IGOR BRAGA RIBEIRO
Projetos de Pesquisa
Unidades Organizacionais
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
30 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 30
- Perspectives toward minimizing the adverse events of endoscopic sleeve gastroplasty(2020) MOURA, Diogo Turiani Hourneaux de; BADURDEEN, Dilhana S.; RIBEIRO, Igor Braga; LEITE, Eduardo Filipe Marques Silva Dantas; THOMPSON, Christopher C.; KUMBHARI, VivekEndoscopic sleeve gastroplasty (ESG) transforms the saccular stomach into a tubular structure along the lesser curvature, thereby reducing gastric functional volume.(1-4) Current medical literature demonstrates that ESG achieves greater than 25% excess weight loss at 12 months with a less than 5% rate of severe adverse events (AEs), which is considered satisfactory according to the Preservation and Incorporation of Valuable endoscopic Innovations document created by a task force assembled by the American Society for Gastrointestinal Endoscopy and the American Society for Metabolic and Bariatric Surgery.(5) Despite widespread adoption of the procedure,(6-8) no peer-reviewed resource exists to guide the physician on how to optimally perform the procedure. The aim of this article is to help physicians currently performing or those contemplating performing ESG by providing technical in-sights to facilitate durable tubularization of the stomach while simultaneously minimizing the rate of AEs.
- Propofolvsmidazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials(2020) GUACHO, John Alexander Lata; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; PONTE NETO, Alberto Machado da; SINGH, Shailendra; TUCCI, Marina Gammaro Baldavira; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBACKGROUND Patients with cirrhosis frequently require sedation for elective endoscopic procedures. Several sedation protocols are available, but choosing an appropriate sedative in patients with cirrhosis is challenging. AIM To conduct a systematic review and meta-analysis to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best approach. METHODS This systematic review and meta-analysis was conducted using the PRISMA guidelines. Electronic searches were performed using MEDLINE, EMBASE, Central Cochrane, LILACS databases. Only randomized control trials (RCTs) were included. The outcomes studied were procedure time, recovery time, discharge time, and adverse events (bradycardia, hypotension, and hypoxemia). The risk of bias assessment was performed using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB-2). Quality of evidence was evaluated by GRADEpro. The meta-analysis was performed using Review Manager. RESULTS The search yielded 3,576 records. Out of these, 8 RCTs with a total of 596 patients (302 in the propofol group and 294 in the midazolam group) were included for the final analysis. Procedure time was similar between midazolam and propofol groups (MD: 0.25, 95%CI: -0.64 to 1.13,P= 0.59). Recovery time (MD: -8.19, 95%CI: -10.59 to -5.79,P< 0.00001). and discharge time were significantly less in the propofol group (MD: -12.98, 95%CI: -18.46 to -7.50,P< 0.00001). Adverse events were similar in both groups (RD: 0.02, 95%CI: 0-0.04,P= 0.58). Moreover, no significant difference was found for bradycardia (RD: 0.03, 95%CI: -0.01 to 0.07,P= 0.16), hypotension (RD: 0.03, 95%CI: -0.01 to 0.07,P= 0.17), and hypoxemia (RD: 0.00, 95%CI: -0.04 to 0.04,P= 0.93). Five studies had low risk of bias, two demonstrated some concerns, and one presented high risk. The quality of the evidence was very low for procedure time, recovery time, and adverse events; while low for discharge time. CONCLUSION This systematic review and meta-analysis based on RCTs show that propofol has shorter recovery and patient discharge time as compared to midazolam with a similar rate of adverse events. These results suggest that propofol should be the preferred agent for sedation in patients with cirrhosis.
- 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 deThe 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.
- Efficacy and Safety of Endoscopic Sleeve Gastroplasty at Mid Term in the Management of Overweight and Obese Patients: a Systematic Review and Meta-Analysis(2020) MIRANDA NETO, Antonio Afonso de; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; KHAN, Ahmad; SINGH, Shailendra; PONTE NETO, Alberto Machado da; MADRUGA NETO, Antonio Coutinho; MONTE JUNIOR, Epifanio Silvino do; TUSTUMI, Francisco; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deBackground Endoscopic sleeve gastroplasty (ESG) has emerged as a promising technique in endoscopic bariatric and metabolic therapies (EBMTs). We aimed to perform a systematic review and meta-analysis to provide an update on its efficacy and safety. Methods This is a systematic review and meta-analysis was performed following the PRISMA guidelines. MEDLINE, Cochrane, EMBASE, and LILACS were searched to identify the studies related to ESG. Results Eleven studies with a total of 2170 patients were included. The average BMI pre-ESG was 35.78 kg/m(2). Pooled mean %TWL observed at 6, 12, and 18 months was 15.3%, 16.1%, and 16.8% respectively. Pooled mean %EWL at 6, 12, and 18 months was 55.8%, 60%, and 73% respectively. No procedure-related mortality was reported. Conclusion ESG is a safe and effective procedure for primary obesity therapy with promising short- and mid-term results.
- DIAGNOSTIC ACCURACY OF GASTROPANEL® FOR ATROPHIC GASTRITIS IN BRAZILIAN SUBJECTS AND THE EFFECT OF PROTON PUMP INHIBITORS(2020) MATTAR, Rejane; MARQUES, Sergio Barbosa; RIBEIRO, Igor Braga; VISCONTI, Thiago Arantes de Carvalho; FUNARI, Mateus; DE MOURA, Eduardo Guimarães HourneauxABSTRACT BACKGROUND: It has been proposed that the combination of gastrin-17 (G-17), pepsinogens I and II (PGI and PGII), and anti-Helicobacter pylori (H. pylori) antibodies (GastroPanel®, BIOHIT HealthCare, Helsinki, Finland) could serve as biomarkers of atrophic gastritis. OBJECTIVE: This study aimed to ensure the diagnostic accuracy of GastroPanel® and evaluate the effect of proton pump inhibitors (PPIs) on these biomarkers. METHODS: Dyspeptic patients who underwent gastrointestinal endoscopy were enrolled in the present study. Histological findings, which were the gold standard to stratify groups, were as follows: no atrophy (controls); antrum atrophy; corpus atrophy; multifocal atrophy; and neoplasia. G-17, PGI, PGII, and anti-H. pylori immunoglobulin (Ig)G antibodies were assayed using commercially available kits. The ratio of PGI/PGII was calculated. RESULTS: Among 308 patients, 159 (51.6%) were PPI users. The overall prevalence of atrophy was 43.8% (n=135). Ninety-two (29.9%) patients were H. pylori positive according to anti-H. pylori IgG levels. G-17 levels were not low in those with antrum atrophy but were high in those with corpus and multifocal atrophies. PGI levels were significantly lower in those with corpus and multifocal atrophies. The sensitivity of PGI <30 µg/L to detect corpus atrophy was 50% (95% CI 27.8-72.1%), with a specificity of 93.2% (95% CI 84.3-97.5%), a positive likelihood ratio of 7.4 (95% CI 2.9-19.2), and a negative likelihood ratio of 0.5 (95% CI 0.3-0.8). A small number of subjects (n=6) exhibited moderate to intense atrophy (4%), among whom 66.7% exhibited decreased PGI levels. PPI significantly increased the levels of G-17 and PGI, except in those with corpus and multifocal atrophies, in whom PGI levels were not increased by PPIs. CONCLUSION: GastroPanel® (Gastrin-17, PGI, and PGI/PGII ratio) did not demonstrate high sensitivity for detecting gastric atrophy.
- 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.
- Surveillance in inflammatory bowel disease: is chromoendoscopy the only way to go? A systematic review and meta-analysis of randomized clinical trials(2020) RESENDE, Ricardo Hannum; RIBEIRO, Igor Braga; MOURA, Diogo Turiani Hourneaux de; GALETTI, Facundo; ROCHA, Rodrigo Silva de Paula; BERNARDO, Wanderley Marques; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux deBackground and study aims Ulcerative colitis (UC) and Crohn's disease (CD) have higher risk of colorectal cancer (CRC). Guidelines recommend dysplasia surveillance with dye-spraying chromoendoscopy (DCE). The aim of this systematic review and meta-analysis was to review all randomized clinical trials (RCTs) available and compare the efficacy of different endoscopic methods of surveillance for dysplasia in patients with UC and CD. Methods Databases searched were Medline, EMBASE, Cochrane and SCIELO/LILACS. It was estimated the risk difference (RD) for dichotomous outcomes (number of patients diagnosed with one or more dysplastic lesions, total number of dysplastic lesions diagnosed and number of dysplastic lesions detected by targeted biopsies) and mean difference for continuous outcomes (procedure time). Results This study included 17 RCTs totaling 2,457 patients. There was superiority of DCE when compared to standard-definiton white light endoscopy (SD-WLE). When compared with high-definition (HD) WLE, no difference was observed in all outcomes (number of patients with dysplasia (RD 0.06; 95 % CI [-0.01, 0.13])). Comparing other techniques, no difference was observed between DCE and virtual chromoendoscopy (VCE - including narrow-band imaging [NBI], i-SCAN and flexible spectral imaging color enhancement), in all outcomes except procedure time (mean difference, 6.33 min; 95 % CI, 1.29, 11.33). DCE required a significantly longer procedure time compared with WLE (mean difference, 7.81 min; 95 % CI, 2.76, 12.86). Conclusions We found that dye-spraying chromoendoscopy detected more patients and dysplastic lesions than SD-WLE. Although no difference was observed between DCE and HD-WLE or narrow-band imaging, the main outcomes favored numerically dye-spraying chromoendoscopy, except procedure time. Regarding i-SCAN, FICE and auto-fluorescence imaging, there is still not enough evidence to support or not their recommendation.
- Extensive squamous metaplasia of the stomach [Metaplasia escamosa extensa do estômago.](2020) MIRANDA NETO, A.A. DE; MARQUES, S.B.; BABA, E.R.; YAMAZAKI, K.; RIBEIRO, I.B.; MOURA, E.G.H. DE
- Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis(2020) MOURA, Diogo Turiani Hourneaux de; MCCARTY, Thomas R.; JIRAPINYO, Pichamol; RIBEIRO, Igor Braga; FARIAS, Galileu Ferreira Ayala; RYOU, Marvin; LEE, Linda S.; THOMPSON, Christopher C.Background/Aims: Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacent to the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed to evaluate the comparative efficacy and safety of FNA versus FNB for LN sampling. Methods: This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNB for LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block analysis, and adverse events. Results: A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22 +/- 8.03 mm, with similar sensitivity and accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). The specificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was not different. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and 80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was a significant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15-23.08; p=0.032). No adverse events were reported in either cohort. Conclusions: Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUS-FNA+ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained a significant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusive diagnoses.
bookPart Hemorragia em Pacientes após Procedimentos Bariátricos | Fatores de Risco e Manejo Endoscópico(2020) MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; BARETTA, Giorgio A. P.
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