MARIANNY NAZARETH SULBARAN NAVA
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- ENDOSCOPIC GASTRIC SUBMUCOSAL DISSECTION: experimental comparative protocol between standard technique and Hybrid-Knife(r)(2016) MENDONÇA, Ernesto Quaresma; ZURETTI, Lucas Snioka; PANZANI, Thiago; SULBARAN, Marianny; SAKAI, Christiano Makoto; SAKAI, PauloABSTRACT Background Endoscopic treatment of superficial gastrointestinal tumors is routinely performed, however the advantages and shortcomings of submucosal pressure-jet dissection is still debated. Objective - Aiming to compare this technique with conventional submucosal dissection, a study was designed in pigs. Methods - Areas of the antral mucosa of the stomach with a diameter of 2 cm2 (6 per animal) were marked, and resected by means of the hybrid-knife (experimental technique), and Flush-knife or IT-knife (controls). An ERBE ICC 300 electrosurgical unit was adopted. End-points were procedural time, complications, and quality of the resected specimen. Results - A total of 27 interventions were conducted in five animals. Time spent with the two options was quite short, and similar: 9.5±3.1 vs 8.0±3.0 minutes (P=0.21). Complications didn't differ (three per group, not significant), and removed specimen looked adequate in both circumstances. Conclusion - The hybrid-knife technique is an acceptable alternative to submucosal dissection, showing no difference compared to the standard technique taking into consideration the procedure, the presence of complications and the quality of the resected specimen.
- 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.
- 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.
- 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.
- Duodenal adenoma surveillance in patients with familial adenomatous polyposis(2015) CAMPOS, Fabio Guilherme; SULBARAN, Marianny; SAFATLE-RIBEIRO, Adriana Vaz; MARTINEZ, Carlos Augusto RealFamilial adenomatous polyposis (FAP) is a hereditary disorder caused by Adenomatous Polyposis Gene mutations that lead to the development of colorectal polyps with great malignant risk throughout life. Moreover, numerous extracolonic manifestations incorporate different clinical features to produce varied individual phenotypes. Among them, the occurrence of duodenal adenomatous polyps is considered an almost inevitable event, and their incidence rates increase as a patient's age advances. Although the majority of patients exhibit different grades of duodenal adenomatosis as they age, only a small proportion (1%-5%) of patients will ultimately develop duodenal carcinoma. Within this context, the aim of the present study was to review the data regarding the epidemiology, classification, genetic features, endoscopic features, carcinogenesis, surveillance and management of duodenal polyps in patients with FAP.
- 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.