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Papers by Stepan Suchanek

Research paper thumbnail of Screening and Surveillance Colonoscopy

Endoscopic Procedures in Colon and Rectum, 2011

Research paper thumbnail of Improved specimen adequacy using jumbo biopsy forceps in patients with Barrett's esophagus

World Journal of Gastroenterology, 2015

To assess the sampling quality of four different forceps (three large capacity and one jumbo) in ... more To assess the sampling quality of four different forceps (three large capacity and one jumbo) in patients with Barrett's esophagus. 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-220K 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. 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. 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.

Research paper thumbnail of Tu1107 The Benefit of Autoflorescence (AFI) in Diagnosis of Intraepitelial Neoplasia in Patients With Barretts Esophagus (BE). Effect of Learning Curve

Research paper thumbnail of Tu1889 A Long-Term Follow-Up of Patients With Recurring Sporadic Polyps: Is There a Benefit From Mutation Testing of Adenomatous Tissue?

Research paper thumbnail of Colonic Neoplasias Detection and Implications of the National Screening Programme

Research paper thumbnail of Colorectal cancer screening in Europe

World Journal of Gastroenterology, 2009

Colorectal cancer (CRC) is the second most frequent malignant disease in Europe. Every year, 412 ... more Colorectal cancer (CRC) is the second most frequent malignant disease in Europe. Every year, 412 000 people are diagnosed with this condition, and 207 000 patients die of it. In 2003, recommendations for screening programs were issued by the Council of the European Union (EU), and these currently serve as the basis for the preparation of European guidelines for CRC screening. The manner in which CRC screening is carried out varies significantly from country to country within the EU, both in terms of organization and the screening test chosen. A screening program of one sort or another has been implemented in 19 of 27 EU countries. The most frequently applied method is testing stool for occult bleeding (fecal occult blood test, FOBT). In recent years, a screening colonoscopy has been introduced, either as the only method (Poland) or the method of choice (Germany, Czech Republic).

Research paper thumbnail of No Benefit of Autoflorescence (AFI) in a Diagnosis of Low Grade Intraepitelial Neoplasia (Lgin) in Patients With Barrett's Esophagus (BE)

Gastroenterology, 2011

should undergo BE screening can decrease over-testing and significantly improve the costeffective... more should undergo BE screening can decrease over-testing and significantly improve the costeffectiveness of endoscopic screening. The aim of this study is to develop a prediction rule to identify patients at high risk for BE. Methods: We are in the midst of performing a retrospective case-control logistic regression analysis. The cases are a cohort of 380 adults who were found to have histologically confirmed BE at the first (index) endoscopy at a single institution. Each case will be matched with two controls (no BE diagnosis at endoscopy) on the basis of the following: indication for endoscopy, year of endoscopy and endoscopist who performed the procedure. As we continue to accrue patient data toward our final goal of 380 BE cases and 760 controls (1:2), this is an interim analysis of 195 patients and 195 controls. Risk factors analyzed (age, gender, BMI, medical and social history and concurrent medications) were extracted from the patients' medical records. In Analysis I, we performed univariate analysis and multivariate logistic regression modeling to identify pivotal risk factors for BE. In Analysis 2, we used similar methods but in a subset of 97 BE cases and 97 controls who underwent an endoscopy for the clinical indication of GERD. Results: Univariate risk factors significantly associated with BE at endoscopy included younger age, male gender, absence of any history of cancer, aspirin use and statin use. BMI > 25 approached statistical significance (OR= 1.517; 95% CI 0.95-2.43). Three of these predictors, male gender (OR= 8.34; 95% CI 3.17-21.9), having a history of cancer (OR= 0.37; 95% CI 0.16-0.88) and increasing age but with a marginal effect size (OR= 0.97; 95% CI 0.94-0.99), remained significant in the multivariate regression model. In the subset analysis of patients with GERD symptoms, only male gender was identified as a predictor for Barrett's esophagus in both univariate and multivariate (OR= 6.5; 95% CI 2.27-18.7) regression models. Conclusion: Our multivariate regression model showed that male gender is a highly significant predictor for BE with an adjusted OR >8, a ratio that is higher than previously published results. Furthermore, we found that a history of cancer was associated with a significantly lower risk of BE. We hypothesize that this finding is a result of surveillance bias, as cancer patients are more likely to undergo unrelated screening studies and are therefore lower risk individuals. These interim findings suggest that effective risk stratification may be possible to determine patients most likely to benefit from endoscopic screening for BE.

Research paper thumbnail of 744 The Efficiency of Colonic Capsule Endoscopy in Detection of Colorectal Polyps and Cancers Comparing to Colonoscopy: Multicenter, Prospective Cross Over Study

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Mo1576 The Efficiency of Colonic Capsule Endoscopy in Detection of Colorectal Polyps and Cancers Comparing to Colonoscopy: Multicenter, Prospective Crosses Over Study

Research paper thumbnail of Sp847 A Successful Endoscopic Treatment of a Large Colonic Perforation Using a New Over-the-Scope Clip

Gastrointestinal Endoscopy, 2011

Research paper thumbnail of Training on an ex vivo animal model improves endoscopic skills: a randomized, single-blind study

Gastrointestinal Endoscopy, 2011

Animal models are used for training of different endoscopic procedures. Whether this really impro... more Animal models are used for training of different endoscopic procedures. Whether this really improves endoscopic skills remains controversial. To assess the effectiveness of training by using an ex vivo animal gastric model on the performance of two therapeutic procedures-hemostasis and treatment of perforation. A randomized, single-blind study. An experimental endoscopy center in a university hospital. Thirty-one gastroenterology fellows with comparable endoscopic experience. Participants were randomized into two groups: with (T, n = 16) and without (S, n = 15) training. All fellows continued with standard endoscopic practice. Baseline skills were assessed at enrollment. All physicians in group T underwent 2 full days of a hands-on course over a 3-month period, in addition to their standard endoscopic practice. Both groups then underwent a blinded, final evaluation. Endoscopic skills were scored from 1 (best) to 5 (poorest) by two expert, blinded tutors. Outcomes of clinical hemostatic procedures also were analyzed. Successful hemostasis and successful perforation closure. Thirty physicians completed the study. Hemostasis results (n = 15): The number of physicians who carried out a successful hemostasis procedure increased significantly in the group with training (27% vs 73%; P = .009) but did not change in the group without training (20% vs 20%). The mean scores of injection and clipping technique improved significantly only after training. The number of clips used decreased significantly only in the group with training; the time of clipping did not change significantly in either group. Perforation results (n = 15): The number of physicians with a successful and complete perforation closure increased nearly significantly in the group with training (40% vs 73%, P = .06) as opposed to the group without training (27% vs 47%; P = .27). The procedure time decreased significantly in the group with training only. In clinical practice, fellows in group T had a significantly higher success rate with respect to hemostatic procedures (83.2%, range 67-100 vs 63.6%, range 25-100; P = .0447). The majority of participants (93%) agreed that such courses should be compulsory in gastroenterological credentials. A retrospective analysis of clinical outcomes. Clinical outcome data were based on self-reporting of the participants. Hands-on training by using an animal ex vivo model improves endoscopic skills in both hemostasis and perforation closure. In clinical practice, the training improves the outcome of hemostatic procedures.

Research paper thumbnail of Su1575 National Colorectal Cancer Screening Programme in the Czech Republic - Quality Control of Screening Colonoscopies

Gastrointestinal Endoscopy, 2011

Research paper thumbnail of S1093 Significant Esophageal Eosinophilia and Typical Endoscopic Features are Highly but Not Exclusively Specific for Eosinofilic Esophagitis

Research paper thumbnail of S1154 National Colorectal Cancer Screening Programme in the Czech Republic

Research paper thumbnail of Colorectal cancer prevention in the Czech Republic

European Journal of Cancer Prevention, 2014

The incidence and mortality of colorectal cancer (CRC) in the Czech Republic is significant. The ... more The incidence and mortality of colorectal cancer (CRC) in the Czech Republic is significant. The National CRC Screening Program started in 2000 and was further enhanced in 2009. In 2010, the European Guidelines were introduced. The aim of the present trend study was to evaluate the quality of the Czech National Colorectal Cancer Screening Program using early performance and long-term impact indicators. The screening program has been assessed using data from three sources: the Czech National Cancer Registry, the Czech National Reference Centre, and the Czech CRC Screening Registry. The data were compared with a set of recommended quality control indicators. Between 2006 and 2010, a total of 1 881 299 fecal occult blood tests were performed, of which 87 397 were positive (4.6%). Until 2011, a total of 68 527 fecal occult blood test follow-up colonoscopies were performed. In addition, between 2009 and 2011, a total of 10 309 screening colonoscopies were performed. As a result, a total of 25 255 adenomas (32.0% rate) and 3379 CRCs (4.3% rate) were detected. A trend of cancer detection in earlier stages has been observed. The overall program coverage has increased to 22.7% of the target population in 2010. The majority of European guidelines' quality indicators for nonpopulation-based programs were implemented in the Czech National CRC Screening program. An improvement in program management was accompanied by an increase in coverage as well as other performance indicators.

Research paper thumbnail of Colorectal cancer screening: 20 years of development and recent progress

World journal of gastroenterology : WJG, Jan 14, 2014

Colorectal cancer (CRC) is the second most common cancer in Europe and its incidence is steadily ... more 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 p...

Research paper thumbnail of Screening and Surveillance Colonoscopy

Endoscopic Procedures in Colon and Rectum, 2011

Research paper thumbnail of Improved specimen adequacy using jumbo biopsy forceps in patients with Barrett's esophagus

World Journal of Gastroenterology, 2015

To assess the sampling quality of four different forceps (three large capacity and one jumbo) in ... more To assess the sampling quality of four different forceps (three large capacity and one jumbo) in patients with Barrett's esophagus. 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-220K 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. 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. 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.

Research paper thumbnail of Tu1107 The Benefit of Autoflorescence (AFI) in Diagnosis of Intraepitelial Neoplasia in Patients With Barretts Esophagus (BE). Effect of Learning Curve

Research paper thumbnail of Tu1889 A Long-Term Follow-Up of Patients With Recurring Sporadic Polyps: Is There a Benefit From Mutation Testing of Adenomatous Tissue?

Research paper thumbnail of Colonic Neoplasias Detection and Implications of the National Screening Programme

Research paper thumbnail of Colorectal cancer screening in Europe

World Journal of Gastroenterology, 2009

Colorectal cancer (CRC) is the second most frequent malignant disease in Europe. Every year, 412 ... more Colorectal cancer (CRC) is the second most frequent malignant disease in Europe. Every year, 412 000 people are diagnosed with this condition, and 207 000 patients die of it. In 2003, recommendations for screening programs were issued by the Council of the European Union (EU), and these currently serve as the basis for the preparation of European guidelines for CRC screening. The manner in which CRC screening is carried out varies significantly from country to country within the EU, both in terms of organization and the screening test chosen. A screening program of one sort or another has been implemented in 19 of 27 EU countries. The most frequently applied method is testing stool for occult bleeding (fecal occult blood test, FOBT). In recent years, a screening colonoscopy has been introduced, either as the only method (Poland) or the method of choice (Germany, Czech Republic).

Research paper thumbnail of No Benefit of Autoflorescence (AFI) in a Diagnosis of Low Grade Intraepitelial Neoplasia (Lgin) in Patients With Barrett's Esophagus (BE)

Gastroenterology, 2011

should undergo BE screening can decrease over-testing and significantly improve the costeffective... more should undergo BE screening can decrease over-testing and significantly improve the costeffectiveness of endoscopic screening. The aim of this study is to develop a prediction rule to identify patients at high risk for BE. Methods: We are in the midst of performing a retrospective case-control logistic regression analysis. The cases are a cohort of 380 adults who were found to have histologically confirmed BE at the first (index) endoscopy at a single institution. Each case will be matched with two controls (no BE diagnosis at endoscopy) on the basis of the following: indication for endoscopy, year of endoscopy and endoscopist who performed the procedure. As we continue to accrue patient data toward our final goal of 380 BE cases and 760 controls (1:2), this is an interim analysis of 195 patients and 195 controls. Risk factors analyzed (age, gender, BMI, medical and social history and concurrent medications) were extracted from the patients' medical records. In Analysis I, we performed univariate analysis and multivariate logistic regression modeling to identify pivotal risk factors for BE. In Analysis 2, we used similar methods but in a subset of 97 BE cases and 97 controls who underwent an endoscopy for the clinical indication of GERD. Results: Univariate risk factors significantly associated with BE at endoscopy included younger age, male gender, absence of any history of cancer, aspirin use and statin use. BMI > 25 approached statistical significance (OR= 1.517; 95% CI 0.95-2.43). Three of these predictors, male gender (OR= 8.34; 95% CI 3.17-21.9), having a history of cancer (OR= 0.37; 95% CI 0.16-0.88) and increasing age but with a marginal effect size (OR= 0.97; 95% CI 0.94-0.99), remained significant in the multivariate regression model. In the subset analysis of patients with GERD symptoms, only male gender was identified as a predictor for Barrett's esophagus in both univariate and multivariate (OR= 6.5; 95% CI 2.27-18.7) regression models. Conclusion: Our multivariate regression model showed that male gender is a highly significant predictor for BE with an adjusted OR >8, a ratio that is higher than previously published results. Furthermore, we found that a history of cancer was associated with a significantly lower risk of BE. We hypothesize that this finding is a result of surveillance bias, as cancer patients are more likely to undergo unrelated screening studies and are therefore lower risk individuals. These interim findings suggest that effective risk stratification may be possible to determine patients most likely to benefit from endoscopic screening for BE.

Research paper thumbnail of 744 The Efficiency of Colonic Capsule Endoscopy in Detection of Colorectal Polyps and Cancers Comparing to Colonoscopy: Multicenter, Prospective Cross Over Study

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Mo1576 The Efficiency of Colonic Capsule Endoscopy in Detection of Colorectal Polyps and Cancers Comparing to Colonoscopy: Multicenter, Prospective Crosses Over Study

Research paper thumbnail of Sp847 A Successful Endoscopic Treatment of a Large Colonic Perforation Using a New Over-the-Scope Clip

Gastrointestinal Endoscopy, 2011

Research paper thumbnail of Training on an ex vivo animal model improves endoscopic skills: a randomized, single-blind study

Gastrointestinal Endoscopy, 2011

Animal models are used for training of different endoscopic procedures. Whether this really impro... more Animal models are used for training of different endoscopic procedures. Whether this really improves endoscopic skills remains controversial. To assess the effectiveness of training by using an ex vivo animal gastric model on the performance of two therapeutic procedures-hemostasis and treatment of perforation. A randomized, single-blind study. An experimental endoscopy center in a university hospital. Thirty-one gastroenterology fellows with comparable endoscopic experience. Participants were randomized into two groups: with (T, n = 16) and without (S, n = 15) training. All fellows continued with standard endoscopic practice. Baseline skills were assessed at enrollment. All physicians in group T underwent 2 full days of a hands-on course over a 3-month period, in addition to their standard endoscopic practice. Both groups then underwent a blinded, final evaluation. Endoscopic skills were scored from 1 (best) to 5 (poorest) by two expert, blinded tutors. Outcomes of clinical hemostatic procedures also were analyzed. Successful hemostasis and successful perforation closure. Thirty physicians completed the study. Hemostasis results (n = 15): The number of physicians who carried out a successful hemostasis procedure increased significantly in the group with training (27% vs 73%; P = .009) but did not change in the group without training (20% vs 20%). The mean scores of injection and clipping technique improved significantly only after training. The number of clips used decreased significantly only in the group with training; the time of clipping did not change significantly in either group. Perforation results (n = 15): The number of physicians with a successful and complete perforation closure increased nearly significantly in the group with training (40% vs 73%, P = .06) as opposed to the group without training (27% vs 47%; P = .27). The procedure time decreased significantly in the group with training only. In clinical practice, fellows in group T had a significantly higher success rate with respect to hemostatic procedures (83.2%, range 67-100 vs 63.6%, range 25-100; P = .0447). The majority of participants (93%) agreed that such courses should be compulsory in gastroenterological credentials. A retrospective analysis of clinical outcomes. Clinical outcome data were based on self-reporting of the participants. Hands-on training by using an animal ex vivo model improves endoscopic skills in both hemostasis and perforation closure. In clinical practice, the training improves the outcome of hemostatic procedures.

Research paper thumbnail of Su1575 National Colorectal Cancer Screening Programme in the Czech Republic - Quality Control of Screening Colonoscopies

Gastrointestinal Endoscopy, 2011

Research paper thumbnail of S1093 Significant Esophageal Eosinophilia and Typical Endoscopic Features are Highly but Not Exclusively Specific for Eosinofilic Esophagitis

Research paper thumbnail of S1154 National Colorectal Cancer Screening Programme in the Czech Republic

Research paper thumbnail of Colorectal cancer prevention in the Czech Republic

European Journal of Cancer Prevention, 2014

The incidence and mortality of colorectal cancer (CRC) in the Czech Republic is significant. The ... more The incidence and mortality of colorectal cancer (CRC) in the Czech Republic is significant. The National CRC Screening Program started in 2000 and was further enhanced in 2009. In 2010, the European Guidelines were introduced. The aim of the present trend study was to evaluate the quality of the Czech National Colorectal Cancer Screening Program using early performance and long-term impact indicators. The screening program has been assessed using data from three sources: the Czech National Cancer Registry, the Czech National Reference Centre, and the Czech CRC Screening Registry. The data were compared with a set of recommended quality control indicators. Between 2006 and 2010, a total of 1 881 299 fecal occult blood tests were performed, of which 87 397 were positive (4.6%). Until 2011, a total of 68 527 fecal occult blood test follow-up colonoscopies were performed. In addition, between 2009 and 2011, a total of 10 309 screening colonoscopies were performed. As a result, a total of 25 255 adenomas (32.0% rate) and 3379 CRCs (4.3% rate) were detected. A trend of cancer detection in earlier stages has been observed. The overall program coverage has increased to 22.7% of the target population in 2010. The majority of European guidelines' quality indicators for nonpopulation-based programs were implemented in the Czech National CRC Screening program. An improvement in program management was accompanied by an increase in coverage as well as other performance indicators.

Research paper thumbnail of Colorectal cancer screening: 20 years of development and recent progress

World journal of gastroenterology : WJG, Jan 14, 2014

Colorectal cancer (CRC) is the second most common cancer in Europe and its incidence is steadily ... more 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 p...