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OBJECTIVES Several microRNAs (miRNAs) have been identified as potential circulating biomarkers in a number of different cancers including colorectal cancer (CRC). This study aims to assess the diagnostic performance of circulating miRNAs in detecting CRC through meta-analysis of all eligible relevant studies. MATERIALS AND METHODS An extensive literature search was performed and studies that estimated the diagnostic accuracy of miRNAs in CRC were identified. Data from the eligible studies were collected and pooled; sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios, weighted symmetric summary ROC curve and the area under the curve (AUC) were calculated. Heterogeneity was evaluated using the Q-test and I(2)-statistics. In addition, subgroup analyses and meta-regression analyses were carried out to explore the potential sources of significant heterogeneity. RESULTS A total of 16 studies were included in the meta-analysis according to the inclusion criteria. The overall analysis showed that circulating miRNAs have a relatively good diagnostic performance in CRC, with a sensitivity of 78%, a specificity of 79% and an AUC of 0.87. Subgroup analyses showed that a single miRNA-21 test, as opposed to a panel miRNAs test, significantly improved the diagnostic accuracy with 83.4% sensitivity, 91.6% specificity, and AUC increasing to 0.94. CONCLUSION Circulating miRNAs, especially miRNA-21, are promising diagnostic biomarkers in CRC. However, more prospective studies are required to further explore their diagnostic role and their usefulness in clinical practice.

Video capsule endoscopy (VCE) is an attractive and patient friendly tool that provides high quality images of the small bowel. The reported yield of VCE in diagnosing celiac disease (CD) has shown variable results.The aim of this study was to assess the accuracy of VCE by pooling data of existing trials.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.Studies that estimated the accuracy of VCE were identified. The two investigators independently conducted the search and data extraction. A total of 166 individuals were included in this meta-analysis.An extensive literature search was performed and studies that estimated the accuracy of VCE in CD were identified. The two investigators independently conducted the search and data extraction. Data from the eligible studies were collected and pooled; sensitivity, specificity, likelihood ratios, and diagnostic odds ratios were computed. In addition, the results of the individual studies were displayed in a receiver operating characteristic (ROC) space to illustrate the distribution of sensitivities and specificities. A weighted symmetric summary ROC curve was computed and the area under the curve (AUC) was calculated, with perfect tests having an AUC of 1 and poor tests having an AUC close to 0.5.Out of 461 titles initially generated by the literature searches, six studies met the inclusion criteria and were eligible for meta-analysis. The overall pooled VCE sensitivity was 89% [95% confidence interval (82-94%)] and specificity was 95% [95% confidence interval (89-98%)]. The AUC under the weighted symmetric summary ROC was 0.9584.The results of this meta-analysis mean that VCE, although it is not as accurate as pathology, could be a reasonable alternative method of diagnosing CD. Hopefully, this method will expand the portfolio of diagnostic methods available, especially in patients unwilling to undergo gastroscopy because of its perceived inconvenience and discomfort. However, larger, multicenter, and well-designed trials are needed to further establish the role of VCE in the diagnosis of CD.

Large gastric phytobezoars may occur in patients with gastric dysmotility disorders. Treatment options include dissolution with enzymes, endoscopic fragmentation with removal or aspiration, and surgery. We report our experience with nasogastric cola lavage therapy. Over an 8-year period, five consecutive patients were referred to our unit for endoscopic treatment of large gastric phytobezoars. They included one patient with lobectomy for lung cancer and four patients with diabetic gastroparesis. An initial attempt of endoscopic fragmentation and removal was unsuccessful. Patients were treated with 3 l of Coca-Cola nasogastric lavage over 12 h. Nasogastric lavage was very well tolerated by the patients. Complete phytobezoar dissolution was achieved in one session in all cases. There were no procedure-related complications. The dissolution of large gastric phytobezoars with cola nasogastric lavage is a safe, rapid and effective method. Patients may be treated in the medical ward, avoiding therapeutic endoscopy or surgery.