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: WANDERLEY MARQUES BERNARDO ×

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Agora exibindo 1 - 10 de 29
  • article 23 Citação(ões) na Scopus
    Comparison between Enteroscopy-Based and Laparoscopy-Assisted ERCP for Accessing the Biliary Tree in Patients with Roux-en-Y Gastric Bypass: Systematic Review and Meta-analysis
    (2018) PONTE-NETO, Alberto Machado da; BERNARDO, Wanderley M.; COUTINHO, Lara M. de A.; JOSINO, Iatagan Rocha; BRUNALDI, Vitor Ottoboni; MOURA, Diogo T. H.; SAKAI, Paulo; KUGA, Rogerio; MOURA, Eduardo G. H. de
    Although balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography (BAE-ERCP) is a well-described means of accessing the duodenal papilla in patients with Roux-en-Y gastric bypass (RYGB), it is associated with modest clinical success rates. Laparoscopy-assisted ERCP (LA-ERCP)performed by advancing a standard duodenoscope through a gastrostomy into the excluded stomach and duodenumhas emerged as a viable alternative to BAE-ERCP, with apparently higher success rates. In this systematic review, we compare LA-ERCP with enteroscopy-based techniques in post-RYGB patients, including 22 case series that provided data on papilla identification, papilla cannulation, and complications. We found that LA-ERCP was superior to the enteroscopy-based techniques in its capacity to reach the duodenal papilla, although complication rates were lower for the latter. Comparative studies are needed in order to corroborate our findings.
  • conferenceObject
    COMPARATION BETWEEN DIFFERENT METHODS OF SURVEILLANCE OF DYSPLASTIC LESIONS IN PATIENTS WIHT ULCERATIVE COLITIS AND CROHN'S DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS
    (2019) RESENDE, Ricardo H.; BERNARDO, Wanderlei M.; MARCO, Michele O. De; REZENDE, Daniel T.; MOTA, Raquel Cristina L.; BRUNALDI, Vitor O.; FURUYA, Carlos K.; ISHIDA, Robson K.; KUGA, Rogerio; MOURA, Eduardo G. de
  • article 10 Citação(ões) na Scopus
    Is Endoscopic Balloon Dilation Still Associated With Higher Rates of Pancreatitis? A Systematic Review and Meta-Analysis
    (2020) MATSUBAYASHI, Carolina Ogawa; RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; BRUNALDI, Vitor Ottoboni; BERNARDO, Wanderley Marques; HATHORN, Kelly E.; MOURA, Eduardo Guimaraes Hourneaux de
    The objective of this study was to compare the efficacy and safety of endoscopic papillary balloon dilation (EPBD), endoscopic sphincterotomy (ES), and the combination of large balloon dilation and ES (ES + EPLBD) in the treatment of common bile duct stones, with a special focus on postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials (RCTs) which evaluated at least one of the following outcomes: PEP, complete stone removal in the first ERCP, need for mechanical lithotripsy, recurrence of common bile duct stones, bleeding, and cholangitis. Twenty-five RCTs were selected for analysis. Pancreatitis rates were higher for EPBD than for ES (P = 0.003), as were severe pancreatitis rates (P = 0.04). However, in the 10-mm or greater balloon subgroup analysis, this difference was not shown (P = 0.82). Rates of PEP were higher in the subgroup of non-Asian subjects (P = 0.02), and the results were not robust when RCTs that used endoscopic nasobiliary drainage were omitted. The incidence of pancreatitis was comparable between EPLBD and ES + EPLBD. All 3 approaches were equally efficacious. Nevertheless, the results should be interpreted with caution, because pancreatitis is a multifactorial pathology, and RCTs can have limited generalizability.
  • 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.
  • conferenceObject
    PREDICTORS OF GASTROESOPHAGEAL REFLUX AFTER POEM FOR ACHALASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS
    (2019) MOTA, Raquel Cristina L.; MOURA, Eduardo G. de; MOURA, Diogo T. de; MOURA, Eduardo T.; FARIAS, Galileu F.; BRUNALDI, Vitor O.; BERNARDO, Wanderlei M.; SAKAI, Paulo; THOMPSON, Christopher C.
  • 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
    Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis
    (2019) SERRANO, Juan Pablo Roman; MOURA, Diogoturiani Hourneaux de; BERNARDO, Wanderley Marques; RIBEIRO, Igor Braga; FRANZINI, Tomazo Prince; MOURA, Eduardo Turiani Hourneaux de; BRUNALDI, Vitor Ottoboni; SALESSE, Marianne Torrezan; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux De
    Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic procedure for treatment of diseases that affect the biliary tree and pancreatic duct. While the therapeutic success rate of ERCP is high, the procedure can cause complications, such as acute pancreatitis (PEP), bleeding, and perforation. This meta-analysis aimed to assess the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing PEP following (ERCP). Materials and methods We searched databases, such as MEDLINE, Embase, and Cochrane Central Library. Only randomized controlled trials (RCTs) that compared the efficacy of NSAIDs and placebo for the prevention of PEP were included. Outcomes assessed included incidence of PEP, severity of pancreatitis, route of administration, and type of NSAIDs. Results Twenty-one RCTs were considered eligible with a total of 6854 patients analyzed. Overall, 3427 patients used NSAIDs before ERCP and 3427 did not use the drugs (control group). In the end, 250 cases of acute pancreatitis post-ERCP were diagnosed in the NSAIDs group and 407 cases in the placebo group. Risk for PEP was lower in the NSAID group (risk difference (RD): -0.05; 95% confidence interval (CI): -0.07 to -0.03; number need to treat (NNT), 20; P<0.05). Use of NSAIDs effectively prevented mild pancreatitis compared with use of placebo (2.5% vs. 4.1%; 95% CI, -0.05 to -0.01; NNT, 33; P<0.05), but the information on moderate and severe PEP could not be completely elucidated. Only rectal administration reduced incidence of PEP (6.8% vs. 13 %; 95% CI, -0.10 to -0.04; NNT, 20; P<0.05). Furthermore, only diclofenac or indomethacin use was effective in preventing PEP. Conclusions Rectal administration of diclofenac and indomethacin significantly reduced risk of developing mild PEP. Further RCTs are needed to compare efficacy between NSAID administration pathways in prevention of PEP after ERCP.
  • article 0 Citação(ões) na Scopus
    Response to ""The Forgotten Fundus-Obesity Treatment with Botulinum Toxin-A Is Not Effective: a Systematic Review and Meta-Analysis""
    (2018) BRUNALDI, Vitor Ottoboni; BUSTAMANTE, Fabio; BERNARDO, Wanderley M.; MOURA, Eduardo G. H. de
  • article
    Prognostic factors for ESD of early gastric cancers: a systematic review and meta-analysis
    (2020) MARCO, Michele Oliveira De; TUSTUMI, Francisco; BRUNALDI, Vitor Ottoboni; RESENDE, Ricardo Hannum; MATSUBAYASHI, Carolina Ogawa; BABA, Elisa Ryoka; CHAVES, Dalton Marques; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
    Background and study aims Gastric neoplasms are one of the leading types of cancer in the world and early detection is essential to improve prognosis. Endoscopy is the gold-standard diagnostic procedure and allows adequate treatment in selected cases. Endoscopic submucosal dissection (ESD) has been reported to safely address most early gastric cancers (EGCs), with high curability rates. However, data on prognostic factors related to ESDs of EGCs are conflicting. Therefore, we aimed to systematically review the available literature and to perform a meta-analysis to identify the relevant prognostic factors in this context. Methods We performed this study according to PRISMA guidelines. Comparative studies assessing the relationship between curative resection or long-term curability rates and relevant prognostic factors were selected. Prognostic factors were demographic data, lesion features (location, morphology of the lesion, size, and depth of invasion), histological findings,Helycobacter pylori(HP) infection, presence of gastric a atrophy and body mass index (BMI). Finally, we also evaluated risk factors related to metachronous gastric neoplasm. Results The initial search retrieved 2829 records among which 46 studies were included for systematic review and meta-analysis. The total sample comprised 28366 patients and 29282 lesions. Regarding curative resection, pooled data showed no significant influence of sex [odds ratio (OR): 1.15 (0,97, 1.36)P = 0.10 I-2 = 47 %] , age [OR: 1.00 (0.61, 1.64)P = 1.00 I-2 = 58 %], posterior vs non-posterior location [OR: 1.35 (0.81, 2.27)P = 0.25 I-2 = 84 %], depressed vs von-depressed macroscopic type[OR: 1.21 (0.99, 1.49)P = 0.07 I-2 = 0 %], non-upper vs upper location [OR: 1.41 (0.93, 2.14)P = 0.10 I-2 = 77 %] and BMI [OR: 0.84 (0.57; 1.26)P = 0.41 I-2 = 0 %]. Differentiated neoplasms presented greater chance of cure compare to undifferentiated [OR: 0.10 (0.07, 0.15)P < 0.00001 I-2 = 0 %]. Ulcerated lesions had lower curative rates compared to non-ulcerated [OR: 3.92 (2.81, 5.47)P < 0.00001 I-2 = 44 %]. Lesions smaller than 20 mm had greater chance of curative resection [OR: 3.94 (3.25, 4.78)P < 0.00001 I-2 = 38 %]. Bleeding during procedure had lower curative rates compared to non-bleeding [OR: 2.13 (1.56, 2.93)P < 0.0001 I-2 = 0 %]. Concerning long-term cure, female gender [OR 1.62 (1.33, 1.97)P < 0.00001 I-2 = 0 %] and the mucosal over SM1 cancers were protective factors [OR: 0.08 (0.02, 0.39)P = 0.002 I-2 = 86 %]. Gastric atrophy [OR: 0.60 (0.45, 0.81)P = 0.0006 I-2 = 42 %] and the pepsinogen I/pepsinogen II ratio [OR 2.29 (1.47, 3.57)P = 0.0002 I-2 = 0 %] were risk factors to metachronous gastric neoplasm. Conclusions Ulcerated lesions, histology, bleeding and size > 20 mm are prognostic factors concerning curative resection. Regarding long-term cure, female gender and mucosal over SM1 cancer are predictive factors.
  • 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.