MARIANNY NAZARETH SULBARAN NAVA
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conferenceObject KI-67 EXPRESSION CAN BE A MARKER OF AGRESSIVENESS OF DUODENAL DISEASE IN FAMILIAL ADENOMATOUS POLYPOSIS(2020) SULBARAN, Marianny; CAMPOS, Fabio G.; PAES, Vitor R.; ALVES, Venancio A.; KISHI, Humberto; MOURA, Eduardo G. de; BUSTAMANTE-LOPEZ, Leonardo A.; NAHAS, Sergio C.; RIBEIRO, Ulysses; COUDRY, Renata; SAFATLE, Adriana V.- Systematic review and meta-analysis of colon capsule endoscopy accuracy for colorectal cancer screening. An alternative during the Covid-19 pandemic?(2022) SULBARAN, Marianny; BUSTAMANTE-LOPEZ, Leonardo; BERNARDO, Wanderley; SAKAI, Christiano M.; SAKAI, Paulo; NAHAS, Sergio; MOURA, Eduardo G. H. deAim To determine the diagnostic accuracy of colon capsule endoscopy for colorectal cancer screening. Methods Studies that compared the diagnostic performance of colonoscopy and second-generation colon capsule endoscopy (CCE-2) for screening of asymptomatic patients aged 50-75 years were included. The primary outcomes were sensitivity, specificity, and positive and negative likelihood ratios for polyps and adenomas measuring at least 6 mm or 10 mm. Results Eight full-text studies that evaluated 1602 patients were included for systematic review. Of these, 840 (52.43%) patients participated in an opportunistic screening program. The pooled outcomes of CCE-2 for polyps at least 6 mm / 10 mm were (CI = confidence interval): sensitivity: 88% (95% CI: 0.84-0.91) / 88% (95% CI: 0.82-0.93), specificity: 94% (95% CI: 0.92-0.95) / 95.5% (95% CI: 0.94-0.97); positive likelihood ratio: 11.86 (95% CI: 5.53-25.46) / 23.07 (95% CI: 6.163-86.36); negative likelihood ratio: 0.14 (95% CI: 0.1-0.21) / 0.14 (95% CI: 0.09-0.21). The area under the summary receiver operating characteristic curve for polyps at least 6 and 10 mm was 96.3% and 96.7%, respectively. The only cancer missed by complete CCE-2 was shown at multiple frames in the unblinded review. In total, 125 (7.8%) patients presented mild adverse events mostly related to bowel preparation. Conclusion CCE-2 is demonstrated to be an effective and safe alternative method for colorectal cancer screening. Diagnostic performance of CCE-2 for polyps of at least 6 and 10 mm was similar. Completion rates still need to be improved.
- 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.
conferenceObject SYSTEMATIC REVIEW AND META-ANALYSIS OF COLON CAPSULE ENDOSCOPY ACCURACY FOR COLORECTAL CANCER SCREENING. AN ALTERNATIVE DURING THE COVID ERA?(2021) SULBARAN, Marianny; BERNARDO, Wanderley M.; BUSTAMANTE-LOPEZ, Leonardo A.; SAKAI, Christiano M.; SAKAI, Paulo; NAHAS, Sergio C.; MOURA, Eduardo G. De- Risk factors for advanced duodenal and ampullary adenomatosis in familial adenomatous polyposis: a prospective, single-center study(2018) SULBARAN, M.; CAMPOS, F. G.; RIBEIRO JR., U.; KISHI, H. S.; SAKAI, P.; MOURA, E. G. H. de; BUSTAMANTE-LOPEZ, L.; TOMITAO, M.; NAHAS, S. C.; CECCONELLO, I.; SAFATLE-RIBEIRO, A. V.Background and study aims To determine the clinical features associated with advanced duodenal and ampullary adenomas in familial adenomatous polyposis. Secondarily, we describe the prevalence and clinical significance of jejunal polyposis. Patients and methods This is a single center, prospective study of 62 patients with familial adenomatous polyposis. Duodenal polyposis was classified according to Spigelman and ampullary adenomas were identified. Patients with Spigelman III and IV duodenal polyposis underwent balloon assisted enteroscopy. Predefined groups according to Spigelman and presence or not of ampullary adenomas were related to the clinical variables: gender, age, family history of familial adenomatous polyposis, type of colorectal surgery, and type of colorectal polyposis. Results Advanced duodenal polyposis was present in 13 patients (21%; 9 male) at a mean age of 37.61 +/- 13.9 years. There was a statistically significant association between family history of the disease and groups according to Spigelman (P=0.03). Seven unrelated patients (6 male) presented ampullary adenomas at a mean age of 36.14 +/- 14.2 years. The association between ampullary adenomas and extraintestinal manifestations was statistically significant in multivariate analysis (P=0.009). Five endoscopic types of non-ampullary adenoma were identified, showing that lesions larger than 10mm or with a central depression presented foci of high grade dysplasia. Among 28 patients in 12 different families, a similar Spigelman score was identified; 10/12 patients (83.3%) who underwent enteroscopy presented small tubular adenomas with low grade dysplasia in the proximal jejunum. Conclusions Advanced duodenal polyposis phenotype may be predictable from disease severity in a first-degree relative. Ampullary adenomas were independently associated with the presence of extraintestinal manifestations.
conferenceObject ENDOSCOPIC ASSISTED COLOSTOMY WITH PERCUTANEOUS COLOPEXY: AN EXPERIMENTAL STUDY.(2015) BUSTAMANTE-LOPEZ, L.; SULBARAN, M.; SAKAI, P.; MOURA, E.; NAHAS, C.; MARQUES, C.; SAKAI, C.; CECCONELLO, I.; PINTO, R.; NAHAS, S.- 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.
- Endoscopic colostomy with percutaneous colopexy: an animal feasibility study(2017) BUSTAMANTE-LOPEZ, Leonardo Alfonso; SULBARAN, Marianny; NAHAS, Sergio Carlos; MOURA, Eduardo Guimaraes Horneaux de; NAHAS, Caio Sergio; MARQUES, Carlos Federico; SAKAI, Christiano; CECONELLO, Ivan; SAKAI, PauloBackground: Indications for colostomy in colorectal diseases are obstruction of the large bowel, such as in cancer, diverticular disease in the acute phase, post-radiotherapy enteritis, complex perirectal fistulas, anorectal trauma and severe anal incontinence. Some critically ill patients cannot tolerate an exploratory laparotomy, and laparoscopic assisted colostomy also requires general anesthesia. Objective: To evaluate the feasibility, safety and efficacy of performing colostomy assisted by colonoscopy and percutaneous colopexy. Materials and methods: Five pigs underwent endoscopic assisted colostomy with percutaneous colopexy. Animals were evaluated in post-operative days 1, 2, 5 and 7 for feeding acceptance and colostomy characteristics. On day 7 full colonoscopy was performed on animals followed by exploratory laparotomy. Results: Average procedure time was 27 minutes (2154 min). Postoperative mobility and feeding of animals were immediate after anesthesia recovery. Position of the colostomy, edges color, appearance of periostomal area, as well as its function was satisfactory in four animals. Retraction of colostomy was present in one pig. The colonoscopy and laparotomy control on the seventh day were considered as normal. A bladder perforation that was successfully repaired through the colostomy incision occurred in one pig. The main limitation of this study is its experimental nature. Conclusion: Endoscopic assisted colostomy with percutaneous colopexy proves to be a safe and effective method with low morbidity for performing colostomy in experimental animals, with possible clinical application in humans.
conferenceObject ADVANCED DUODENAL AND AMPULLARY ADENOMATOSIS IN A BRAZILIAN POPULATION OF FAMILIAL ADENOMATOUS POLYPOSIS: PROSPECTIVE CLINICAL AND MOLECULAR STUDY.(2017) NAVA, M. Sulbaran; CAMPOS, F.; RIBEIRO JUNIOR, U.; COUDRY, R.; MEIRELES, S.; LISBOA, B.; KISHI, H.; SAKAI, P.; MOURA, E. de; BUSTAMANTE-LOPEZ, L.; TOMITAO, M.; NAHAS, S.; RIBEIRO, A. Safatle- A novel technique for correction of total rectal prolapse: Endoscopic-assisted percutaneous rectopexy with the aid of the EndoLifter(2016) BUSTAMANTE-LOPEZ, L.; SULBARAN, M.; SAKAI, C.; MOURA, E. G. de; BUSTAMANTE-PEREZ, L.; NAHAS, C. S.; NAHAS, S. C.; CECCONELLO, I.; SAKAI, P.Introduction and aims: Rectal prolapse is common in the elderly, having an incidence of 1% in patients over 65 years of age. The aim of this study was to evaluate the safety and feasibility of a new endoluminal procedure for attaching the previously mobilized rectum to the anterior abdominal wall using an endoscopic fixation device. Materials and methods: The study is a single-arm phase I experimental trial. Under general anesthesia, total rectal prolapse was surgically reproduced in five pigs. Transanal endoscopic reduction of the rectal prolapse was performed. The best site for transillumination of the abdominal wall, suitable for rectopexy, was identified. The EndoLifter was used to approximate the anterior wall of the proximal rectum to the anterior abdominal wall. Two percutaneous rectopexies were performed by puncture with the Loop Fixture II Gastropexy Kit at the preset site of transillumination. After the percutaneous rectopexies, rectoscopy and exploratory laparotomy were performed. Finally, the animals were euthanized. Results: The mean procedure time was 16 min (11-21) and the mean length of the mobilized specimen was 4.32 cm (range 2.9-5.65cm). A total of 10 fixations were performed with a technical success rate of 100%. There was no evidence of postoperative rectal prolapse in any of the animals. The EndoLifter facilitated the process by allowing the mucosa to be held and manipulated during the repair. Conclusions: Endoscopic-assisted percutaneous rectopexy is a safe and feasible endoluminal procedure for fixation of the rectum to the anterior abdominal wall in experimental animals. (C) 2016 Asociacion Mexicana de Gastroenterologia.