PEDRO VICTOR ANIZ GOMES DE OLIVEIRA
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- Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures: a systematic review and meta-analysis(2020) OLIVEIRA, Pedro Victor Aniz Gomes de; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; BAZARBASHI, Ahmad Najdat; FRANZINI, Tomazo Antonio Prince; SANTOS, Marcos Eduardo Lera dos; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deObjective Indeterminate biliary strictures remain a significant diagnostic challenge. Digital single-operator cholangioscopy (D-SOC) incorporates digital imaging which enables higher resolution for better visualization and diagnosis of biliary pathology. We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to determine the efficacy of D-SOC in the visual interpretation of indeterminate biliary strictures. Material and methods Electronic searches were performed using Medline (PubMed), EMBASE, and Cochrane Library. All D-SOC studies that reported the diagnostic performance in visual interpretation of indeterminate biliary strictures and biliary malignancies were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was used to evaluate the quality of the included studies. All data were extracted and pooled to construct a 2 x 2 table. The visual interpretation of D-SOC was compared to resected surgical specimens or clinical follow-up in the included patients. Pooled sensitivity, specificity, positive predictive value, negative predictive value, prevalence, positive likelihood ratio (+LR), negative likelihood ratio (-LR), and diagnostic odds ratio (OR) were calculated. The summarized receiver operating characteristic (SROC) curve corresponding with the area under the curve (AUC) was also analyzed. Results The search yielded 465 citations. Of these, only six studies with a total of 283 procedures met inclusion criteria and were included in the meta-analysis. The overall pooled sensitivity and specificity of D-SOC in the visual interpretation of biliary malignancies was 94% (95% CI 89-97) and 95% (95%CI 90-98), respectively, while +LR, -LR, diagnostic OR, and AUC were 15.20 (95%CI 5.21-44.33), 0.08 (95%CI 0.04-0.14), 308.83 (95%CI 106.46-872.82), and 0.983, respectively. The heterogeneity among 6 included studies was moderate for specificity (I-2 = 0.51) and low for sensitivity (I-2 = 0.17) and diagnostic OR (I-2 = 0.00). Conclusion D-SOC is associated with high sensitivity and specificity in the visual interpretation of indeterminate biliary strictures and malignancies. D-SOC should be considered routinely in the diagnostic workup of indeterminate biliary lesions.
conferenceObject EFFICACY OF DIGITAL SINGLE-OPERATOR CHOLANGIOSCOPY IN THE VISUAL INTERPRETATION OF BILIARY MALIGNANCIES: A SYSTEMATIC REVIEW AND META-ANALYSIS(2020) OLIVEIRA, Pedro Victor Aniz Gomes de; MIRANDA, Antonio A. de; MONTE, Epifanio S. do; LATA, John; SINGH, Shailendra; MOURA, Diogo T. de; THOMPSON, Christopher C.; MOURA, Eduardo G. de- Diagnostic Characteristics of Serological-Based COVID-19 Testing: A Systematic Review and Meta-Analysis(2020) MOURA, Diogo Turiani Hourneaux de; MCCARTY, Thomas R.; RIBEIRO, Igor Braga; FUNARI, Mateus Pereira; OLIVEIRA, Pedro Victor Aniz Gomes de; MIRANDA NETO, Antonio Afonso de; MONTE JUNIOR, Epifanio Silvino do; TUSTUMI, Francisco; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de; THOMPSON, Christopher C.Serologic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) promises to assist in assessing exposure to and confirming the diagnosis of coronavirus disease 2019 (COVID-19), and to provide a roadmap for reopening countries worldwide. Considering this, a proper understanding of serologic-based diagnostic testing characteristics is critical. The aim of this study was to perform a structured systematic review and meta-analysis to evaluate the diagnostic characteristics of serological-based COVID-19 testing. Electronic searches were performed using Medline (PubMed), EMBASE, and Cochrane Library. Full-text observational studies that reported IgG or IgM diagnostic yield and used nucleic acid amplification tests (NAATs) of respiratory tract specimens, as a the reference standard in English language were included. A bivariate model was used to compute pooled sensitivity, specificity, positive/negative likelihood ratio (LR), diagnostic odds ratio (OR), and summary receiver operating characteristic curve (SROC) with corresponding 95% confidence intervals (CIs). Five studies (n=1,166 individual tests) met inclusion criteria. The pooled sensitivity, specificity, and diagnostic accuracy for IgG was 81% [(95% CI, 61-92);I-2 =95.28], 97% [(95% CI, 78-100);I-2 =97.80], and 93% (95% CI, 91-95), respectively. The sensitivity, specificity, and accuracy for IgM antibodies was 80% [(95% CI, 57-92);I-2 =94.63], 96% [(95% CI, 81-99);I-2 =92.96] and 95% (95% CI, 92-96). This meta-analysis demonstrates suboptimal sensitivity and specificity of serologic-based diagnostic testing for SARS-CoV-2 and suggests that antibody testing alone, in its current form, is unlikely to be an adequate solution to the difficulties posed by COVID-19 and in guiding future policy decisions regarding social distancing and reopening of the economy worldwide.
conferenceObject STENT VERSUS BALLOON DILATION FOR THE TREATMENT OF DOMINANT STRICTURES IN PRIMARY SCLEROSING CHOLANGITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS(2020) TUCCI, Marina; MIRANDA, Antonio A. de; OLIVEIRA, Pedro Victor Aniz Gomes de; PONTE, Alberto M. da; SINGH, Shailendra; MOURA, Diogo T. de; MOURA, Eduardo G. de- 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
conferenceObject ENDOSCOPIC STENTING VERSUS ENDOSCOPIC VACUUM THERAPY IN THE MANAGEMENT OF UPPER GASTROINTESTINAL TRANSMURAL DEFECTS: A SYSTEMATIC REVIEW AND META-ANALYSIS(2020) MONTE, Epifanio S. do; MOURA, Diogo T. de; OLIVEIRA, Pedro Victor Aniz Gomes de; TUCCI, Marina; RIBEIRO, Igor B.; SINGH, Shailendra; THOMPSON, Christopher C.; MOURA, Eduardo G. de- Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis(2021) FERREIRA, Marina Tucci Gammaro Baldavira; RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; MCCARTY, Thomas R.; PONTE NETO, Alberto Machado da; FARIAS, Galileu Ferreira Ayala; MIRANDA NETO, Antonio Afonso de; OLIVEIRA, Pedro Victor Aniz Gomes de; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBackground/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients. Methods: Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (ie., pancreatitis, cholangitis, bleeding, perforation and death). Results: A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I-2=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I-2=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stem placement (RD, -0.34; 95% CI, -0.45 to -0.23; I-2=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I-2=51%). Conclusions: Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.