SPENCER CHENG
Projetos de Pesquisa
Unidades Organizacionais
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- Suction versus slow-pull for endoscopic ultrasound-guided fine-needle aspiration of pancreatic tumors: a prospective randomized trial(2020) CHENG, Spencer; BRUNALDI, Vitor O.; MINATA, Mauricio K.; CHACON, Danielle A.; SILVEIRA, Eduardo B.; MOURA, Diogo T. H. de; SANTOS, Marcos E. L. Dos; MATUGUMA, Sergio E.; CHAVES, Dalton M.; FRANCA, Raony F.; JACOMO, Alfredo L.; ARTIFON, Everson L. A.Background: Suction (S) is commonly used to improve cell acquisition during endoscopic ultrasoundguided fine-needle aspiration (EUS-FNA). Slow-pull (SP) sampling is another technique that might procure good quality specimens with less bloodiness. We aimed to determine if SP improves the diagnostic yield of EUS-FNA of pancreatic masses. Methods: Patients with pancreatic solid masses were randomized to four needle passes with both techniques in an alternate fashion. Sensitivity, specificity, positive, and negative predictive values were calculated. Cellularity and bloodiness of cytological samples were assessed and compared according to the technique. Results: Sensitivity, specificity, and accuracy of suction vs. SP were 95.2% vs. 92.3%; 100% vs. 100; 95.7% vs. 93%, respectively. As to the association of methods, they were 95.6, 100 and 96%, respectively. Positive predictive values for S and SP were 100%. There was no difference in diagnostic yield between S and SP (p = 0.344). Cellularity of samples obtained with SP and Suction were equivalent in both smear evaluation (p = 0.119) and cell-block (0.980). Bloodiness of SP and suction techniques were similar as well. Conclusions: S and SP techniques provide equivalent sensitivity, specificity, and accuracy. Association of methods seems to improve diagnostic yield. Suction does not increase the bloodiness of samples compared to slow-pull.
- Pure Cut or Endocut for Biliary Sphincterotomy? A Multicenter Randomized Clinical Trial(2023) FUNARI, Mateus Pereira; BRUNALDI, Vitor Ottoboni; PROENCA, Igor Mendonca; GOMES, Pedro Victor Aniz; QUEIROZ, Lucas Tobias Almeida; VIEIRA, Yuri Zamban; MATUGUMA, Sergio Eiji; IDE, Edson; FRANZINI, Tomazo Antonio Prince; SANTOS, Marcos Eduardo Lera dos; CHENG, Spencer; MINATA, Mauricio Kazuyoshi; SANTOS, Jose Sebastio dos; MOURA, Diogo Turiani Hourneaux de; KEMP, Rafael; MOURA, Eduardo Guimares Hourneaux deINTRODUCTION: Adverse events (AE) after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and post-ERCP acute pancreatitis (PEP) is the most important one. Thermal injury from biliary sphincterotomy may play an important role and trigger PEP or bleeding. Therefore, this study evaluated the outcomes of 2 electric current modes used during biliary sphincterotomy. METHODS: From October 2019 to August 2021, consecutive patients with native papilla undergoing ERCP with biliary sphincterotomy were randomized to either the pure cut or endocut after cannulation. The primary outcome was PEP incidence. Secondary outcomes included intraprocedural and delayed bleeding, infection, and perforation. RESULTS: A total of 550 patients were randomized (272 pure cut and 278 endocut). The overall PEP rate was 4.0% and significantly higher in the endocut group (5.8% vs 2.2%, P = 0.034). Univariate analysis revealed >5 attempts (P = 0.004) and endocut mode (P = 0.034) as risk factors for PEP. Multivariate analysis revealed >5 attempts (P = 0.005) and a trend for endocut mode as risk factors for PEP (P = 0.052). Intraprocedural bleeding occurred more often with pure cut (P = 0.018), but all cases were controlled endoscopically during the ERCP. Delayed bleeding was more frequent with endocut (P = 0.047). There was no difference in perforation (P = 1.0) or infection (P = 0.4999) between the groups. DISCUSSION: Endocut mode may increase thermal injury leading to higher rates of PEP and delayed bleeding, whereas pure cut is associated with increased intraprocedural bleeding without clinical repercussion. The electric current mode is not related to perforation or infection. Further RCT assessing the impact of electric current on AE with overlapping preventive measures such as rectal nonsteroidal anti-inflammatory drugs and hyperhydration are needed. The study was submitted to the Brazilian Clinical Trials Platform (http://www.ensaiosclinicos.gov.br) under the registry number RBR-5d27tn.
conferenceObject PURE CUT OR ENDOCUT FOR BILIARY SPHINCTEROTOMY? A MULTICENTER RANDOMIZED CLINICAL TRIAL(2023) FUNARI, Mateus; BRUNALDI, Vitor; PROENCA, Igor; OLIVEIRA, Pedro Victor Aniz Gomes De; QUEIROZ, Lucas; VIEIRA, Yuri; MATUGUMA, Sergio; IDE, Edson; FRANZINI, Tomazo; SANTOS, Marcos Eduardo Lera Dos; CHENG, Spencer; MINATA, Mauricio; SANTOS, Jose Sebastiao Dos; MOURA, Diogo De; KEMP, Rafael; MOURA, Eduardo De- Pancreatitis after endoscopic retrograde cholangiopancreatography: A narrative review(2021) RIBEIRO, Igor Braga; MONTE JUNIOR, Epifanio Silvino do; MIRANDA NETO, Antonio Afonso; PROENCA, Igor Mendonca; MOURA, Diogo Turiani Hourneaux de; MINATA, Mauricio Kazuyoshi; IDE, Edson; SANTOS, Marcos Eduardo Lera dos; LUZ, Gustavo de Oliveira; MATUGUMA, Sergio Eiji; CHENG, Spencer; BARACAT, Renato; MOURA, Eduardo Guimaraes Hourneaux deAcute post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a feared and potentially fatal complication that can be as high as up to 30% in high-risk patients. Pre-examination measures, during the examination and after the examination are the key to technical and clinical success with a decrease in adverse events. Several studies have debated on the subject, however, numerous topics remain controversial, such as the effectiveness of prophylactic medications and the amylase dosage time. This review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.
conferenceObject PURE CUT OR ENDOCUT FOR BILIARY SPHINCTEROTOMY? A MULTICENTER RANDOMIZED CLINICAL TRIAL(2023) FUNARI, Mateus; BRUNALDI, Vitor; PROENCA, Igor; OLIVEIRA, Pedro Victor Aniz Gomes De; QUEIROZ, Lucas; VIEIRA, Yuri; MATUGUMA, Sergio; IDE, Edson; FRANZINI, Tomazo; SANTOS, Marcos Eduardo Lera Dos; CHENG, Spencer; MINATA, Mauricio; SANTOS, Jose Sebastiao Dos; MOURA, Diogo De; KEMP, Rafael; MOURA, Eduardo DebookPart Tratamento Endoscópico Paliativo de Neoplasia Avançada de Estômago e Duodeno(2017) MINATA, Mauricio Kazuyoshi; CHENG, Spencer; UEDA, Sérgio Shiguetoshi; MOURA, Eduardo Guimarães Hourneaux de- Endoscopic approach to complex gastric tube stricture after laparoscopic sleeve gastroplasty: a case report(2021) FUNARI, Mateus Pereira; MIRANDA NETO, Antonio Afonso; SAGAE, Vitor Massaro Takamatsu; SOUZA, Thiago Ferreira de; MINATA, Mauricio Kazuyoshi; CHENG, Spencer; MOURA, Eduardo Guimaraes Hourneaux de
- Endoscopic-ultrasound evaluation and fine needle aspiration with a linear echoendoscope in the cecum: it is possible(2019) CHENG, Spencer; BRUNALDI, Vitor Ottoboni; SILVA, Gustavo Luis Rodela; FURUYA, Carlos Kiyoshi; MINATA, Mauricio Kazuyoshi; MATUGUMA, Sergio Eiji; ARTIFON, Everson Luiz de Almeida
- Colonoscopic Ultrasound-Guided Fine-Needle Aspiration Using a Curvilinear Array Transducer: A Single-Center Retrospective Cohort Study(2022) CHENG, Spencer; MATUGUMA, Sergio E.; OLIVEIRA, Guilherme H. P. de; SILVA, Gustavo L. R.; CHENG, Henrique; SANCHEZ-LUNA, Sergio A.; MINATA, Mauricio K.BACKGROUND: Curvilinear array ultrasound transducers enable tissue sampling and have therapeutic capabilities. Nevertheless, colonic intubation and maneuvering with these transducers is technically challenging and is therefore typically limited to the rectosigmoid area. This retrospective cohort study aimed to evaluate the safety, feasibility, and diagnostic yield of colonoscopic ultrasound-guided fine-needle aspiration in deep colonic intubation. IMPACT OF INNOVATION: The impact of this innovation is to enable tissue sampling of colonic and extracolonic lesions guided by endoscopic ultrasound. TECHNOLOGY, MATERIALS, AND METHODS: Curvilinear array ultrasound is used in the evaluation of luminal and extraluminal colonic diseases. Thirteen patients underwent colonoscopic ultrasound with a curvilinear array ultrasound endoscope in a single center for subepithelial lesions, cancer staging, and extracolonic lesions from July 2015 to February 2021. Endosonography was performed using an Olympus EU-ME1 and GF-UCT 180 with a 5-12MHz curvilinear array transducer. The primary outcome was the percentage of patients who were successfully scanned with the endoscopic ultrasound. The secondary outcomes included the success rate of fine-needle aspiration, the diagnostic yield of the tissue samples, and the adverse events related to the procedure. PRELIMINARY RESULTS: A total of 13 female patients underwent colonoscopic ultrasound. All patients (100%, 13/13) were successfully scanned. Fine-needle aspiration was deemed necessary and successfully performed in 100% (5/5) of the patients. Tissue samples collected by fine-needle aspiration resulted in a diagnostic yield of 60%, and no adverse events resulted from this intervention. CONCLUSIONS: This study demonstrates the feasibility of performing colonoscopic ultrasound with a curvilinear array transducer. Fine-needle aspiration for subepithelial, colonic, and extracolonic lesions is feasible and safe in this setting with no adverse events reported in our study. FUTURE DIRECTIONS: Future research should be directed toward validating colonoscopic ultrasound with a curvilinear array transducer technique in prospective randomized trials. Studies evaluating the feasibility and safety of endoscopic ultrasound-guided interventions in the colon, such as abscess drainage and enteral anastomosis, should be considered.
- Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review(2016) MINATA, Mauricio Kazuyoshi; BERNARDO, Wanderley Marques; ROCHA, Rodrigo Silva de Paula; MORITA, Flavio Hiroshi Ananias; AQUINO, Julio Cesar Martins; CHENG, Spencer; ZILBERSTEIN, Bruno; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux deBackground and study aims: Palliative treatment of gastric outlet obstruction can be done with surgical or endoscopic techniques. This systematic review aims to compare surgery and covered and uncovered stent treatments for gastric outlet obstruction (GOO). Patients and methods: Randomized clinical trials were identified in MEDLINE, Embase, Cochrane, LILACs, BVS, SCOPUS and CINAHL databases. Comparison of covered and uncovered stents included: technical success, clinical success, complications, obstruction, migration, bleeding, perforation, stent fracture and reintervention. The outcomes used to compare surgery and stents were technical success, complications, and reintervention. Patency rate could not be included because of lack of uniformity of the extracted data. Results: Eight studies were selected, 3 comparing surgery and stents and 5 comparing covered and uncovered stents.The meta-analysis of surgical and endoscopic stent treatment showed no difference in the technical success and overall number of complications. Stents had higher reintervention rates than surgery (RD: 0.26, 95% CI [0.05, 0.47], NNH: 4). There is no significant difference in technical success, clinical success, complications, stent fractures, perforation, bleeding and the need for reintervention in the analyses of covered and uncovered stents. There is a higher migration rate in the covered stent therapy compared to uncovered self-expanding metallic stents (SEMS) in the palliation of malignant GOO (RD: 0.09, 95% CI [0.04, 0.14], NNH: 11). Nevertheless, covered stents had lower obstruction rates (RD: -0.21, 95% CI [-0.27,-0.15], NNT: 5). Conclusions: In the palliation of malignant GOO, covered SEMS had higher migration and lower obstruction rates when compared with uncovered stents. Surgery is associated with lower reintervention rates than stents.