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Clinical & Experimental Ophthalmology Jan 2020In classic familial adenomatous polyposis (FAP) adenomas become malignant. Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is a retinal pigmented lesion...
In patients with a positive family history of familial adenomatous polyposis can the condition be diagnosed from the presence of congenital hypertrophy of the retinal pigment epithelium detected via an eye examination: A systematic review.
In classic familial adenomatous polyposis (FAP) adenomas become malignant. Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is a retinal pigmented lesion and is the earliest and most common potential extraintestinal manifestation of FAP. This review aims to summarize and analyse all of the published data on CHRPE in patients with classic FAP and then ascertain whether these patients should undergo a relatively cheap and non-invasive dilated fundus examination to screen for CHRPE. Adhering to Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines our database search identified 102 relevant articles of which 13 were selected for further analysis. The percentage of FAP patients with CHRPE was found to be 80.00%, whereas the percentage of at-risk patients with CHRPE was 31.12%. Despite various statistically significant findings, CHRPE alone cannot be used as a surrogate for diagnosing FAP in those with a positive family history. The authors advocate a combined approach of eye examinations, colonoscopy and genetic testing.
Topics: Adenomatous Polyposis Coli; Colorectal Surgery; Humans; Hypertrophy; Physical Examination; Pigment Epithelium of Eye; Predictive Value of Tests
PubMed: 31525261
DOI: 10.1111/ceo.13643 -
International Journal of Colorectal... Sep 2023The incremental yield of I-Scan virtual chromoendoscopy compared to high-definition white light endoscopy (HD-WLE) in detection of colorectal adenomas has not been... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The incremental yield of I-Scan virtual chromoendoscopy compared to high-definition white light endoscopy (HD-WLE) in detection of colorectal adenomas has not been thoroughly elucidated.
METHODS
A systematic search from inception to April 2023 was conducted to identify randomized controlled trials (RCTs) comparing I-Scan to HD-WLE for detection of adenomas. A random effects model was used to compute risk difference (RD) with corresponding 95% confidence intervals in adenoma detection rate (ADR). Influence analysis was done to assess robustness of findings. The number needed to diagnose was computed. Heterogeneity was assessed using the I statistic and explored further by subgroup analyses defined a priori. Certainty in effect estimates was assessed using the GRADE approach.
RESULTS
We identified four studies (I-Scan n = 730, HD-WLE n = 765). I-Scan increased adenoma detection by 9% (risk difference (RD), 0.09; 0.04, 0.14; I 02%; certainty, low). Influence analysis revealed that the gain in yield remained statistically significant with exclusion of all but one study. The number needed to capture one additional adenomatous polyp with I-Scan use was 11.2. I-Scan 1 use was associated with a statistically significant gain in ADR, whereas no significant difference in ADR was noted with I-Scan use on subgroup analysis.
DISCUSSION
In conclusion, I-Scan increases the yield of adenoma detection by 9% compared to HD-WLE, with low certainty in the estimate of this effect. Data on the gain in yield of detecting large polyps, sessile serrated lesions, and on the impact of formally training endoscopists and trainees in I-Scan use and similar technology on adenoma detection rate are needed.
Topics: Humans; Colonoscopy; Adenoma; Colorectal Neoplasms; Light; Polyps
PubMed: 37755588
DOI: 10.1007/s00384-023-04533-3 -
Advances in Therapy May 2021The study aimed to investigate the application of core needle biopsy through the trocar hole during surgery on endoscopically unresectable giant colon polyps.
INTRODUCTION
The study aimed to investigate the application of core needle biopsy through the trocar hole during surgery on endoscopically unresectable giant colon polyps.
METHODS
The clinical data of 51 patients with endoscopically unresectable giant colon polyps from May 2016 to May 2020 were retrospectively analyzed. The primary observational outcomes were two comparative analyses of pathologic results, using the kappa index: comparison of the pathologic results from the preoperative colonoscopy and the postoperative pathologic results and comparison of the intraoperative pathologic results from core needle biopsy of the intestinal wall and the postoperative pathologic results. The secondary observational outcomes were duration of needle biopsy, operation duration, volume of intraoperative hemorrhage, rate of postoperative wound infection, rate of abdominal cavity infection, length of stay, and number and positivity of lymph node dissections after laparoscopic radical resection of colon cancer.
RESULTS
Poor consistency was found between the preoperative (colonoscopy) and postoperative pathologic results, with kappa = 0.222 (i.e., kappa < 0.4), P < 0.05. However, good consistency was found between the intraoperative (core needle biopsy) and postoperative pathologic results, with kappa = 0.923 (i.e., kappa ≥ 0.75), P < 0.05. The postoperative pathologic results were as follows: 7 cases of adenomatous polyps of the colon, 12 cases of low-grade intraepithelial neoplasia, 12 cases of high-grade intraepithelial neoplasia, and 25 cases of invasive colon cancer. There was no incision infection, no abdominal cavity infection or formation of an abdominal abscess, no anastomotic leakage, and no death for any of the 51 patients. Postoperative complications occurred in two cases (3.92%).
CONCLUSION
Biopsy through the trocar hole during laparoscopic surgery produced highly accurate pathologic results and was a fast, safe, and effective diagnostic method. Pathologic results from intraoperative biopsy could accurately determine the nature of colon polyps and provide a basis for choosing an appropriate surgical scheme.
Topics: Biopsy, Large-Core Needle; Colon; Colonic Polyps; Humans; Laparoscopy; Retrospective Studies; Surgical Instruments
PubMed: 33864202
DOI: 10.1007/s12325-021-01635-8 -
Medicine Apr 2020The methylation status of the adenomatous polyposis coli (APC) promoter has been shown to be associated with the occurrence of gastric cancer, but this finding remains... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The methylation status of the adenomatous polyposis coli (APC) promoter has been shown to be associated with the occurrence of gastric cancer, but this finding remains controversial. The aim of this study was to investigate the relationship between methylation of the APC gene promoter and gastric cancer.
METHODS
We searched the Web of Science, EMBASE, Medline, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from the date of creation until August 1, 2019. According to the inclusion criteria, the relationship between the methylation status of the APC gene promoter and gastric cancer was investigated. The incidence of APC promoter methylation in the tissues or blood of patients with and without gastric cancer was compared. The results are expressed as the odds ratio (OR) and 95% confidence interval (CI). The pooled OR of each study was estimated using a fixed effects model or a random effects model to generate forest plots. We further validated the results using the MethHC database.
RESULTS
Eight studies (985 samples) were included. Our meta-analysis showed that the incidence of APC promoter methylation in patients with gastric cancer was higher than that of patients without gastric cancer (OR = 3.86, 95% CI 1.71-8.74, P = .001). Methylation of the APC promoter is associated with the incidence of gastric cancer, and it increases the risk of gastric cancer.
CONCLUSION
This study provides a new strategic direction for research on gastric cancer. Methylation of the APC promoter may be a potential biomarker for the diagnosis of gastric cancer, but the results of this work require further confirmation.
Topics: Adenomatous Polyposis Coli; Biomarkers, Tumor; Computational Biology; DNA Methylation; Genes, APC; Genetic Predisposition to Disease; Humans; Incidence; Promoter Regions, Genetic; Risk Factors; Stomach Neoplasms
PubMed: 32312003
DOI: 10.1097/MD.0000000000019828