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
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- Endoscopic polymer injection and endoluminal plication in treatment of gastroesophageal reflux disease: evaluation of long-term results(2018) MOURA, Eduardo Guimaraes Hourneaux De; SAIIUM, Rubens A. A.; NASI, Ary; CORONEL, Martin; MOURA, Diogo Turiani Hourneaux De; MOURA, Eduardo Turiani Hourneaux De; MINATA, Mauricio Kazuyoshi; CURY, Marcelo; FALCAO, Angela; CECCONELLO, Ivan; SAKAI, PauloBackground and study aims Us of proton pump inhibitors (PPIs) has made endoscopic treatment of gastroesophageal reflux disease (GERD) more efficient, with reduction in morbidity and complications. However, some patients persist with symptoms despite medical treatment and some are not compliant with it or cannot afford it for financial reasons, and thus they require non-pharmacological therapeutic options such as surgical fundoplication. Surgery may be effective in the short term, but there is related morbidity and concern about its long-term efficacy. The possibility of minimally invasive endoluminal surgeries has resulted in interest in and development of newly endoscopic devices. Good short-term results with surgical fundoplication lack of studies of is with long follow-up justify our interest in this study. The aim of this study was to investigate the efficacy of endoscopic polymer injection and endoluminal full-thickness plication in the long-term control of GERD. Patients and methods Forty-seven patients with GERD who underwent an endoscopic procedure were followed up for 60 months and evaluated for total response (RT), partial response (RP) and no response (SR) to endoscopic treatment with reintroduction of PPIs. Results Twenty-one patients received polymer injection (G0) and 26 endoluminal plication (G1). The number of patients with no response to endoscopic treatment with reintroduction of PPIs increased in time for both techniques (G0 P = 0.006; G1 P < 0.001). There was symptomatic improvement up to 12 months, with progressive loss of this trending up to 60 months in G0 and G1 (P < 0.001). Health-related quality of life score (GERD-HRQL) demonstrated TR in G0 and G1 at 1, 3, 6 and 12 months. The 60-month analysis showed an increased number of patients with SR in both groups. The quality of life assessment (SF-36) showed benefit in G0 up to 3 months. G0 showed a higher rate of complications. There were no deaths. There was healing of esophagitis at 3 months in 45 % of patients in G0 and 40 % in G1. There was no improvement in manometric or pH findings. Conclusion Endoscopic therapies were ineffective in controlling GERD in the long term.
article Pancreatic Metastasis from Papillary Thyroid Carcinoma: A Case Report(2020) MACHADO, Andressa A.; LENZ, Luciano; DOMINGUES, Regina B.; LIMA, Gustavo R. A.; JOSINO, Iatagan R.; CORDERO, Martin A. C.; V, Adriana Safatle-Ribeiro; MARTINS, Bruno C.; PENNACCHI, Caterina M. P. S.; GUSMON, Carla C.; PAULO, Gustavo A.; LIMA, Marcelo S.; BABA, Elisa R.; KAWAGUTI, Fabio S.; UEMURA, Ricardo S.; MALUF-FILHO, FauzeIntroduction differentiated thyroid carcinoma presents with distant metastasis in 4% of cases, usually occurring in the lungs, bones and thoracic lymph nodes. Pancreatic involvement is extremely rare, with few cases reported in the literature. Case report A 47-years-old female patient presented abdominal pain. She had a history of papillary thyroid carcinoma surgically resected in 2009. After 10 years, computed tomography revealed hepatic lesions suggestive of secondary involvement and a solid mass in the pancreatic head. Endoscopic ultrasound fine-needle aspiration was performed in a heterogeneous hypoechoic mass located at pancreatic head. Cell block with immunohistochemistry was positive for thyroglobulin, suggesting papillary thyroid carcinoma metastasis. The patient still survives at present, treating metastasis with Cabozantinib. Conclusion endoscopic ultrasound fine-needle aspiration is a minimally invasive and accurate method of sampling lesions of the pancreas. In combination with clinical history and immunohistochemistry, can confirm diagnosis and define management.- Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer(2023) JOSINO, Iatagan R.; MARTINS, Bruno C.; MACHADO, Andressa A.; LIMA, Gustavo R. de A.; CORDERO, Martin A. C.; POMBO, Amanda A. M.; SALLUM, Rubens A. A.; JR, Ulysses Ribeiro; BARON, Todd H.; MALUF-FILHO, FauzeBackground/Aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMSERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer. Methods: This retrospective study was performed at the Instituto do Cancer do Estado de Sao Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study. Results: Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15-5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01- 4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26-0.85; p=0.01). No difference was observed in overall survival. Conclusions: The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.
- 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.
- Carbon dioxide versus air insufflation enteroscopy: a systematic review and meta-analysis based on randomized controlled trials(2018) AQUINO, Julio Cesar Martins; BERNARDO, Wanderley Marques; MOURA, Diogo Turiani Hourneaux de; MORITA, Flavio Hiroshi Ananias; ROCHA, Rodrigo Silva de Paula; MINATA, Mauricio Kazuyoshi; CORONEL, Martin; RODELA, Gustavo Luis da Silva; ISHIDA, Robson Kiyoshi; KUGA, Rogerio; MOURA, Eduardo Guimaraes Hourneaux deObjectives To compare the insufflation of CO2 and ambient air in enteroscopy. Search sources The investigators researched the electronic databases MedLine, Cochrane Library, Central, LILACS, BVS, Scopus and Cinahl. The grey search was conducted in the base of theses of the University of Sao Paulo, books of digestive endoscopy and references of selected articles and in previous systematic revisions. Study eligibility criteria The evaluation of eligibility was performed independently, in a non-blind manner, by two reviewers, firstly by title and abstract, followed by complete text. Disagreements between the reviewers were resolved by consensus. Data collection and analysis method Through the spreadsheet of data extraction, where one author extracted the data and a second author checked the extraction. Disagreements were resolved by debate between the two reviewers. The quality analysis of the studies was performed using the Jadad score. The software RevMan 5 version 5.3 was used for the meta-analysis. Results Four randomized clinical trials were identified, totaling 473 patients submitted to enteroscopy and comparing insufflation of CO2 and ambient air. There was no statistical difference in the intubation depth between the two groups. When CO2 insufflation was reduced, there was a significant difference in pain levels 1 hour after the procedure (95% IC, -2.49 [-4.72, -0.26], P: 0.03, I-2: 20%) and 3 hours after the procedure (95% IC, -3.05 [-5.92, -0.18], P: 0.04, I-2: 0 %). There was a usage of lower propofol dosage in the CO2 insufflation group, with significant difference (95% IC, -67.68 [-115.53, -19.84], P: 0.006, I-2: 0%). There was no significant difference between the groups in relation to the use of pethidine and to the oxygen saturation. Limitations Restricted number of randomized clinical trials and nonuniformity of data were limitations to the analysis of the outcomes. Conclusion The use of CO2 as insufflation gas in enteroscopy reduces the pain levels 1 hour and 3 hours after the procedure, in addition to the reduction of the sedation (propofol) dosage used.
- Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer(2023) MACHADO, Andressa A.; MARTINS, Bruno C.; JOSINO, Iatagan R.; CHEN, Andre T. C.; HONG, Carlos B. C.; SANTOS, Alisson L. D. R.; LIMA, Gustavo R. A.; CORDERO, Martin A. C.; V, Adriana Safatle-Ribeiro; PENNACCHI, Caterina; GUSMON, Carla C.; PAULO, Gustavo A.; LENZ, Luciano; LIMA, Marcelo S.; BABA, Elisa R.; KAWAGUTI, Fabio S.; UEMURA, Ricardo S.; SALLUM, Rubens A. A.; JR, Ulysses Ribeiro; MALUF-FILHO, FauzeSelf-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.
- 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.
- 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.