R Lambert

..Concerted efforts to control colorectal cancer are therefore of great importance worldwide. They will require allocation of additional resources and should be based on an appropriate balance between prevention, diagnosis and treatment...

..The study confirmed that NBI had the same efficacy as white light in the detection of intestinal metaplasia, with a higher proportion of dysplasia detected (30 vs 21%) and a lower number of biopsies per patient (3.6 vs 7.6)...

..The technique of endoscopic submucosal dissection should be diffused because it reduces the number of surgical indications...

..The 5-year relative survival from digestive cancer is also lower. In developing countries, there is room for prevention of cancer burden through lifestyle interventions and through improved early detection of cancer...

..Preneoplastic conditions of the oesophagogastric mucosa include erosive oesophagitis in alcoholics, columnar lined oesophagus as a complication of gastro-oesophageal reflux disease, and atrophic gastritis following H. pylori infection...

..Indeed the risk of CRC is very low in most regions of Africa, and in some countries of South America and Asia...

..Recent alternatives to colonoscopy (3D radiological imaging, colon capsule) should not invalidate the priority attributed to colonoscopy which associates treatment to the early detection of colorectal cancer and precursors...

..In contrast, an increased incidence occurs in the world at tumor sites related to human papilloma virus infection in relation to changes in sexual habits...

..The technique also proves helpful for the assessment of the vascular pattern in chronic inflammatory disorders of the digestive mucosa...

..The miss rate for small but potentially cancerous lesions is often responsible for interval cancers. There is also a danger of overdetection and overtreatment of lesions with a very low risk of progression to malignancy...

..Future progress is based upon a Quality Assurance program for quality, experience of the operator a control of the cost and a research programme on tolerance with a trend to reduced sedation...

..In Japan, the results of the National Survey of Gastric Cancer, with cases detected by screening, confirmed the benefits of adherence to these guidelines; most patients were treated surgically, and only 7% with endoscopic therapy...

..On the other hand, a minority of male patients--providing a good performance status--should enter into surveillance protocols when high-risk factors such as a long history of reflux symptoms and smoking habits are present...

..In conclusion, the increasing progress being made in the accuracy of endoscopic diagnosis emphasizes the need for cost-benefit analyses of screening and surveillance protocols...

..After stenting the survival period is short and there is a toll of complications...

..On the other hand excess in the repetition of negative endoscopic procedures during surveillance raises ethical problems, increased costs, and may be considered as unethical...

..The classification in the sub-types 0 of neoplastic lesions has some relevance to prediction of depth of invasion. In the esophagus, EUS staging with high frequency miniprobes is a useful complement...

..Concerted efforts to control colorectal cancer are therefore of great importance worldwide. They will require allocation of additional resources and should be based on an appropriate balance between prevention, diagnosis and treatment...

..The trend to early detection of premalignant lesions justifies the development of mini-invasive endoscopic procedures of treatment...

..Endoscopic palliative treatment is not indicated, however, for infiltrative tumors that can induce rapid duodenal obstruction...