VITOR OTTOBONI BRUNALDI

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: MARCO AURELIO SANTO ×

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  • article
    Long-term follow-up after transoral outlet reduction following Roux-en-Y gastric bypass: Back to stage 0?
    (2023) BRUNALDI, Vitor Ottoboni; OLIVEIRA, Guilherme Henrique Peixoto de; KERBAGE, Anthony; RIBAS, Pedro Henrique; NUNES, Felipe; FARIA, Galileu; MOURA, Diogo de; RICCIOPPO, Daniel; SANTO, Marco; MOURA, Eduardo de
    Background and study aims Significant weight regain affects up to one-third of patients after Roux-en-Y gastric bypass (RYGB) and demands treatment. Transoral outlet reduction (TORe) with argon plasma coagulation (APC) alone or APC plus full-thickness suturing TORe (APC-FTS) is effective in the short term. However, no study has investigated the course of gastrojejunostomy (GJ) or quality of life (QOL) data after the first post-procedure year.Patients and methods Patients eligible for a 36-month follow-up visit after TORe underwent upper gastrointestinal endoscopy with measurement of the GJ and answered QOL questionnaires (RAND-36). The primary aim was to evaluate the long-term outcomes of TORe, including weight loss, QOL, and GJ anastomosis (GJA) size. Comparisons between APC and APC-FTS TORe were a secondary aim.Results Among 39 eligible patients, 29 returned for the 3-year follow-up visit. There were no significant differences in demographics between APC and APC-FTS TORe groups. At 3 years, patients from both groups regained all the weight lost at 12 months, and the GJ diameter was similar to the pre-procedure assessment. As to QOL, most improvements seen at 12 months were lost at 3 years, returning to pre-procedure levels. Only the energy/fatigue domain improvement was kept between the 1- and 3-year visits.Conclusions Obesity is a chronic relapsing disease. Most effects of TORe are lost at 3 years, and redilation of the GJA occurs. Therefore, TORe should be considered iterative rather than a one-off procedure.
  • article 58 Citação(ões) na Scopus
    Endoscopic Treatment of Weight Regain Following Roux-en-Y Gastric Bypass: a Systematic Review and Meta-analysis
    (2018) BRUNALDI, Vitor Ottoboni; JIRAPINYO, Pichamol; MOURA, Diogo Turiani H. de; OKAZAKI, Ossamu; BERNARDO, Wanderley M.; GALVO NETO, Manoel; CAMPOS, Josemberg Marins; SANTO, Marco Aurelio; MOURA, Eduardo G. H. de
    Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure. Despite its high efficacy, some patients regain part of their lost weight. Several endoscopic therapies have been introduced as alternatives to treat weight regain, but most of the articles are relatively small with unclear long-term data. To systematically assess the efficacy of endoscopic therapies for weight regain after RYGB. We searched MEDLINE, EMBASE, Scopus, Web of Science, Cochrane, OVID, CINAHL/EBSCo, LILACS/Bireme, and gray literature. Primary outcomes were absolute weight loss (AWL), excess weight loss (EWL), and total body weight loss (TBWL). Thirty-two studies were included in qualitative analysis. Twenty-six described full-thickness (FT) endoscopic suturing and pooled AWL, EWL, and TBWL at 3 months were 8.5 +/- 2.9 kg, 21.6 +/- 9.3%, and 7.3 +/- 2.6%, respectively. At 6 months, they were 8.6 +/- 3.5 kg, 23.7 +/- 12.3%, and 8.0 +/- 3.9%, respectively. At 12 months, they were 7.63 +/- 4.3 kg, 16.9 +/- 11.1%, and 6.6 +/- 5.0%, respectively. Subgroup analysis showed that all outcomes were significantly higher in the group with FT suturing combined with argon plasma coagulation (APC) (p < 0.0001). Meta-analysis included 15 FT studies and showed greater results. Three studies described superficial-thickness suturing with pooled AWL of 3.0 +/- 3.8, 4.4 +/- 0.07, and 3.7 +/- 7.4 kg at 3, 6, and 12 months, respectively. Two articles described APC alone with mean AWL of 15.4 +/- 2.0 and 15.4 +/- 9.1 kg at 3 and 6 months, respectively. Full-thickness suturing is effective at treating weight regain after RYGB. Performing APC prior to suturing seems to result in greater weight loss. Head-to-head studies are needed to confirm our results. Few studies adequately assess effectiveness of other endoscopic techniques.
  • article 33 Citação(ões) na Scopus
    Obesity Treatment with Botulinum Toxin-A Is Not Effective: a Systematic Review and Meta-Analysis
    (2017) BUSTAMANTE, Fabio; BRUNALDI, Vitor Ottoboni; BERNARDO, Wanderley Marques; MOURA, Diogo Turiani H. de; MOURA, Eduardo Turiani H. de; GALVAO, Manoel; SANTO, Marco Aurelio; MOURA, Eduardo Guimares H. de
    The effectiveness of gastric injections of botulinum toxin-A (BTA) as primary treatment for obesity is not well known since results in literature are discrepant. Hence, we aimed to systematically review and meta-analyze the available data to assess the real effect of BTA therapy. We searched MEDLINE, Embase, Cochrane, SCOPUS, EBSCO, LILACS, and BVS. We considered eligible only randomized controlled trials enrolling obese patients comparing BTA versus saline injections. Our initial search identified 8811 records. Six studies fulfilled eligibility criteria. After critical appraisal, two articles were excluded and we meta-analyzed the remainder. The mean difference for absolute weight loss and BMI reduction were 0.12 [CI 95%, - 1.14, 1.38] and - 0.06 [95% CI, - 0.92, 0.81], respectively. Therefore, we concluded that treatment of obesity with BTA is not effective.
  • article 58 Citação(ões) na Scopus
    Efficacy and Safety of Stents in the Treatment of Fistula After Bariatric Surgery: a Systematic Review and Meta-analysis
    (2018) OKAZAKI, Ossamu; BERNARDO, Wanderley M.; BRUNALDI, Vitor O.; CLEMENTE JUNIOR, Cesar C. de; MINATA, Mauricio K.; MOURA, Diogo T. H. de; SOUZA, Thiago F. de; CAMPOS, Josemberg Marins; SANTO, Marco Aurelio; MOURA, Eduardo G. H. de
    Fistula development is a serious complication after bariatric surgery. We performed a systematic review and meta-analysis to assess the efficacy of fistula closure and complications associated with endoscopic stent treatment of fistulas, developed after bariatric surgeries, particularly Roux-en-Y gastric bypass (RYGB) and gastric sleeve (GS). Studies involving patients with fistula after RYGB or GS and those who received stent treatment only were selected. The analyzed outcomes were overall success rate of fistula closure, mean number of stents per patient, mean stent dwelling time, and procedure-associated complications. Current evidence from identified studies demonstrates that, in selected patients, endoscopic stent treatment of fistulas after GS or RYGB can be safe and effective.
  • conferenceObject
    Systematic Review and Meta-Analysis of the Endoscopic Treatment for Weight Regain Following Roux-En-Y Gastric Bypass and the Role of Argon Plasma Coagulation Prior to Endoscopic Suture
    (2017) BRUNALDI, Vitor O.; BERNARDO, Wanderlei M.; OKAZAKI, Ossamu; MARINHO, Fabio R.; MOURA, Diogo T. de; RICCIOPPO, Daniel; SANTO, Marco Aurelio; GALVAO NETO, Manoel; MOURA, Eduardo G. de
  • article 32 Citação(ões) na Scopus
    EUS-Guided Intragastric Injection of Botulinum Toxin A in the Preoperative Treatment of Super-Obese Patients: a Randomized Clinical Trial
    (2019) MOURA, Eduardo Guimaraes Hourneaux de; RIBEIRO, Igor Braga; FRAZAO, Mariana Souza Varela; MESTIERI, Luiz Henrique Mazzonetto; MOURA, Diogo Turiani Hourneaux de; BO, Creusa Maria Roveri Dal; BRUNALDI, Vitor Ottoboni; MOURA, Eduardo Turiani Hourneaux de; NUNES, Gabriel Cairo; BUSTAMANTE, Fabio Alberto Castillo; GALVAO NETO, Manoel dos Passos; MATUGUMA, Sergio Eiji; BERNARDO, Wanderley Marques; SANTO, Marco Aurelio
    BackgroundObesity is a disease that is highly prevalent in Brazil, and the associated comorbidities represent a major global public health challenge. Botulinum toxin type A (BTX-A) is a potent neurotoxin and inhibitor of gastric smooth muscle activity. In theory, BTX-A administration should promote early satiety and weight loss because it delays gastric emptying by inhibiting acetylcholine-mediated peristalsis, which is primarily responsible for gastric motility. Because results in the literature are discrepant, the efficacy of intragastric injections of BTX-A as a primary treatment for obesity remains unknown. The objective of this prospective, double-blind, single-center randomized study was to evaluate the effects of endoscopic ultrasound-guided intragastric BTX-A injections, as a bridge to bariatric surgery, in super-obese patients.MethodsThirty-two super-obese patients were randomized to one of two groups: BTX-A, in which 200units of BTX-A were injected into the gastric antrum and body; and control, in which the same injections were performed with 0.9% saline. Weight, body mass index (BMI), and loss of excess weight were measured monthly over a 6-month period. Gastric emptying scintigraphy was performed before and after the procedure.ResultsThe patients in both groups showed significant weight loss over the course of the study (p<0.001). There were no statistically significant differences between the groups regarding weight loss, excess weight, total loss of excess weight, total weight loss, or change in BMI.ConclusionsIntragastric injection of BTX-A does not appear to be an effective method of achieving preoperative weight loss in super-obese patients.
  • article 16 Citação(ões) na Scopus
    Argon plasma coatmlation alone versus argon plasma coagulation plus full-thickness endoscopic suturing to treat weight regain after Roux-en-Y gastric bypass: a prospective randomized trial (with videos)
    (2020) BRUNALDI, Vitor Ottoboni; FARIAS, Galileu Ferreira Ayala; REZENDE, Daniel Tavares de; CAIRO-NUNES, Gabriel; RICCIOPPO, Daniel; MOURA, Diogo Turiani Hourneaux de; SANTO, Marco Aurelio; MOURA, Eduardo Guimaraes Hourneaux de
    Background and Aims: A significant number of patients regain weight after Roux-en-Y gastric bypass. Ablation with argon plasma coagulation (APC) plus endoscopic full-thickness suturing (FTS-APC) and ablation alone have been reported for treating weight regain when associated with gastrojejunostomy (GJ) dilation. However, comparative controlled data are still lacking. Methods: This was a pilot single-center open-label randomized trial comparing the effectiveness and safety of APC alone versus FTS-APC for transoral outlet reduction. Patients with at least 20% weight regain from the nadir, and GJ >= 15 mm were considered eligible. The primary outcome was percentage total weight loss (%TWL) at 12 months. Secondary outcomes were the incidence of adverse events, amelioration of metabolic laboratory parameters, and improvement in quality of life and eating behavior. Results: Forty patients meeting the eligibility criteria were enrolled from October 2017 to July 2018. Technical and clinical success rates were similar between the groups. At 12 months, the mean %TWL was 8.3% +/- 5.5% in the APC alone group versus 7.5% +/- 7.7% in the Fl S-APC group (P = .71). The pre-revisional % solid gastric retention at 1 hour positively correlated with the probability of achieving >= 10% TWL at 12 months. Both groups experienced significant reductions in low-density lipoprotein and triglyceride levels at 12 months, and improvement in eating behavior and quality of life at 3 months. There were 2 cases of stenoses (1 from each group), which were successfully treated with endoscopic balloon dilation. Conclusion: APC alone is similar to FTS-APC in terms of technical and clinical outcomes within 1 year of followup.
  • conferenceObject
    ENDOSCOPIC VACUUM THERAPY FOR ESOPHAGEAL POST-MEGASTENT PERFORATION.
    (2018) BRUNALDI, Vitor O.; RICCIOPPO, Daniel; MOURA, Diogo T. de; MINATA, Mauricio K.; MORITA, Flavio Hiroshi A.; ROCHA, Rodrigo S.; FARIAS, Galileu F.; SANTO, Marco Aurelio; MOURA, Eduardo G. de
  • conferenceObject
    FULL-THICKNESS ENDOSCOPIC SUTURING PLUS APC VERSUS APC ALONE TO TREAT WEIGHT REGAIN FOLLOWING ROUX-EN-Y GASTRIC BYPASS: AN INTERIM ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL
    (2019) BRUNALDI, Vitor O.; FARIAS, Galileu F.; REZENDE, Daniel T.; NUNES, Gabriel C.; MOURA, Diogo T. de; NETO, Manoel Galvao; SOUZA, Thiago F.; RICCIOPPO, Daniel; SANTO, Marco Aurelio; MOURA, Eduardo G. de
  • article 9 Citação(ões) na Scopus
    The Effectiveness of Endoscopic Gastroplasty for Obesity Treatment According to FDA Thresholds: Systematic Review and Meta-Analysis Based on Randomized Controlled Trials
    (2018) MADRUGA-NETO, Antonio Coutinho; BERNARDO, Wanderley Marques; MOURA, Diogo Turiani Hourneaux de; BRUNALDI, Vitor Ottoboni; MARTINS, Rafael Krieger; JOSINO, Iatagan Rocha; MOURA, Eduardo Turiani Hourneaux de; SOUZA, Thiago Ferreira de; SANTO, Marco Aurelio; MOURA, Eduardo Guimares Hourneaux de
    Endoscopic bariatric therapies (EBTs) are promising alternatives to conventional surgery for obesity. The aim of this study is to compare efficacy and safety through a systematic review and meta-analysis of the endoscopic gastroplasty techniques versus conservative treatment. We searched MEDLINE, EMBASE, Cochrane CENTRAL, Lilacs/Bireme. Randomized controlled trials (RCTs) enrolling obese patients comparing endoscopic gastroplasty to sham or diet/exercise were considered eligible. Among 6014 records, three RCTs were selected for meta-analysis. The total sample was 459 patients (312 EBTs vs 147 control). Mean total body weight loss in the intervention group (IG) was 4.8% higher than the control group (CG) at 12 months (p = 0.01). The IG responder rate was 44.31% at 12 months. Therefore, the endoscopic gastroplasty is more effective than conservative therapies but do not achieve FDA thresholds.