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Igor Logetto Caetité Gomes,Diogo Turiani Hourneaux de Moura,Igor Braga Ribeiro,Sérgio Barbosa Marques,Alexandre de Sousa Carlos,Beanie Conceição Medeiros Nunes,Bruno Salomão Hirsch,Guilherme Henrique 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.2
Background/Aims: Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett’s esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported. Methods: An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], –0.03; 95% confidence interval [CI], –0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, –0.03; 95% CI, –0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate. Conclusions: Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.
Bruno Salomão Hirsch,Igor Braga Ribeiro,Mateus Pereira Funari,Diogo Turiani Hourneaux de Moura,Sergio Eiji Matuguma,Sergio A. Sánchez-Luna,Fabio Catache Mancini,Guilherme Henrique Peixoto de Oliveira 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5
Background/Aims: Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for gastric antral vascularectasia (GAVE). Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility,efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review that included only randomizedcontrolled trials (RCTs) on this topic. Methods: A comprehensive search was performed using electronic databases to identify RCTs comparing APC and EBL for thetreatment of GAVE following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results: Four RCTs were included, with a total of 204 patients. EBL was related to higher endoscopic eradication rates risk difference[RD], 0.29; 95% confidence interval [CI] [0.14, 0.44]; I2=0%) and less bleeding recurrence than APC (RD, 0.29; 95% CI [0.15, 0.44];I2=0%). Patients treated with EBL required fewer blood transfusions (mean difference [MD], 1.49; 95% CI [0.28, 2.71]; I2=96%) andhospitalizations (MD, 0.29; 95% CI [0.19, 0.39]; I2=0%). The number of sessions required for the obliteration of lesions was higherwith APC. There was no difference in the incidence of adverse events. Conclusions: EBL is superior to APC in the treatment of GAVE in terms of endoscopic eradication rates, recurrence of bleeding, andtransfusion requirements.
Marina Tucci Gammaro Baldavira Ferreira,Igor Braga Ribeiro,Diogo Turiani Hourneaux de Moura,Thomas R. McCarty,Alberto Machado da Ponte Neto,Galileu Ferreira Ayala Farias,Antônio Afonso de Miranda Neto 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Background/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remainschallenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment ofdominant strictures among PSC patients. Methods: Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studiespublished until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate,transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death). Results: A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (riskdifference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I2=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01;I2=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I2=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia weresignificantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I2=51%). Conclusions: Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complicationrates without significant differences in efficacy.
Diogo Turiani Hourneax de Moura,Marvin Ryou,Eduardo Guimarães Hourneaux De Moura,Igor Braga Ribeiro,Wanderlei Marques Bernardo,Christopher C. Thompson 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.4
Background/Aims: The diagnosis of biliary strictures can be challenging. There are no systematic reviews studying same-sessionendoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling and endoscopic ultrasound-guided fine needleaspiration (EUS-FNA) for the diagnosis of biliary strictures. Methods: A systematic review was conducted on studies analyzing same-session EUS and ERCP for tissue diagnosis of suspectedmalignant biliary strictures. The primary outcome was the accuracy of each method individually compared to the two methodscombined. The secondary outcome was the accuracy of each method in pancreatic and biliary etiologies. In the meta-analysis, we usedForest plots, summary receiver operating characteristic curves, and estimates of the area under the curve for intention-to-treat analysis. Results: Of the 12,132 articles identified, six were included, resulting in a total of 497 patients analyzed. The sensitivity, specificity,positive likelihood ratio, negative likelihood ratio, and accuracy of the association between the two methods were: 86%, 98%, 12.50,0.17, and 96.5%, respectively. For the individual analysis, the sensitivity, specificity and accuracy of EUS-FNA were 76%, 100%, and94.5%, respectively; for ERCP-based tissue sampling, the sensitivity, specificity, and accuracy were 58%, 98%, and 78.1%, respectively. For pancreatic lesions, EUS-FNA was superior to ERCP-based tissue sampling. However, for biliary lesions, both methods had similarsensitivities. Conclusions: Same-session EUS-FNA and ERCP-based tissue sampling is superior to either method alone in the diagnosis of suspectedmalignant biliary strictures. Considering these results, combination sampling should be performed when possible.
Diogo Turiani Hourneaux de Moura,Thomas R. McCarty,Pichamol Jirapinyo,Igor Braga Ribeiro,Galileu Ferreira Ayala Farias,Marvin Ryou,Linda S. Lee,Christopher C. Thompson 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.5
Background/Aims: Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacentto the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed toevaluate the comparative effcacy and safety of FNA versus FNB for LN sampling. Methods: This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNBfor LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacyof rapid on-site evaluation (ROSE), cell-block analysis, and adverse events. Results: A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivityand accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). Thespecificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was notdifferent. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was asignificant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15–23.08; p=0.032). No adverse events were reported ineither cohort. Conclusions: Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUS-FNA+ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained asignificant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusivediagnoses.
Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report
Epifanio Silvino do Monte Junior,Marcos Eduardo Lera dos Santos,Igor Braga Ribeiro,Gustavo de Oliveira Luz,Elisa Ryoka Baba,Bruno Salomão Hirsch,Mateus Pereira Funari,Eduardo Guimarães Hourneaux De Mo 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.6
The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptomsof COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections. Mucormycosis isa rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergencyroom with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Fivedays following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three unitsof red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deephemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died36 hours after the esophagogastroduodenoscopy.
John Alexander Lata Guacho,Diogo Turiani Hourneaux De Moura,Igor Braga Ribeiro,Bruna Furia Buzetti Hourneaux de Moura,Megui Marilia Mansilla Gallegos,Thomas McCarty,Ricardo Katsuya Toma,Eduardo Guimar 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.2
Background/Aims: Carbon dioxide is increasingly used in insufflation during colonoscopy in adult patients; however, air insufflationremains the primary practice among pediatric gastroenterologists. This systematic review and meta-analysis aims to evaluateinsufflation using CO2 versus air in colonoscopies in pediatric patients. Methods: Individualized search strategies were performed using MEDLINE, Cochrane Library, EMBASE, and LILACS databasesfollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane workingmethodology. Randomized control trials (RCTs) were selected for the present meta-analysis. Pooled proportions were calculated foroutcomes including procedure time and abdominal pain immediately and 24 hours post-procedure. Results: The initial search yielded 644 records, of which five RCTs with a total of 358 patients (CO2: n=178 versus air: n=180) wereincluded in the final analysis. The procedure time was not different between the CO2 and air insufflation groups (mean difference,10.84; 95% confidence interval [CI], -2.55 to 24.22; p=0.11). Abdominal pain immediately post-procedure was significantly lowerin the CO2 group (risk difference [RD], -0.15; 95% CI; -0.26 to -0.03; p=0.01) while abdominal pain at 24 hours post-procedure wassimilar (RD, -0.05; 95% CI; -0.11 to 0.01; p=0.11). Conclusions: Based on this systematic review and meta-analysis of RCT data, CO2 insufflation reduced abdominal pain immediatelyfollowing the procedure, while pain was similar at 24 hours post-procedure. These results suggest that CO2 is a preferred insufflationtechnique when performing colonoscopy in pediatric patients.