Gastric polyposis is a rare disease. Not all polyps progress to cancer. Monoallelic mutation in Fanconi anemia(FA) genes, unlike biallelic gene mutations that causes typical FA phenotype, can increase risks of cancers...Gastric polyposis is a rare disease. Not all polyps progress to cancer. Monoallelic mutation in Fanconi anemia(FA) genes, unlike biallelic gene mutations that causes typical FA phenotype, can increase risks of cancers in a sporadic manner. Aberrations in the FA pathway were reported in all molecular subtypes of gastric cancer. We studied a patient with synchronous gastric cancer from gastric polyposis by conducting a 13-year long-term follow up. Via pathway-driven massive parallel genomic sequencing, a germline mutation at FANCA D1359Y was identified. We identified several recurrent mutations in DNA methylation(TET1, V873I), the β-catenin pathway(CTNNB1, S45F) and RHO signaling pathway(PLEKHG5, R203C) by comparing the genetic events between benign and malignant gastric polyps. Furthermore, we revealed gastric polyposis susceptible genes and genetic events promoting malignant transformation using pathway-driven targeted gene sequencing.展开更多
AIM:To evaluate the effect of hands-on training of gastroenterology fellows in gastric polypectomy using an ex vivo simulator.METHODS:Eight gastroenterology fellows at Mackay Memorial Hospital,Taipei were evaluated in...AIM:To evaluate the effect of hands-on training of gastroenterology fellows in gastric polypectomy using an ex vivo simulator.METHODS:Eight gastroenterology fellows at Mackay Memorial Hospital,Taipei were evaluated in gastricpolypectomy techniques using a pig stomach with artificial polyps created by a rubber band ligation device.The performance of four second year(year-2)fellows who had undergone one year of clinical training was compared with that of four f irst year(year-1)fellows both before and after a 4-h workshop using the ex vivo simulator.The workshop allowed for hands-on train-ing in the removal of multiple artif icial polyps and the placement of hemoclips at the excision site.Evaluation included observation of technical skills,procedure time,and the fellows' conf idence scale.RESULTS:One week after the workshop,the year-1 fellows were re-evaluated and had significantly im-proved mean performance scores(from 17.9 ± 1.8 to 22.5 ± 0.7),conf idence scale(from 4.5 ± 1.0 to 7.8 ± 0.5)and procedure time(from 615.0 ± 57.4 s to 357.5 ± 85.0 s)compared with their baseline performance.After 4 h of training using the ex vivo simulator,the skills of the year-1 fellows were statistically similar to those of the year-2 fellows.CONCLUSION:Use of this ex vivo simulator significantly improved the endoscopic gastric polypectomy skills of gastroenterology fellows who had not had previous clinical training in gastric polypectomy.展开更多
基金Supported by the Mackay Memorial Hospital,No.MMH-106-62
文摘Gastric polyposis is a rare disease. Not all polyps progress to cancer. Monoallelic mutation in Fanconi anemia(FA) genes, unlike biallelic gene mutations that causes typical FA phenotype, can increase risks of cancers in a sporadic manner. Aberrations in the FA pathway were reported in all molecular subtypes of gastric cancer. We studied a patient with synchronous gastric cancer from gastric polyposis by conducting a 13-year long-term follow up. Via pathway-driven massive parallel genomic sequencing, a germline mutation at FANCA D1359Y was identified. We identified several recurrent mutations in DNA methylation(TET1, V873I), the β-catenin pathway(CTNNB1, S45F) and RHO signaling pathway(PLEKHG5, R203C) by comparing the genetic events between benign and malignant gastric polyps. Furthermore, we revealed gastric polyposis susceptible genes and genetic events promoting malignant transformation using pathway-driven targeted gene sequencing.
文摘AIM:To evaluate the effect of hands-on training of gastroenterology fellows in gastric polypectomy using an ex vivo simulator.METHODS:Eight gastroenterology fellows at Mackay Memorial Hospital,Taipei were evaluated in gastricpolypectomy techniques using a pig stomach with artificial polyps created by a rubber band ligation device.The performance of four second year(year-2)fellows who had undergone one year of clinical training was compared with that of four f irst year(year-1)fellows both before and after a 4-h workshop using the ex vivo simulator.The workshop allowed for hands-on train-ing in the removal of multiple artif icial polyps and the placement of hemoclips at the excision site.Evaluation included observation of technical skills,procedure time,and the fellows' conf idence scale.RESULTS:One week after the workshop,the year-1 fellows were re-evaluated and had significantly im-proved mean performance scores(from 17.9 ± 1.8 to 22.5 ± 0.7),conf idence scale(from 4.5 ± 1.0 to 7.8 ± 0.5)and procedure time(from 615.0 ± 57.4 s to 357.5 ± 85.0 s)compared with their baseline performance.After 4 h of training using the ex vivo simulator,the skills of the year-1 fellows were statistically similar to those of the year-2 fellows.CONCLUSION:Use of this ex vivo simulator significantly improved the endoscopic gastric polypectomy skills of gastroenterology fellows who had not had previous clinical training in gastric polypectomy.
