ADRIANA VAZ SAFATLE RIBEIRO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/24 - Laboratório de Oncologia Experimental, Hospital das Clínicas, Faculdade de Medicina
12 resultados
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- Neurotuberculosis in a patient with Ulcerative Colitis using adalimumab for a long period in Brazil(2021) FACANALI, M.; FACANALI, C. Bortolozzo Graciolli; BOARINI, L. Rodrigues; RIBEIRO, A. Vaz Safatle; SOBRADO, C. W.
- Diagnosis of Clinical Complete Response by Probe-Based Confocal Laser Endomicroscopy (pCLE) After Chemoradiation for Advanced Rectal Cancer(2021) SAFATLE-RIBEIRO, Adriana Vaz; MARQUES, Carlos Frederico Sparapan; PIRES, Clelma; ARRAES, Livia; BABA, Elisa Ryoka; MEIRELLES, Luciana; KAWAGUTI, Fabio Shigehissa; MARTINS, Bruno da Costa; LENZ, Luciano Tolentino; LIMA, Marcelo Simas de; GUSMON-OLIVEIRA, Carla Cristina; RIBEIRO JR., Ulysses; MALUF-FILHO, Fauze; NAHAS, Sergio CarlosBackground Neoadjuvant chemoradiotherapy (nCRxt) followed by radical surgery is the optimal treatment for advanced rectal adenocarcinoma. Patients with clinical complete response (cCR) may be followed closely without immediate surgery. Probe-based confocal laser endomicroscopy (pCLE) is a real-time in vivo method that allows acquisition of optical biopsies with 1000 times magnification, evaluating both epithelial and vascular patterns. Aim To evaluate the role of pCLE in the diagnosis of cCR after nCRxt for advanced rectal adenocarcinoma. Methods pCLE was performed in 47 patients with locally advanced rectal adenocarcinoma (T3/T4, or N+) who underwent nCRxt (5-fluorouracil, 5040 cGy). Results Twenty-seven (57.5%) patients were men, and the mean age was 62.8 years. Thirty-seven had partial response confirmed by pCLE. Ten (21.3%) patients had good endoscopic response and presented small ulcer (n = 5) or residual scar (n = 5). After nCRxt, the essential features to differentiate malignancy from post-radiation alterations at pCLE were the presence of irregular crypts, budding, back-to-back glands, cribriform pattern, increased vessel/crypt ratio, and fluorescein leakage. A scoring system was created considering these epithelial and vascular features, with high accuracy for differentiating patients with complete response from those with residual neoplasia (p < 0.00001). pCLE sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100%, 71.4%, 95.2%, 100%, and 95.7%, respectively. Conclusions (1) pCLE evaluation of epithelial and vascular features may improve the diagnosis of cCR and may alter patient management; (2) pCLE might be valuable for identifying patients with advanced rectal cancer who will benefit from watch and wait strategy, avoiding immediate surgical treatment.
- Risk factors for adverse events of colorectal endoscopic submucosal dissection: a systematic review and meta-analysis(2021) SANTOS, Juliana B.; NOBRE, Moacyr R. C.; OLIVEIRA, Cleyton Z.; SAFATLE-RIBEIRO, Adriana V.; KAWAGUTI, Fabio; MARTINS, Bruno; NAHAS, Sergio C.; RIBEIRO JR., Ulysses; ZHANG, Lanjing; MALUF-FILHO, FauzeColorectal endoscopic submucosal dissection (ESD) is already an established treatment for superficial colorectal tumors. However, its technical difficulty and high adverse events rates, compared to endoscopic piecemeal mucosal resection, are a concern to some specialists and have probably contributed to discouragement in its widespread adoption. The debate mentioned above stimulated us to perform a systematic review aiming to identify risk factors for colorectal ESD-related adverse events. We conducted this study following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement and registered in the PROSPERO (University of York) international database (CRD42016042625). We searched MEDLINE, EMBASE, Cochrane Library and LILACS for the publications focused on risk factors for colorectal ESD-related adverse events from inception until April 2020. We included a total of 22 qualified studies in this analysis. We found that fibrosis had an odds ratio (OR) for perforation of 2.90 [95% confidence interval, (1.83-4.59)], right colon location of 2.35 (1.58-3.50), colonic location of 2.20 (1.44-3.35) and larger size of 2.17 (1.47-3.21), as well as one protective factor, the endoscopist experience OR = 0.62 (0.45-0.86). For bleeding, we considered rectal location a risk factor [OR = 3.55 (2.066.12)]. Through the several meta-analyses that we performed in this article, we could summarize the main risk factors for perforation and bleeding on colorectal ESD. Therefore, we provide insightful information for clinical judgment on regions where colorectal ESD is already widespread and help in the learning process of this challenging technique.
conferenceObject RISK FACTORS FOR STENOSIS AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION OF LARGE LESIONS OF THE RECTUM(2021) REZENDE, Daniel T.; KAWAGUTI, Fabio S.; MARTINS, Bruno; SAFATLE-RIBEIRO, Adriana V.; NAHAS, Caio Sergio R.; MARQUES, Carlos F.; POMBO, Amanda A.; SANTOS, Alisson L.; BRAGHIROLI, Oddone F.; RIBEIRO, Ulysses; NAHAS, Sergio C.; MALUF-FILHO, Fauze- Small-bowel cryptococcosis diagnosed by double-balloon endoscopy in patient without human immunodeficiency virus(2021) PRAZERES, Tulio Riguetti; VASCONCELLOS, Marcela Almeida Menezes de; SOUSA, Marcella Salazar; ORTIZ, Evelin Sanchez; RIBEIRO JUNIOR, Ulysses; NAHAS, Sergio Carlos; SAFATLE-RIBEIRO, Adriana Vaz
- UNDERWATER ENDOSCOPIC MUCOSAL RESECTION FOR SMALL RECTAL NEUROENDOCRINE TUMORS(2021) COUTINHO, Lara Meireles Azeredo; LENZ, Luciano; KAWAGUTI, Fabio S; MARTINS, Bruno Costa; BABA, Elisa; GUSMON, Carla; ANDRADE, Gustavo; SIMAS, Marcelo; SAFATLE-RIBEIRO, Adriana; MALUF-FILHO, Fauze; RODRIGUES, Rodrigo; RIBEIRO JR, UlyssesABSTRACT BACKGROUND: A common site of neuroendocrine tumors (NETs) is the rectum. The technique most often used is endoscopic mucosal resection with saline injection. However, deep margins are often difficult to obtain because submucosal invasion is common. Underwater endoscopic mucosal resection (UEMR) is a technique in which the bowel lumen is filled with water rather than air, precluding the need for submucosal lifting. OBJECTIVE: This study aimed to evaluate the efficacy and safety of UEMR for removing small rectal neuroendocrine tumors (rNETs). METHODS: Retrospective study with patients who underwent UEMR in two centers. UEMR was performed using a standard colonoscope. No submucosal injection was performed. Board-certified pathologists conducted histopathologic assessment. RESULTS: UEMR for small rNET was performed on 11 patients (nine female) with a mean age of 55.8 years and 11 lesions (mean size 7 mm, range 3-12 mm). There were 9 (81%) patients with G1 rNET and two patients with G2, and all tumors invaded the submucosa with only one restricted to the mucosa. None case showed vascular or perineural invasion. All lesions were removed en bloc. Nine (81%) resections had free margins. Two patients had deep margin involvement; one had negative biopsies via endoscopic surveillance, and the other was lost to follow-up. No perforations or delayed bleeding occurred. CONCLUSION: UEMR appeared to be an effective and safe alternative for treatment of small rNETs without adverse events and with high en bloc and R0 resection rates. Further prospective studies are needed to compare available endoscopic interventions and to elucidate the most appropriate endoscopic technique for resection of rNETs.
- Indocyanine green and near-infrared fluorescence imaging in gastric cancer precision surgical approach [Uso da fluorescência a laser com infravermelho e indocianina verde no tratamento cirúrgico do câncer gástrico](2021) SAKAMOTO, E.; DIAS, A. R.; RAMOS, M. F. K. P.; SAFATLE-RIBEIRO, A. V.; ZILBERSTEIN, B.; RIBEIRO JUNIOR, U.[No abstract available]
- Indocyanine green imaging to guide lymphadenectomy in laparoscopic distal gastrectomy-With video(2021) SAKAMOTO, Erica; RAMOS, Marcus Fernando Kodama Pertille; DIAS, Andre Roncon; SAFATLE-RIBEIRO, Adriana Vaz; ZILBERSTEIN, Bruno; NAHAS, Sergio Carlos; RIBEIRO JUNIOR, UlyssesGastric cancer (GC) is one of the most lethal malignancies and Gastrectomy with D2 lymphadenectomy is considered the standard surgical treatment. Adequate lymph node dissection is necessary for patients' prognosis, but D2 lymphadenectomy is technically demanding due to the complexity of anatomy, even more so if performed laparoscopically. The learning curve requires a high degree of training with a considerable number of cases and standardization of the technique. Recently, Indocyanine Green (ICG) and Near-Infrared (NIR) Fluorescence Imaging have been presented as promising image-guided surgery techniques, providing real-time anatomy assessment and intra-operative visualization of blood flow, lymph nodes and lymphatic vessels. ICG fluorescence imaging has been studied in GC surgery, especially for real-time lymphatic mapping. At present, we are conducting a prospective, open-label, single-arm clinical trial (Clinical trial NCT03021200) to evaluate the feasibility and outcomes of ICG and NIR Fluorescence Imaging in GC surgery. In this technical note, we present one approach to the use of this technique to guide lymphadenectomy in laparoscopic distal gastrectomy.
conferenceObject EPSTEIN-BARR TUMOR-ASSOCIATED INFECTION IS RESTRICTED TO MORE DISTAL ADENOCARCINOMA OF ESOPHAGOGASTRIC JUNCTION (AEGJ), WHILE PD-L1 IS HIGHLY IMMUNOEXPRESSED IN BOTH, ESOPHAGEAL SQUAMOUS CELL CARCINOMA (ESCC) AND AEGJ(2021) RIBEIRO, Mateus B.; MARQUES, Sergio B.; SOARES, Ibere C.; PEREIRA, Marina A.; TAKEDA, Flavio R.; MALUF-FILHO, Fauze; SALLUM, Rubens A.; ZILBERSTEIN, Bruno; SAFATLE-RIBEIRO, Adriana V.; RIBEIRO, Ulysses- Underwater endoscopic resection of an ileal neuroendocrine tumor(2021) REZENDE, Daniel T.; KAWAGUTI, Fabio S.; SAFATLE-RIBEIRO, Adriana V.; TOLENTINO, Luciano H. L.; RIBEIRO JUNIOR, Ulysses; MALUF-FILHO, Fauze