A meta-analysis evaluating the accuracy of colon capsule endoscopy in detecting colon polyps.

BACKGROUND: Colon capsule endoscopy (CCE) is a new, noninvasive method for examining the entire colon. The reported yield of CCE in detecting colorectal polyps has shown variable results. OBJECTIVE: To assess the accuracy of CCE by pooling data of existing trials. DESIGN: Meta-analysis. The fixed-effects or random-effects model was used as appropriate, based on whether homogeneity or heterogeneity, respectively, was indicated by the Cochran Q test. SETTING: Studies that estimated the accuracy of CCE were identified. Two investigators independently conducted the search and data extraction. PATIENTS: A total of 626 individuals were included in this meta-analysis. INTERVENTION: Each patient underwent CCE and conventional colonoscopy. MAIN OUTCOME MEASUREMENTS: Per-patient sensitivity and specificity, with 95% confidence intervals (CI). RESULTS: Findings were categorized as "significant polyps," that is, a report of a polyp >6 mm in size or 3 or more polyps of any size, or "any polyp," that is, a report of any polyp found, independent of size. Pooled data on sensitivity and specificity with a 95% CI were estimated. For any polyp found, the pooled data showed per-patient CCE sensitivity of 73% (95% CI, 68%-77%) and specificity of 89% (95% CI, 81%-94%). For significant polyps, the respective values were 69% (95% CI, 62%-75%) and 86% (95% CI, 82%-90%). LIMITATIONS: A small number of studies met inclusion criteria. CONCLUSION: CCE is a reasonable method for screening asymptomatic individuals for colorectal polyps. It may be particularly useful for patients with "incomplete" colonoscopy, those with contraindications for conventional colonoscopy, and those unwilling to undergo colonoscopy because of its perceived inconvenience and discomfort.

Differential rates of proliferation and apoptosis in nasal polyps correspond to alterations in DNA spatial distribution and nuclear polarization as observed by confocal microscopy.

The study aimed to investigate the expression of p53, Bcl-2 and Ki-67 in relation to the histologic and nuclear qualitative and spatial characteristics of chronic rhinosinusitis with polyposis (CRP). Imprint smears obtained from surgically removed nasal polyps of 20 patients were studied. The polyps were classified according to their histological characteristics as: hyperplasia (simple and pronounced) and squamous metaplasia. The expression of p53, Bcl-2 and Ki-67 was assessed by immunocytochemistry. DNA spatial distribution and nuclear orientation were studied by staining with propidium iodide and examined by confocal microscopy. Positive immunoreaction for p53, Ki-67 and Bcl-2 was observed in 50, 65, and 50% of polyp's smears, respectively. For each diagnosis, the rates were simple hyperplasia 60, 80 and 30%, pronounced hyperplasia 80, 100 and 40%, metaplasia 0, 0 and 100%, respectively. Abnormal chromatin distribution and nuclear disorientation was observed in three cases of pronounced hyperplasia combined with positive immunoreaction for Ki-67 and p53 and negative immunoreaction for Bcl-2. CRP demonstrated different proliferation and apoptotic rates, according to their histology. Nuclear characteristics observed by confocal microscopy are associated with the immunocytochemical markers of proliferation and apoptosis.

Celiac-like Enteropathy Associated With Mycophenolate Sodium in Renal Transplant Recipients.

BACKGROUND: Although colonic injury is a well-known complication of mycophenolic acid (MPA), the involvement of the upper gastrointestinal tract is less extensively documented. We present the occurrence of celiac-like duodenopathy manifested as a severe diarrhea syndrome in 2 renal transplant recipients on enteric-coated mycophenolate sodium. METHODS: The patients belong to a setting of 16 renal transplant recipients under MPA suffering from chronic diarrhea in the absence of MPA-related colitis. RESULTS: Both patients had a history of persistent diarrhea with significant weight loss. Colonic mucosa was unremarkable, whereas duodenal biopsies revealed celiac-like changes with increased epithelial cell apoptosis. Clinical symptoms completely resolved, and follow-up biopsies demonstrated normalization of histology after enteric-coated mycophenolate sodium withdrawal and switching to azathioprine. CONCLUSIONS: Celiac-like enteropathy seems to represent a rare side effect of MPA-associated immunosuppressive therapy and should be taken into account in the differential diagnosis of diarrhea in transplant recipients treated with MPA particularly in the absence of MPA-related colitis. As macroscopic lesions are usually missing, blind duodenal biopsies are necessary to establish the diagnosis.