The efficacy of treatment of local residual neoplasia under standardized conditions.

OBJECTIVES: Piecemeal endoscopic mucosal resection (EMR) is frequently used for the treatment of non-poly-poid colorectal lesions larger than 20 mm. Nevertheless, local residual neoplasia occurs (LRN) in as much as 15 % of cases. The aim of our prospective interventional study was to evaluate the efficacy of treatment of LRN under standardized conditions. METHODS: In two high volume non-university endoscopy centers, LRN has been treated according to the newly proposed classification based on endoscopic appearance by argon plasma coagulation (APC), endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Primary outcome, efficacy of LRN treatment, was defined as both endoscopic and histological absence of neoplastic tissue in the post-EMR site 6 months after LRN treatment session. RESULTS: Twenty-five patients with 25 LRN lesions were enrolled. Among them, 12 (48 %), 8 (32 %) and 5 (20 %) were treated by APC, EMR and ESD, respectively, with efficacy in 10 (90.9 %), 7 (87.5 %) and 4 (100 %), respectively. CONCLUSIONS: Using standardized approach based on therapy directed by LRN morphology, LRN may be eradicated in 91.3 % during one session. KEY WORDS: colonoscopy - endoscopic mucosal resection - local residual neoplasia.

[Overview of current modalities of colorectal cancer screening]. / Prehled soucasných metod screeningu kolorektálního karcinomu.

There are one-step and two-steps programs for colorectal cancer screening. The aim of all screening examinations is to detect early stage of the disease in asymptomatic patient. The aim of this article is actual review of current screening modalities such as fecal occult blood test, flexible sigmoideoscopy, colonoscopy, CT colonography, capsule endoscopy, blood-based tests and stool DNA tests. Colonoscopy still remains the gold standard for detection of colorectal neoplasias. In majority of countries worldwide programs for colorectal cancer screening are based on immunochemical fecal occult blood test followed by colonoscopy when positive.

Dietary habits of colorectal neoplasia patients in comparison to their first-degree relatives.

AIM: To compare the dietary habits between colorectal neoplasia patients, their first-degree relatives, and unrelated controls. METHODS: From July 2008 to April 2011, we collected epidemiological data relevant to colorectal cancer from patients with colorectal neoplasias, their first-degree relatives, and also from a control group consisting of people referred for colonoscopy with a negative family history of colorectal cancer and without evidence of neoplasia after colonoscopic examination. The first-degree relatives were divided into two groups following the colonoscopic examination: (1) patients with neoplasia or (2) patients without neoplasia. Dietary habits of all groups were compared. A χ (2) test was used to assess the association between two dichotomous categorical variables. RESULTS: The study groups consisted of 242 patients with colorectal neoplasias (143 men, 99 women; mean age: 64 ± 12 years) and 160 first-degree relatives (66 men, 94 women; mean age: 48 ± 11 years). Fifty-five of the first-degree relatives were found to have a neoplastic lesion upon colonoscopy, while the remaining 105 were without neoplasia. The control group contained 123 individuals with a negative family history for neoplastic lesions (66 men, 57 women; mean age: 54 ± 12 years). Two hypotheses were tested. In the first, the dietary habits of first-degree relatives with neoplasia were more similar to those of patients with neoplasia, while the dietary habits of first-degree relatives without neoplasia were similar to those of the control group. In the second, no sex-related differences in dietary habits were expected between the particular groups. Indeed, no significant differences were observed in the dietary habits between the groups of patients, controls and first-degree relatives with/without neoplastic lesions. Nevertheless, statistically significant sex-related differences were observed in all groups, wherein women had healthier dietary habits than men. CONCLUSION: In all groups examined, women had healthier dietary habits than men. Modification of screening guidelines according to sex may improve the efficiency of screening programs.