The incidence and prevalence of metabolic syndrome(MS) and colorectal cancer(CRC) has been rising in developed countries. The association between these two diseases has been widely studied and reported. Less evidence ...The incidence and prevalence of metabolic syndrome(MS) and colorectal cancer(CRC) has been rising in developed countries. The association between these two diseases has been widely studied and reported. Less evidence is available about the relationship between MS and CRC precancerous lesions(adenomatous polyps, adenomas). The aim of this paper is to present an overview of our scientific understanding of that topic and its implication in clinical practice. One of the principal goals of current CRC secondary prevention efforts is to detect and remove the precancerous lesions in individuals with an average CRC risk to prevent the development of invasive cancer. MS is not currently considered a high-risk CRC factor and is therefore not included in the guidelines of organized screening programs. However, in light of growing scientific evidence, the approach to patients with MS should be changed. Metabolic risk factors for the development of adenomas and cancers are the same- obesity, impaired glucose tolerance, dyslipidemia, hypertension, cardiovascular diseases and diabetes mellitus type 2. Therefore, the key issue in the near future is the development of a simple scoring system, easy to use in clinical practice, which would identify individuals with high metabolic risk of colorectal neoplasia and would be used for individual CRC secondary prevention strategies. Currently, such scoring systems have been published based on Asian(Asia-Pacific Colorectal Screening Score; APCS) and Polish populations.展开更多
Colorectal cancer(CRC)is the second most common cancer in Europe and its incidence is steadily increasing.This trend could be reversed through timely secondary prevention(screening).In the last twenty years,CRC screen...Colorectal cancer(CRC)is the second most common cancer in Europe and its incidence is steadily increasing.This trend could be reversed through timely secondary prevention(screening).In the last twenty years,CRC screening programs across Europe have experienced considerable improvements(fecal occult blood testing;transition from opportunistic to population based program settings).The Czech Republic is a typical example of a country with a long history of nationwide CRC screening programs in the face of very high CRC incidence and mortality rates.Each year,approximately 8000 people are diagnosed with CRC and some 4000 die from this malignancy.Twenty years ago,the first pilot studies on CRC screening led to the introduction of the opportunistic Czech National Colorectal Cancer Screening Program in 2000.Originally,this program was based on the guaiac fecal occult blood test(FOBT)offered by general practitioners,followed by colonoscopy in cases of FOBT positivity.The program has continuously evolved,namely with the implementation of immunochemical FOBTs and screening colonoscopy,as well as the involvement of gynecologists.Since the establishment of the Czech CRC Screening Registry in 2006,2405850 FOBTs have been performed and 104565 preventive colonoscopies recorded within the screening program.The overall program expanded to cover 25.0%of the target population by 2011.However,stagnation in the annual number of performed FOBTs lately has led to switching to the option of a population-based program with personal invitation,which is currently being prepared.展开更多
Colorectal cancer(CRC)is the second most frequent malignant disease in Europe.Every year,412 000people are diagnosed with this condition,and 207 000patients die of it.In 2003,recommendations forscreening programs were...Colorectal cancer(CRC)is the second most frequent malignant disease in Europe.Every year,412 000people are diagnosed with this condition,and 207 000patients die of it.In 2003,recommendations forscreening programs were issued by the Council of the European Union(EU),and these currently serve as thebasis for the preparation of European guidelines forCRC screening.The manner in which CRC screening iscarried out varies significantly from country to countrywithin the EU,both in terms of organization and thescreening test chosen.A screening program of onesort or another has been implemented in 19 of 27 EUcountries.The most frequently applied method is testing stool for occult bleeding(fecal occult blood test,FOBT).In recent years,a screening colonoscopy hasbeen introduced,either as the only method(Poland)orthe method of choice(Germany,Czech Republic).展开更多
AIM: To compare molecular profiles of proximal colon, distal colon and rectum in large adenomas, early and late carcinomas. To assess feasibility of testing directed at molecular markers from this study in routine cli...AIM: To compare molecular profiles of proximal colon, distal colon and rectum in large adenomas, early and late carcinomas. To assess feasibility of testing directed at molecular markers from this study in routine clinical practice. METHODS: A prospective 3-year study has resulted in the acquisition of samples from 159 large adenomas and 138 carcinomas along with associated clinical parameters including localization, grade and histological type for adenomas and localization and stage for carcinomas. A complex molecular phenotyping has been performed using multiplex ligation-dependent probe amplification technique for the evaluation of Cp G-islandmethylator phenotype(CIMP), PCR fragment analysis for detection of microsatellite instability and denaturing capillary electrophoresis for sensitive detection of somatic mutations in KRAS, BRAF, TP53 and APC genes.RESULTS: Molecular types according to previously introduced Jass classification have been evaluated for large adenomas and early and late carcinomas. An increase in CIMP+ type, eventually accompanied with KRAS mutations, was notable between large adenomas and early carcinomas. As expected, the longitudinal observations revealed a correlation of the CIMP+/BRAF + type with proximal location. CONCLUSION: Prospective molecular classification of tissue specimens is feasible in routine endoscopy practice. Increased frequency of some molecular types corresponds to the developmental stages of colorectal tumors. As expected, a clear distinction is notable for tumors located in proximal colon supposedly arising from the serrated(methylation) pathway.展开更多
AIM:To assess the sampling quality of four different forceps(three large capacity and one jumbo) in patients with Barrett's esophagus.METHODS:This was a prospective,single-blind study.A total of 37 patients with B...AIM:To assess the sampling quality of four different forceps(three large capacity and one jumbo) in patients with Barrett's esophagus.METHODS:This was a prospective,single-blind study.A total of 37 patients with Barrett's esophagus were enrolled.Targeted or random biopsies with all four forceps were obtained from each patient using a diagnostic endoscope during a single endoscopy.The following forceps were tested:A:FB-220 K disposable large capacity;B:BI01-D3-23 reusable large capacity;C:GBF-02-23-180 disposable large capacity;and jumbo:disposable Radial Jaw 4 jumbo.The primary outcome measurement was specimen adequacy,defined as a well-oriented biopsy sample 2 mm or greater with the presence of muscularis mucosa.RESULTS:A total of 436 biopsy samples were analyzed.We found a significantly higher proportion of adequate biopsy samples with jumbo forceps(71%)(P < 0.001 vs forceps A:26%,forceps B:17%,and forceps C:18%).Biopsies with jumbo forceps had the largest diameter(median 2.4 mm)(P < 0.001 vs forceps A:2 mm,forceps B:1.6 mm,and forceps C:2mm).There was a trend for higher diagnostic yield per biopsy with jumbo forceps(forceps A:0.20,forceps B:0.22,forceps C:0.27,and jumbo:0.28).No complications related to specimen sampling were observed with any of the four tested forceps.CONCLUSION:Jumbo biopsy forceps,when used with a diagnostic endoscope,provide more adequate specimens as compared to large-capacity forceps in patients with Barrett's esophagus.展开更多
基金Supported by Intern Grant Agency of the Czech Ministry of Health(IGA)No.NT 13673-4
文摘The incidence and prevalence of metabolic syndrome(MS) and colorectal cancer(CRC) has been rising in developed countries. The association between these two diseases has been widely studied and reported. Less evidence is available about the relationship between MS and CRC precancerous lesions(adenomatous polyps, adenomas). The aim of this paper is to present an overview of our scientific understanding of that topic and its implication in clinical practice. One of the principal goals of current CRC secondary prevention efforts is to detect and remove the precancerous lesions in individuals with an average CRC risk to prevent the development of invasive cancer. MS is not currently considered a high-risk CRC factor and is therefore not included in the guidelines of organized screening programs. However, in light of growing scientific evidence, the approach to patients with MS should be changed. Metabolic risk factors for the development of adenomas and cancers are the same- obesity, impaired glucose tolerance, dyslipidemia, hypertension, cardiovascular diseases and diabetes mellitus type 2. Therefore, the key issue in the near future is the development of a simple scoring system, easy to use in clinical practice, which would identify individuals with high metabolic risk of colorectal neoplasia and would be used for individual CRC secondary prevention strategies. Currently, such scoring systems have been published based on Asian(Asia-Pacific Colorectal Screening Score; APCS) and Polish populations.
基金Supported by The Intern Grant Agency of the Czech Ministry of Health(IGA),No.NT 13673-4
文摘Colorectal cancer(CRC)is the second most common cancer in Europe and its incidence is steadily increasing.This trend could be reversed through timely secondary prevention(screening).In the last twenty years,CRC screening programs across Europe have experienced considerable improvements(fecal occult blood testing;transition from opportunistic to population based program settings).The Czech Republic is a typical example of a country with a long history of nationwide CRC screening programs in the face of very high CRC incidence and mortality rates.Each year,approximately 8000 people are diagnosed with CRC and some 4000 die from this malignancy.Twenty years ago,the first pilot studies on CRC screening led to the introduction of the opportunistic Czech National Colorectal Cancer Screening Program in 2000.Originally,this program was based on the guaiac fecal occult blood test(FOBT)offered by general practitioners,followed by colonoscopy in cases of FOBT positivity.The program has continuously evolved,namely with the implementation of immunochemical FOBTs and screening colonoscopy,as well as the involvement of gynecologists.Since the establishment of the Czech CRC Screening Registry in 2006,2405850 FOBTs have been performed and 104565 preventive colonoscopies recorded within the screening program.The overall program expanded to cover 25.0%of the target population by 2011.However,stagnation in the annual number of performed FOBTs lately has led to switching to the option of a population-based program with personal invitation,which is currently being prepared.
基金Supported by International Agency for Research on Cancer(Lawrence von Karsa,MD)International Digestive Cancer Alliance(Professor Meinhard Classen,MD,Professor Sidney JWinawer,MD)
文摘Colorectal cancer(CRC)is the second most frequent malignant disease in Europe.Every year,412 000people are diagnosed with this condition,and 207 000patients die of it.In 2003,recommendations forscreening programs were issued by the Council of the European Union(EU),and these currently serve as thebasis for the preparation of European guidelines forCRC screening.The manner in which CRC screening iscarried out varies significantly from country to countrywithin the EU,both in terms of organization and thescreening test chosen.A screening program of onesort or another has been implemented in 19 of 27 EUcountries.The most frequently applied method is testing stool for occult bleeding(fecal occult blood test,FOBT).In recent years,a screening colonoscopy hasbeen introduced,either as the only method(Poland)orthe method of choice(Germany,Czech Republic).
基金Supported by Internal Grant Agency of the Czech Ministry of Health,No.NT 14383
文摘AIM: To compare molecular profiles of proximal colon, distal colon and rectum in large adenomas, early and late carcinomas. To assess feasibility of testing directed at molecular markers from this study in routine clinical practice. METHODS: A prospective 3-year study has resulted in the acquisition of samples from 159 large adenomas and 138 carcinomas along with associated clinical parameters including localization, grade and histological type for adenomas and localization and stage for carcinomas. A complex molecular phenotyping has been performed using multiplex ligation-dependent probe amplification technique for the evaluation of Cp G-islandmethylator phenotype(CIMP), PCR fragment analysis for detection of microsatellite instability and denaturing capillary electrophoresis for sensitive detection of somatic mutations in KRAS, BRAF, TP53 and APC genes.RESULTS: Molecular types according to previously introduced Jass classification have been evaluated for large adenomas and early and late carcinomas. An increase in CIMP+ type, eventually accompanied with KRAS mutations, was notable between large adenomas and early carcinomas. As expected, the longitudinal observations revealed a correlation of the CIMP+/BRAF + type with proximal location. CONCLUSION: Prospective molecular classification of tissue specimens is feasible in routine endoscopy practice. Increased frequency of some molecular types corresponds to the developmental stages of colorectal tumors. As expected, a clear distinction is notable for tumors located in proximal colon supposedly arising from the serrated(methylation) pathway.
文摘AIM:To assess the sampling quality of four different forceps(three large capacity and one jumbo) in patients with Barrett's esophagus.METHODS:This was a prospective,single-blind study.A total of 37 patients with Barrett's esophagus were enrolled.Targeted or random biopsies with all four forceps were obtained from each patient using a diagnostic endoscope during a single endoscopy.The following forceps were tested:A:FB-220 K disposable large capacity;B:BI01-D3-23 reusable large capacity;C:GBF-02-23-180 disposable large capacity;and jumbo:disposable Radial Jaw 4 jumbo.The primary outcome measurement was specimen adequacy,defined as a well-oriented biopsy sample 2 mm or greater with the presence of muscularis mucosa.RESULTS:A total of 436 biopsy samples were analyzed.We found a significantly higher proportion of adequate biopsy samples with jumbo forceps(71%)(P < 0.001 vs forceps A:26%,forceps B:17%,and forceps C:18%).Biopsies with jumbo forceps had the largest diameter(median 2.4 mm)(P < 0.001 vs forceps A:2 mm,forceps B:1.6 mm,and forceps C:2mm).There was a trend for higher diagnostic yield per biopsy with jumbo forceps(forceps A:0.20,forceps B:0.22,forceps C:0.27,and jumbo:0.28).No complications related to specimen sampling were observed with any of the four tested forceps.CONCLUSION:Jumbo biopsy forceps,when used with a diagnostic endoscope,provide more adequate specimens as compared to large-capacity forceps in patients with Barrett's esophagus.
