Netzer P, Büttiker U, Pfister M, Halter F, Schmassmann A
Department of Internal Medicine Inselspital, University of Berne, Switzerland.
Dis Colon Rectum. 1999 May;42(5):661-7. doi: 10.1007/BF02234146.
Screening endoscopy has the potential to reduce colorectal cancer mortality. However, the efficacy of screening flexible sigmoidoscopy compared with colonoscopy strongly depends on the frequency of advanced proximal neoplasms without an index polyp in the rectosigmoid. We have therefore determined this frequency in our endoscopy population.
Endoscopic and histologic data were analyzed from all patients on whom integral colonoscopy was performed between 1980 and 1995. Advanced neoplasia was defined as cancer or adenomas >10 mm in diameter, adenomas with a villous component, or severe dysplasia. Patients with polyposis syndrome or inflammatory bowel disease were excluded.
Colonoscopy was performed on 11,760 patients. 2,272 (19.3 percent) had at least one colorectal neoplasm, of which 39 percent had the neoplasm above the rectosigmoid. Twenty-two percent of all patients with neoplasia had no index polyp in the rectosigmoid and 16 percent of these had no index polyp, but at least one advanced proximal neoplasm.
Although 39 percent of patients had neoplasms above the rectosigmoid, only 16 percent had an advanced proximal neoplasm without an index polyp in the rectosigmoid. This gives a figure on which to base the evaluation of screening sigmoidoscopy programs against those of screening colonoscopy.
筛查性内镜检查有可能降低结直肠癌死亡率。然而，与结肠镜检查相比，筛查性乙状结肠镜检查的疗效很大程度上取决于直肠乙状结肠中无指示息肉的近端晚期肿瘤的发生率。因此，我们在我们的内镜检查人群中确定了这一发生率。
分析了1980年至1995年间接受全结肠镜检查的所有患者的内镜和组织学数据。晚期肿瘤定义为癌症或直径>10 mm的腺瘤、具有绒毛成分的腺瘤或重度发育异常。排除患有息肉病综合征或炎症性肠病的患者。
对11760例患者进行了结肠镜检查。2272例（19.3%）至少有1个结直肠肿瘤，其中39%的肿瘤位于直肠乙状结肠上方。所有患有肿瘤的患者中，22%在直肠乙状结肠中没有指示息肉，其中16%没有指示息肉，但至少有1个近端晚期肿瘤。
虽然39%的患者在直肠乙状结肠上方有肿瘤，但只有16%的患者在直肠乙状结肠中没有指示息肉却有近端晚期肿瘤。这为评估乙状结肠镜筛查方案与结肠镜筛查方案提供了一个数据依据。
