CINTIA MORAIS LIMA DOS SANTOS LATORRE
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- 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.
- Endoscopic versus surgical resection for early colorectal cancer-a systematic review and meta-analysis(2016) SILVA, Gustavo Luis Rodela; MOURA, Eduardo Guimaraes Hourneaux de; BERNARDO, Wanderley Marques; CASTRO, Vinicius Leite de; MORAIS, Cintia; BABA, Elisa Ryoka; SAFATLE-RIBEIRO, Adriana VazBackground: To investigate the available data on the treatment of early colorectal cancer (CRC), either endoscopically or surgically. Methods: Two independent reviewers searched MEDLINE, EMBASE, CENTRAL COCHRANE, LILACS and EBSCO for articles published up to August 2015. No language or dates filters were applied. Inclusion criteria were studies with published data about patients with early colonic or rectal cancer undergoing either endoscopic resection (i.e., mucosectomy or submucosal dissection) or surgical resection (i.e., open or laparoscopic). Extracted data items undergoing meta-analysis were en bloc resection rate, curative resection rate, and complications. A complementary analysis was performed on procedure time. The risk of bias among studies was evaluated with funnel-plot expressions, and sensitivity analyses were carried out whenever a high heterogeneity was found. The risk of bias within studies was assessed with the Newcastle score. Results: A total of 12,819 articles were identified in the preliminary search. After applying inclusion and exclusion criteria, three cohort studies with a total of 768 patients undergoing endoscopic resection and 552 patients undergoing surgical resection were included. The en bloc resection rate risk difference was -11% [-13%, -8% confidence interval (CI)], demonstrating worse outcome results for the endoscopic resection group as compared to the surgical resection group [number need to harm (NNH) = 10]. The curative resection rate risk difference was -9% [(-12%, 6% CI)] after a sensitivity analysis was performed, which also demonstrated worse outcomes in the intervention group (NNH = 12). The complications rate exhibited a -7% risk difference [(-11%, -4% CI)], denoting a lesser number of complications in the endoscopic group [Number Need to Treat (NNT = 15). A complementary analysis of procedure time with two of the selected studies demonstrated a mean difference of -118.32 min [(-127.77, -108.87 CI)], in favor of endoscopic resection, even though such data lacks homogeneity across studies, and could be heavily influenced by local expertise. Long-term results were found in only one study and therefore were not included in the final analysis. Conclusions: According to the current available data, the treatment of early CRC by surgical resection is associated with higher curative resection rates and higher en bloc resection rates, despite of higher complications rates, as compared to endoscopic resection. Shorter procedure times are associated with the endoscopic methods of treatment, however high heterogeneity levels limit this conclusion.
- 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.
bookPart Tratamento Endoscópico de Neoplasia Maligna Colorretal Precoce(2017) SILVA, Gustavo Luís Rodela; SANTOS, Cíntia Morais Lima dos; SAFATLE-RIBEIRO, Adriana Vaz; TOMISHIGE, Toshiro; YAMAZAKI, Kendi; MIYAJIMA, Nelson TomiobookPart Gastrostomia endoscópica percutânea, jejunostomias transgástrica e direta(2014) SANTOS, Cíntia Morais Lima dos; FYLYK, Sonia Nadia; HONDO, Fabio Yuji; MOURA, Eduardo Guimarães Hourneaux debookPart Sedação e anestesia na prática endoscópica(2014) CARVALHO, Paulo Henrique Boaventura de; SANTOS, Cíntia Morais Lima dos; SANTOS, Marcos Eduardo Lera dos; ARTIFON, Everson Luiz de Almeida