Tomas Grega

Background/Objectives: Colorectal cancer (CRC) incidence and mortality in the Czech Republic ranked among the highest worldwide for decades. The performance of the national screening program over 25 years is reported alongside concurrent population trends. Methods: In this retrospective population-based analysis, registry and health-insurance data on program indicators for 2006–2025 were analyzed by calendar year and screening pathway, together with national incidence and mortality for 1977–2024. Introduced in 2000 with guaiac fecal occult blood testing, the program added screening colonoscopy in 2009, completed the transition to fecal immunochemical testing (FIT) by 2014, and has used quantitative FIT only since 2020. The target age was 50 and over, redefined as 45–74 from 2026. Results: Among 653,825 preventive colonoscopies, at least one adenoma was detected in 251,974 examinations and cancer, including carcinoma in situ, in 16,575. The positive predictive value for adenoma after a positive fecal test rose from 29.6% to 48.3%, and the adenoma detection rate at screening colonoscopy from 25.3% to 32.6%. Cancer detection fell from 6.3% to 2.8% and from 1.8% to 0.5%, respectively. Coverage by screening modalities was 33.7%, and 41.0% including examinations outside the program. Six-month compliance with colonoscopy after a positive FIT was 58.0%. This figure counts colonoscopy under any procedure code and therefore measures whether colonoscopy was performed rather than whether it was reported under the dedicated pathway code. Of all patients with a positive FIT, 37.6% underwent colonoscopy reported under the dedicated FOBT+ colonoscopy code, a subset of the overall 58.0%. Waiting time for FOBT+ colonoscopy was 80 days on average. Age-standardized incidence and mortality were 31.7% and 50.0% lower in 2022–2024 than in 1998–2000. The declines were not uniform across age: the incidence decline was most pronounced at ages 75 and older, whereas the mortality decline was concentrated at ages 50 to 74. Conclusions: Sustained organized screening coincided with a substantial decline in one of the world’s highest CRC burdens, although its earlier part preceded program expansion. Coverage and completion of FOBT+ colonoscopy remain the principal implementation challenges.

Kolorektální karcinom patří celosvětově k nejčastějším malignitám a zaujímá třetí místo v incidenci zhoubných nádorových onemocnění. Praktičtí lékaři mají klíčovou roli nejen v oblasti primární prevence tohoto onemocnění, ale také v procesu časného zachycení již přítomných nádorových lézí. V úvodní části přehledu je podrobně diskutována epidemiologie kolorektálního karcinomu, současná data o incidenci a mortalitě, význam a výsledky populačního screeningového programu v České republice. Dále je zdůrazněna role primární péče v podpoře screeningových programů a v časném zachycení asymptomatických jedinců s vysokým rizikem vzniku kolorektálního karcinomu. Druhá část článku se již specificky zaměřuje na problematiku klinického hodnocení osob v primární péči, zejména s ohledem na identifikaci a stratifikaci rizikových jedinců s pozitivní rodinnou anamnézou kolorektálního karcinomu

We assessed the diagnostic performance of the Narrow-Band Imaging (NBI) International Colorectal Endoscopic Classification (NICE) and the Japan NBI Expert Team classification (JNET) in predicting histological outcomes of advanced colorectal lesions. Additionally, we evaluated the sensitivity and positive predictive value (PPV) of the JNET and NICE classifications individually for high-grade lesions (including HGD adenomas, intramucosal carcinomas, and T1 carcinomas). This was a retrospective analysis of prospectively collected data, involving 211 patients (130 men, mean age 60 years) who underwent colonoscopy with endoscopic resection of advanced colorectal neoplasia (lesions ≥ 10 mm). Lesions were classified using both NICE and JNET criteria, and final histopathological results were used for comparison. Of the 257 lesions analyzed, the NICE classification accurately classifies a large proportion of lesions (93.8%). In JNET classification we observed 77.4% correctly classified lesions. Specifically, the sensitivity and positive predictive value (PPV) of the NICE classification for high-grade lesions were 100% and 24.4%, respectively. For the JNET classification, the sensitivity and PPV for high-grade lesions were 56.6% and 57.7%, respectively. The JNET classification, with a positive predictive value of 57.7% for high-grade colorectal lesions (including HGD adenomas, intramucosal carcinomas, and T1 carcinomas), should be used for decision-making regarding appropriate subsequent endoscopic therapy.

Kolorekt?ln? karcinom je celosv?tov? druh?m nej?ast?j??m karcinomem a p?edstavuje v?znamnou zdravotn? z?t?, zejm?na v ekonomicky rozvinut?ch zem?ch. ?esk? republika m? v evropsk?m m???tku vysokou incidenci, av?ak d?ky dlouhodob?mu screeningov... Kolorekt?ln? karcinom je celosv?tov? druh?m nej?ast?j??m karcinomem a p?edstavuje v?znamnou zdravotn? z?t?, zejm?na v ekonomicky rozvinut?ch zem?ch. ?esk? republika m? v evropsk?m m???tku vysokou incidenci, av?ak d?ky dlouhodob?mu screeningov...

Aims The main aim was to determine and compare the diagnostic accuracy of the narrow-band imaging (NBI) International Colorectal Endoscopic Classification (NICE) and the Japan NBI Expert Team (JNET) classification in predicting histology. Secondary aim was to determine the positive predictive value (PPV) for the NICE and JNET classification. Methods 211 patients aged 18–75 years (130 men, 62%; mean age 60 years) underwent colonoscopy with endoscopic resection of advanced colorectal neoplasia (defined by size lesions ≥ 10 mm). The Paris classification, NICE and JNET classifications were used for each lesion. The results were compared with the final pathological diagnoses. Results 257 lesions were analyzed, including 8 (3.1 %) hyperplastic polyps, 47 sessile serrated polyps (18.2 %), 152 (59.1 %) adenomas with LGD, 36 (14.2 %) high-grade adenomas, 12 (4,6 %) superficial submucosal (SM-s) carcinomas and 2 (0.8 %) deep submucosal (SM-d) carcinomas. A total of 200 lesions (77.8 %) were correctly classified according to the JNET classification and 242 lesions (94.2 %) were correctly classified according to the NICE classification. The PPV for NICE 1 lesion was 95.9 %, NICE 2 97.0 % and NICE 3 22.0 %. The PPV for JNET 1 lesions was 95.9 %, JNET 2A 83 %, JNET 2B 52.2 % and JNET 3 22.5 %. Conclusions The NICE classification was associated with a higher proportion of correctly classified lesions compared to the JNET classification. NICE 3 and JNET 3 were characterized by low PPV. NBI virtual chromoendoscopy shows a low PPV for HGD adenomas and SM-s carcinomas. Increasing the accuracy of the prediction of these lesions and determining the limiting factors will be the subject of further investigation. Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

A substantial body of literature has provided evidence that type 2 diabetes mellitus (T2DM) and colorectal neoplasia share several common factors. Both diseases are among the leading causes of death worldwide and have an increasing incidence. In addition to usual risk factors such as sedentary lifestyle, obesity, and family history, common pathophysiological mechanisms involved in the development of these diseases have been identified. These include changes in glucose metabolism associated with adipose tissue dysfunction including insulin resistance resulting to hyperinsulinemia and chronic hyperglycemia. In addition to altered glucose metabolism, abdominal obesity has been associated with accented carcinogenesis with chronic subclinical inflammation. An increasing number of studies have recently described the role of the gut microbiota in metabolic diseases including T2DM and the development of colorectal cancer (CRC). Due to the interconnectedness of different pathophysiological processes, it is not entirely clear which factor is crucial in the development of carcinogenesis in patients with T2DM. The aim of this work is to review the current knowledge on the pathophysiological mechanisms of colorectal neoplasia development in individuals with T2DM. Here, we review the potential pathophysiological processes involved in the onset and progression of colorectal neoplasia in patients with T2DM. Uncovering common pathophysiological characteristics is essential for understanding the nature of these diseases and may lead to effective treatment and prevention.

Background and Aims: Adequate bowel preparation is essential for successful and effective colonoscopy. Several types of cleansing agents are currently available including low-volume solutions. The aim of this study was to compare the efficacy of four different bowel cleansing agents. Methods: A single-center, prospective, randomized, and single-blind study was performed. Consecutive patients referred for colonoscopy were enrolled and randomized into one of the following types of laxatives: polyethylenglycol 4L (PEG), oral sulfate solution (OSS), 2L polyethylenglycol + ascorbate (2L-PEG/Asc), or magnesium citrate + sodium picosulfate (MCSP). The primary outcome was quality of bowel cleansing evaluated according to the Boston Bowel Preparation Scale (BBPS). Secondary outcomes were polyp detection rate (PDR) and tolerability. Results: Final analysis was performed on 431 patients. The number of patients with adequate bowel preparation (BBPS total scores ≥6 and sub scores ≥2 in each segment) was not significantly different throughout all groups (95.4% PEG; 94.6% OSS; 96.3% 2L-PEG/Asc; 96.2% MCSP; p=0.955). Excellent bowel preparation (BBPS total scores ≥ 8) was associated with younger age (p=0.007). The groups did not have significantly different PDRs (49.5% PEG; 49.1% OSS; 38% 2L-PEG/Asc; 40.4% MCSP; p=0.201). The strongest predictors of pathology identification were age and male gender. The best-tolerated solution was MCSP (palatability: p<0.001; nausea: p=0.024).