ultrasound transducers enable tissue sampling and have therapeutic capabilities. Nevertheless, colonic intubation and maneuvering with these transducers is technically challenging and is therefore typically limited to the rectosigmoid area. This retrospective cohort study aimed to evaluate the safety, feasibility, and diagnostic yield of colonoscopic ultrasound-guided fine-needle aspiration in deep colonic intubation. IMPACT OF INNOVATION: The impact of this innovation is to enable tissue sampling of colonic and extracolonic lesions guided by endoscopic ultrasound. TECHNOLOGY, MATERIALS, AND METHODS: Curvilinear array ultrasound is used in the evaluation of luminal and extraluminal colonic diseases. Thirteen patients underwent colonoscopic ultrasound with a curvilinear array ultrasound endoscope in a single center for subepithelial lesions, cancer staging, and extracolonic lesions from July 2015 to February 2021. Endosonography was performed using an Olympus EU-ME1 and GF-UCT 180 with a 5-12MHz curvilinear array transducer. The primary outcome was the percentage of patients who were successfully scanned with the endoscopic ultrasound. The secondary outcomes included the success rate of fine-needle aspiration, the diagnostic yield of the tissue samples, and the adverse events related to the procedure. PRELIMINARY RESULTS: A total of 13 female patients underwent colonoscopic ultrasound. All patients (100%, 13/13) were successfully scanned. Fine-needle aspiration was deemed necessary and successfully performed in 100% (5/5) of the patients. Tissue samples collected by fine-needle aspiration resulted in a diagnostic yield of 60%, and no adverse events resulted from this intervention. CONCLUSIONS: This study demonstrates the feasibility of performing colonoscopic ultrasound with a curvilinear array transducer. Fine-needle aspiration for subepithelial, colonic, and extracolonic lesions is feasible and safe in this setting with no adverse events reported in our study. FUTURE DIRECTIONS: Future research should be directed toward validating colonoscopic ultrasound with a curvilinear array transducer technique in prospective randomized trials. Studies evaluating the feasibility and safety of endoscopic ultrasound-guided interventions in the colon, such as abscess drainage and enteral anastomosis, should be considered.