MARTIN ANDRES CORONEL CORDERO
Projetos de Pesquisa
Unidades Organizacionais
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
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- A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis(2018) GUEDES, Hugo Goncalo; MOURA, Diogo Turiani Hourneaux de; DUARTE, Ralph Braga; CORDERO, Martin Andres Coronel; SANTOS, Marcos Eduardo Lera dos; CHENG, Spencer; MATUGUMA, Sergio Eiji; CHAVES, Dalton Marques; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deOur aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.
- Primary adenocarcinoma arising in esophageal colon interposition for corrosive esophageal injury: a case report and review of the literature(2018) MOURA, Diogo Turiani Hourneaux De; RIBEIRO, Igor Braga; CORONEL, Martin; MOURA, Eduardo Turiani Hourneaux De; CARVALHO, Joana Rita; BABA, Elisa Ryoka; MOURA, Eduardo Guimaraes Hourneaux DeBackground and study aims Colon interposition for benign strictures is associated with significant perioperative complications that carry high morbidity and mortality. Although rarely reported in the literature, adenocarcinoma can occur as a late complication in an interposed colonic segment. We report a case of a late-stage adenocarcinoma in a colonic interposition performed for benign esophageal stricture.
- Cholangioscopy-guided lithotripsy vs. conventional therapy for complex bile duct stones: a systematic review and meta-analysis(2020) GALETTI, Facundo; MOURA, Diogo Turiani Hourneaux de; RIBEIRO, Igor Braga; FUNARI, Mateus Pereira; CORONEL, Martin; SACHDE, Amit H.; BRUNALDI, Vitor Ottoboni; FRANZINI, Tomazo Prince; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux deIntroduction: Endoscopic removal of common bile duct stones has a high success rate ranging from 85% to 95%. Bile duct stones >15 mm are difficult and frequently require lithotripsy. Peroral cholangioscopy (POC) allows lithotripsy with similar success rates. Aim: To determine the efficacy and safety of cholangioscopy-guided lithotripsy used in the treatment of difficult to remove bile duct stones vs. conventional therapy. Methods: Search was based in Medlin, Embase, Cochrane Central, Lilacs/Bireme. Studies enrolling patients referred for the removal of difficult bile duct stones via POC were considered eligible. Two analyses were carried out separately, one included randomized controlled trials (RCTs) and another observational studies. Results: Forty-six studies were selected (3 RTC and 43 observational). In the analysis there was no statistical significant difference between successful endoscopic clearance (RD=-0.02 CI: -0.17, 0.12/I-2-0%), mean fluoroscopy time (MD--0.14 CI -1.60, 1.32/I-2 -21%) and adverse events rates (RD=-0.06 CI: -0.14, 0.02/I-2=0%), by contrast, the mean procedure time favored conventional therapy with statistical significance (MD-27.89 CI: 16.68, 39.10/I-2-096). In observational studies, the successful endoscopic clearance rate was 8829% (CI95: 86.996-90.7%), the first session successful endoscopic clearance rate was 72.7 % (CI95: 69.9%-75.3%), the mean procedure time was 47.50 +/- 6 min for session and the number of sessions to clear bile duct was 15 +/- 0.18. The adverse event rate was 8.7% (C195: 7%-10.9%). Concussions: For complex common bile duct stones, cholangioscopy-guided lithotripsy has a success rate that is similar to traditional ERCP techniques in terms of therapeutic success, adverse event rate and means fluoroscopy time. Conventional ERCP methods have a shorter mean procedure time.
- Comparison between endoscopic sphincterotomy vs endoscopic sphincterotomy associated with balloon dilation for removal of bile duct stones: A systematic review and meta-analysis based on randomized controlled trials(2018) CLEMENTE JUNIOR, Cesar Capel de; BERNARDO, Wanderley Marques; FRANZINI, Tomazo Prince; LUZ, Gustavo Oliveira; SANTOS, Marcos Eduardo Lera dos; COHEN, Jonah Maxwell; MOURA, Diogo Turiani Hourneaux de; MARINHO, Fabio Ramalho Tavares; CORONEL, Martin; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux deAIM To compare gallstones removal rate and incidence of bleeding, pancreatitis, use of mechanical lithotripsy, cholangitis and perforation between isolated sphincterotomy vs sphincterotomy associated with balloon dilation of papilla in choledocholithiasis through the meta-analysis of randomized clinical trials. METHODS We conducted a systematic review according to the PRISMA guidelines. Literature search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane Library, LILACS, and EMBASE database platforms in July 2017. The manual search included references of retrieved articles. We extracted data focusing on outcomes: The primary endpoint was the stones removal rate; Secondary endpoints were rates of pancreatitis, bleeding, use of mechanical lithotripsy (ML), perforation and cholangitis. RESULTS Eleven RCTs with 1824 patients were included. EST was associated with more post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding [FE RD-0.02, CI (-0.03, -0.00), I-2 = 33%, P = 0.05] and more need of mechanical lithotripsy in general [RE RD-0.16, CI (-0.25, -0.06), I-2 = 90%, P = 0.002] and in subgroup analysis of stones greater than 15 mm [RE RD-0.20, CI (-0.38, -0.02), I-2 = 82%, P = 0.003]. Incidence of pancreatitis [FE RD-0.01, CI (-0.03, 0.01), I-2 = 0, P = 0.36], cholangitis [FE RD-0.00, CI (-0.01, 0.01), I-2 = 0, P = 0.97] and perforation [FE RD-0.01, CI (-0.01, 0.00), I-2 = 0, P = 0.23] was similar between the groups as well as similar stone removal rates in general [FE RD-0.01, CI (-0.01, 0.04), I-2 = 0, P = 0.23] and pooled analysis of stones greater than 15 mm [FE RD-0.02, CI (-0.02, 0.07), I-2 = 11%, P = 0.31]. CONCLUSION Through meta-analysis of randomized clinical trials we found that isolated sphincterotomy was associated with more post-ERCP bleeding and more need for mechanical lithotripsy. However, there was no statistical difference in the stone removal rate between isolated sphincterotomy and sphincterotomy associated with balloon dilation in the approach to remove gallstones.
- THE EFFICACY OF THE DIFFERENT ENDOSCOPIC TREATMENTS VERSUS SHAM, PHARMACOLOGIC OR SURGICAL METHODS FOR CHRONIC GASTROESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS(2018) CORONEL, Martin Andrés; BERNARDO, Wanderley Marques; MOURA, Diogo Turiani Hourneaux de; MOURA, Eduardo Turiani Hourneaux de; RIBEIRO, Igor Braga; MOURA, Eduardo Guimarães Hourneaux deABSTRACT BACKGROUND: Endoscopic antireflux treatments for gastroesophageal reflux disease (GERD) are still evolving, and most of the published studies address symptom relief in the short-term. Objective - We aimed to perform a systematic review and meta-analysis focused on evaluating the efficacy of the different endoscopic procedures. METHODS: Search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane, SciELO, and EMBASE for patients with chronic GERD (>6 months), over 18 years old and available follow up of at least 3 months. The main outcome was to evaluate the efficacy of the different endoscopic treatments compared to sham, pharmacological or surgical treatment. Efficacy was measured by different subjective and objective outcomes. RESULTS: We analyzed data from 16 RCT, totaling 1085 patients. The efficacy of endoscopic treatments compared to sham and proton pump inhibitors (PPIs) treatment showed a significant difference up to 6 months in favor of endoscopy with no heterogeneity (P<0.00001) (I2: 0%). The subgroup analysis showed a statistically significant difference up to 6 months in favor of endoscopy: endoscopy vs PPI (P<0.00001) (I2: 39%). Endoscopy vs sham (P<0.00001) (I2: 0%). Most subjective and objective outcomes were statistically significant in favor of endoscopy up to 6 and 12 months follow up. CONCLUSION: This systematic review and meta-analysis shows a good short-term efficacy in favor of endoscopic procedures when comparing them to a sham and pharmacological or surgical treatment. Data on long-term follow up is lacking and this should be explored in future studies.
- Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis(2018) RIBEIRO, Igor Braga; BERNARDO, Wanderley Marques; MARTINS, Bruno da Costa; MOURA, Diogo Turiani Hourneaux de; BABA, Elisa Ryoka; JOSINO, Iatagan Rocha; MIYAJIMA, Nelson Tomio; CORDERO, Martin Andres Coronel; VISCONTI, Thiago Arantes de Carvalho; IDE, Edson; SAKAI, Paulo; MOURA, Eduardo Guimaraes Hourneaux deBackground and study aims Colorectal cancer (CRC) is the third most common malignancy and the third leading cause of cancer death worldwide. Malignant colonic obstruction (MCO) due to CRC occurs in 8% to 29% of patients. The aim of this study was to perform a systematic review and meta-analysis of RCTs comparing colonic SEMS versus emergency surgery (ES) for MCO in palliative patients. This was the first systematic review that included only randomized controlled trials in the palliative setting. Methods A literature search was performed according to the PRISMA method using online databases with no restriction regarding idiom or year of publication. Data were extracted by two authors according to a predefined data extraction form. Primary outcomes were: mean survival, 30-day adverse events, 30-day mortality and length of hospital stay. Stoma formation, length of stay on intensive care unit (ICU), technical success and clinical success were recorded for secondary outcomes. Technical success (TS) was defined as successful stent placement across the stricture and its deployment. Clinical success (CS) was defined as adequate bowel decompression within 48 h of stent insertion without need for re-intervention. Results We analyzed data from four RCT studies totaling 125 patients. The 30-day mortality was 6.3% for SEMS-treated patients and 6.4% for ES-treated patients, with no difference between groups (RD: -0.00, 95% CI [-0.10, 0.10], I-2: 0 %). Mean survival was 279 days for SEMS and 244 days for ES, with no significant difference between groups (RD: 20.14, 95% CI: [-42.92, 83.21], I-2: 44%). Clinical success was 96% in the ES group and 86.1% in the SEMS group (RD: -0.13, 95% CI [-0.23, -0.02], I-2: 51%). Permanent stoma rate was 84% in the ES group and 14.3% in the SEMS group (RR: 0.19, 95% CI: [0.11, 0.33], I-2: 28%). Length of hospital stay was shorter in SEMS group (RD: -5.16, 95% CI: [-6.71, -3.61], I-2: 56%). There was no significant difference between groups regarding adverse events (RD 0.18, 95% CI: [-0.19, 0.54;]) neither regarding ICU stay. (RD: -0.01, 95% CI: [-0.08, 0.05], I-2: 7%). The most common stent-related complication was perforation (42.8% of all AE). Conclusion Mortality, mean survival, length of stay in the ICU and early complications of both methods were similar. SEMS may be an alternative to surgery with the advantage of early hospital discharge and lower risk of permanent stoma.