LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo
URI Permanente desta comunidade
O Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo é ligado ao Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP).
Linhas de pesquisa: fisiologia aplicada à digestão; tratamento cirúrgico de câncer de esôfago e cárdia; imunomodulação em cirurgia; mecanismos envolvidos na disfagia alta e reflexo gastroesofágico; anatomia cirúrgica do fígado; transplante do fígado e regeneração hepática; efeitos de dietas e nutrientes, in vitro, sobre comportamento imunológico de células brancas; ciclo celular; apoptose e expressão gênica em linhagens de celular de tumor de mama, e, in vivo, em modelos de queimaduras cutâneas; síndrome do intestino curto; colite experimental; cicatrização de feridas e pancreatite aguda.
Site oficial: http://limhc.fm.usp.br/portal/lim35-laboratorio-de-nutricao-e-cirurgia-metabolica-do-aparelho-digestivo/
Linhas de pesquisa: fisiologia aplicada à digestão; tratamento cirúrgico de câncer de esôfago e cárdia; imunomodulação em cirurgia; mecanismos envolvidos na disfagia alta e reflexo gastroesofágico; anatomia cirúrgica do fígado; transplante do fígado e regeneração hepática; efeitos de dietas e nutrientes, in vitro, sobre comportamento imunológico de células brancas; ciclo celular; apoptose e expressão gênica em linhagens de celular de tumor de mama, e, in vivo, em modelos de queimaduras cutâneas; síndrome do intestino curto; colite experimental; cicatrização de feridas e pancreatite aguda.
Site oficial: http://limhc.fm.usp.br/portal/lim35-laboratorio-de-nutricao-e-cirurgia-metabolica-do-aparelho-digestivo/
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Coleções desta Comunidade
- LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo
- LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo
- LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo
Submissões Recentes
Management of a refractory marginal ulcer following Roux-en-Y gastric bypass with EUS-guided Roux-en-Y gastric bypass reversal
(2023) KERBAGE, A.; ANNAN, K. Al; BRUNALDI, V. O.; RAZZAK, F. A.; ABBOUD, D. M.; GALA, K.; GHANEM, O.; DAYYEH, B. K. Abu
Endoscopic resection of a gastric GI stromal tumor using the helix-snaring technique
(2023) QUADROS, L. G. de; BRUNALDI, V. O.; SILVA, M. C.; GALVAO NETO, M.; GALA, K.; DAYYEH, B. Abu
SYSTEMATIC REVIEW AND META-ANALYSIS OF COLON CAPSULE ENDOSCOPY ACCURACY FOR COLORECTAL CANCER SCREENING. AN ALTERNATIVE DURING THE COVID ERA?
(2021) SULBARAN, Marianny; BERNARDO, Wanderley M.; BUSTAMANTE-LOPEZ, Leonardo A.; SAKAI, Christiano M.; SAKAI, Paulo; NAHAS, Sergio C.; MOURA, Eduardo G. De
Endoscopic retrograde cholangiopancreatography (ERCP) approach for patients with Roux-en-Y gastric bypass: a comparative study between four ERCP techniques with proposed management algorithm
(2024) GHAZI, Rabih; RAZZAK, Farah Abdul; KERBAGE, Anthony; BRUNALDI, Vitor; STORM, Andrew C.; VARGAS, Eric J.; BOFILL-GARCIA, Aliana; CHANDRASEKHARA, Vinay; LAW, Ryan J.; MARTIN, John A.; GHANEM, Omar M.; PETERSEN, Bret T.; DAYYEH, Barham K. Abu
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with Roux-en-Y gastric bypass (RYGB) due to altered anatomy.Objective: To compare the procedural and clinical outcomes of 4 different ERCP techniques in RYGB patients.Setting: Academic tertiary referral center in the United States. Methods: A retrospective cohort study including patients with RYGB anatomy who underwent an ERCP between January 2015 and September 2020. We compared procedural success and adverse events (AEs) rates of balloon-assisted enteroscopy (BAE), gastrostomy-assisted ERCP (GAE), endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE), and rendezvous guidewire-assisted ERCP (RGA).Results: Seventy-eight RYGB patients underwent a total of 132 ERCPs. The mean age was 60 +/- 11.8 years, with female predominance (85.7%). The ERCP procedures performed were BAE (n = 64; 48.5%), GAE (n = 18; 13.7%), EDGE (n = 25; 18.9%), and RGA (n = 25; 18.9%), with overall procedure success rates of 64.1%, 100%, 89.5%, and 91.7%, respectively. All approaches were superior to BAE (GAE versus BAE, P =.003; EDGE versus BAE, P =.034; RGA versus BAE, P =.011). The overall AE rates were 10.9%, 11.1%, 15.8 %, and 25.0%, respectively. There was no statistical difference in AEs. There were also no differences in bleeding, post-ERCP pancreatitis, and perforation rates between the 4 approaches.Conclusion: Procedure success was similar between GAE, RGA, and EDGE, but superior to BAE. AE rates were similar between approaches. (Surg Obes Relat Dis 2024;20:53-61.) (c) 2024 American Society for Metabolic and Bariatric Surgery.
Complex Intrahepatic Lithiasis: A Case Report of Combined Treatment With Surgical Exploration of the Bilioenteric Anastomosis and Laser Lithotripsy by Cholangioscopy
(2023) SANTOS, Marcos Eduardo Lera dos; SASSO, Joao Guilherme Ribeiro Jordao; FIGUEIRA, Estela R.; OLIVEIRA, Victor L. De; ARABI, Arthur Youssif Mota; MEIRA JUNIOR, Jose Donizeti; SILVA, Nathalia Camin Calixto Sarroche da; MOURA, Diogo Turiani De; JUKEMURA, Jose; MOURA, Eduardo Guimaraes De
Intrahepatic lithiasis, or hepatolithiasis, is an endemic disease in southeast Asia, although, with immigration from Eastern countries, the incidence of this pathology is rising worldwide. The Latin American experience demonstrates morbidity and mortality compatible with other Western countries, but minimally invasive procedures are lacking. We demonstrate a case of a combined surgical and endoscopic approach for stone clearance.We present a case of a 47-year-old female patient with biliary enteric anastomosis to treat recurrent pyogenic cholangitis resulting from intrahepatic lithiasis. The patient was admitted to the emergency room, presented with a new episode of cholangitis, and submitted to transcutaneous hepatobiliary drainage. The multidisciplinary approach, including the endoscopic and surgical teams, successfully performed the stone clearance with laser lithotripsy and stone removal by open access. The postoperative period was uneventful, and the patient did not present any sign of recurrence after one year. A combined surgical and endoscopic approach achieved short-term clinical and technical success in this novel case. Moreover, individualizing cases requiring open surgical access is feasible, which allows a combined endoscopic approach with safety.
Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis
(2024) VERAS, Matheus de Oliveira; MOURA, Diogo Turiani Hourneaux de; MCCARTY, Thomas R.; OLIVEIRA, Guilherme Henrique Peixoto de; GOMES, Romulo Sergio Araujo; LANDIM, Davi Lucena; NUNES, Felipe Giacobo; FRANZINI, Tomazo Antonio Prince; SANTOS, Marcos Eduardo Lera dos; BERNARDO, Wanderley Marques; MOURA, Eduardo Guimaraes Hourneaux de
Background and study aims Recurrent biliary stent occlusion and tumor ingrowth remain a major concern among patients with malignant biliary obstruction (MBO) with significant impact on patient morbidity and survival. Intraductal radiofrequency ablation (RFA) has emerged as a promising treatment that seeks to extend stent patency. This study aimed to evaluate the impact of RFA on overall survival (OS) and stent patency among patients with unresectable MBO.Methods A comprehensive search of electronic databases was performed for randomized controlled trials (RCTs) comparing RFA plus biliary stent (RFA+S) versus biliary stent alone (S-alone). Outcomes assessed included overall survival, stent patency, and adverse events (AEs) with mean difference (MD) calculated from pooled proportions. Subgroup analyses were performed for hilar strictures and cholangiocarcinoma (CCA).Results Six RCTs (n=439 patients) were included and demonstrated improved survival among patients who received RFA+S (MD 85.80 days; 95% confidence interval [CI] 35.02-136.58; I 2 =97%; P <0.0009). The pooled MD for total stent patency was 22.25 days (95% CI 17.38-61.87; I (2) =97%; P =0.27). There was no difference in AEs between RFA+S vs S-alone ( P >0.05). On subgroup analyses, RFA+S was associated with improved stent patency (MD 76.73 days; 95% CI 50.11-103.34; I 2 =67%; P <0.01) and OS (MD 83.14 (95% CI 29.52-136.77; I- 2 =97%; P <0.01] for CCA. For hilar strictures, stent patency was improved among patients with RFA+S [MD 83.71 days (95% CI 24.85-142.56; I 2 =84%; P <0.01].Conclusions RFA+S improved OS in the treatment of MBO when compared with S-alone. Moreover, the RFA therapy prolonged stent patency in hilar strictures and CCA, with similar rates of AEs.
MANAGEMENT OF SYMPTOMS RECURRENCE AFTER MYOTOMY FOR ACHALASIA. A PRACTICAL APPROACH
(2023) TUSTUMI, Francisco; SZACHNOWICZ, Sergio; ANDREOLLO, Nelson Adami; SEGURO, Francisco Carlos Bernal da Costa; BIANCHI, Edno Tales; DUARTE, Andre Fonseca; NASI, Ary; SALLUM, Rubens Antonio Aissar
BACKGROUND: Achalasia is an esophageal motility disorder, and myotomy is one of the most used treatment techniques. However, symptom persistence or recurrence occurs in 9 to 20% of cases. AIMS: This study aims to provide a practical approach for managing the recurrence or persistence of achalasia symptoms after myotomy. METHODS: A critical review was performed to gather evidence for a rational approach for managing the recurrence or persistence of achalasia symptoms after myotomy. RESULTS: To properly manage an achalasia patient with significant symptoms after myotomy, such as dysphagia, regurgitation, thoracic pain, and weight loss, it is necessary to classify symptoms, stratify severity, perform appropriate tests, and define a treatment strategy. A systematic differential diagnosis workup is essential to cover the main etiologies of symptoms recurrence or persistence after myotomy. Upper digestive endoscopy and dynamic digital radiography are the main tests that can be applied for investigation. The treatment options include endoscopic dilation, peroral endoscopic myotomy, redo surgery, and esophagectomy, and the decision should be based on the patient's individual characteristics. CONCLUSIONS: A good clinical evaluation and the use of proper tests jointly with a rational assessment, are essential for the management of symptoms recurrence or persistence after achalasia myotomy.
Evaluation of gut microbiota predictive potential associated with phenotypic characteristics to identify multifactorial diseases
(2024) FONSECA, Danielle Cristina; ROCHA, Ilanna Marques Gomes da; BALMANT, Bianca Depieri; CALLADO, Leticia; PRUDENCIO, Ana Paula Aguiar; ALVES, Juliana Tepedin Martins o; TORRINHAS, Raquel Susana; FERNANDES, Gabriel da Rocha; WAITZBERG, Dan Linetzky
Gut microbiota has been implicated in various clinical conditions, yet the substantial heterogeneity in gut microbiota research results necessitates a more sophisticated approach than merely identifying statistically different microbial taxa between healthy and unhealthy individuals. Our study seeks to not only select microbial taxa but also explore their synergy with phenotypic host variables to develop novel predictive models for specific clinical conditions. Design: We assessed 50 healthy and 152 unhealthy individuals for phenotypic variables (PV) and gut microbiota (GM) composition by 16S rRNA gene sequencing. The entire modeling process was conducted in the R environment using the Random Forest algorithm. Model performance was assessed through ROC curve construction. Results: We evaluated 52 bacterial taxa and pre-selected PV (p < 0.05) for their contribution to the final models. Across all diseases, the models achieved their best performance when GM and PV data were integrated. Notably, the integrated predictive models demonstrated exceptional performance for rheumatoid arthritis (AUC = 88.03%), type 2 diabetes (AUC = 96.96%), systemic lupus erythematosus (AUC = 98.4%), and type 1 diabetes (AUC = 86.19%). Conclusion: Our findings underscore that the selection of bacterial taxa based solely on differences in relative abundance between groups is insufficient to serve as clinical markers. Machine learning techniques are essential for mitigating the considerable variability observed within gut microbiota. In our study, the use of microbial taxa alone exhibited limited predictive power for health outcomes, while the integration of phenotypic variables into predictive models substantially enhanced their predictive capabilities.
ROBOTIC ASSISTED VERSUS LAPAROSCOPIC DISTAL PANCREATECTOMY: A RETROSPECTIVE STUDY
(2023) JUREIDINI, Ricardo; NAMUR, Guilherme Naccache; RIBEIRO, Thiago Costa; BACCHELLA, Telesforo; STOLZEMBURG, Lucas; JUKEMURA, Jose; RIBEIRO JUNIOR, Ulysses; CECCONELLO, Ivan
BACKGROUND: Minimally invasive distal pancreatectomy (MIDP) is associated with less blood loss and faster functional recovery. However, the benefits of robotic assisted distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) are unknown. AIMS: To compare RDP versus LDP for surgical treatment of benign lesions, pre-malignant and borderline malignant pancreatic neoplasias. METHODS: This is a retrospective study comparing LDP with RDP. Main outcomes were overall morbidity and overall costs. Secondary outcomes were pancreatic fistula (PF), infectious complications, readmission, operative time (OT) and length of hospital stay (LOS). RESULTS: Thirty patients submitted to LDP and 29 submitted to RDP were included in the study. There was no difference regarding preoperative characteristics. There was no difference regarding overall complications (RDP - 72,4% versus LDP - 80%, p=0,49). Costs were superior for patients submitted to RDP (RDP=US$ 6,688 versus LDP=US$ 6,149, p=0,02), mostly due to higher costs of surgical materials (RDP=US$ 2,364 versus LDP=1,421, p=0,00005). Twenty-one patients submitted to RDP and 24 to LDP developed pancreatic fistula (PF), but only 4 RDP and 7 LDP experienced infectious complications associated with PF. OT (RDP=224 min. versus LDP=213 min., p=0.36) was similar, as well as conversion to open procedure (1 RDP and 2 LDP). CONCLUSIONS: The postoperative morbidity of robotic distal pancreatectomy is comparable to laparoscopic distal pancreatectomy. However, the costs of robotic distal pancreatectomy are slightly higher.
Effect of Roux-en-Y Gastric Bypass on circulating oxylipin profile in women with obesity and type 2 diabetes
(2024) MANCUZO, Daiane Cavalari; MACHADO, Natasha Mendonca; TEPPEDINO, Juliana; SANTANDER, Lucas; CALDER, Philip C.; WAITZBERG, Dan Linetzky; TORRINHAS, Raquel Susana
Background & Aims: Chronic inflammation associated with obesity directly contributes to metabolic comor-bidities, including type 2 diabetes (T2D). Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity-associated T2D. We investigated the effect of RYGB on the circulating profile of oxylipins derived from arachidonic (ARA), eicosapentaenoic (EPA), and docosahexaenoic (DHA) acids as a potential mechanism un-derlying the metabolic benefits of the surgery. Methods: Plasma samples were collected from 28 women with obesity and T2D before and 3 months after RYGB. Circulating levels of oxylipins and their precursors, along with biochemical markers of glucose homeostasis, were evaluated using untargeted mass spectrometry and routine biochemical techniques, respectively. Results: No significant changes were observed in the levels of oxylipins derived from EPA and DHA. However, there was an increase in ARA and its derived oxylipins, TXB2 (an inert derivative of TXA2) and PGD2 (Wilcoxon, p <= 0.05). Positive correlations were observed between hemoglobin A1c levels and TXB2 as well as ARA levels (Spearman, p <= 0.05). Conclusions: Our data suggest that the anti-inflammatory oxylipins derived from EPA and DHA may not be involved in the metabolic benefits associated with RYGB. However, the findings indicate that the pro-inflammatory oxylipin TXA2 and its precursor ARA may negatively impact glucose homeostasis both before and after RYGB.