Lewis James D, Ng Kimmie, Hung Kenneth E, Bilker Warren B, Berlin Jesse A, Brensinger Colleen, Rustgi Anil K
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Dr, Seventh Floor Blockley Hall, Philadelphia, PA 19104-6021, USA.
Arch Intern Med. 2003 Feb 24;163(4):413-20. doi: 10.1001/archinte.163.4.413.
The relative effectiveness of flexible sigmoidoscopy compared with colonoscopy to screen for colorectal cancer depends on the magnitude of the association between findings in the proximal and distal colon and the false-negative rate of screening sigmoidoscopy for proximal neoplasia. To address this, we performed a systematic review and meta-analysis of screening colonoscopy studies.
Published studies through July 31, 2000, of asymptomatic patients undergoing screening colonoscopy were identified from the MEDLINE database. We generated pooled estimates of the odds ratio for the association between findings in the distal and proximal colon and the prevalence of isolated proximal adenomatous neoplasia.
Using the sigmoid-descending colon junction to identify the beginning of the distal colon, the pooled odds ratio for the association between distal adenomatous polyps and any proximal neoplasia was 2.40 (95% confidence interval [CI], 1.42-4.05). Diminutive distal adenomatous polyps were also associated with proximal neoplasia (odds ratio, 2.36; 95% CI, 1.30-4.29). Distal hyperplastic polyps were not associated with proximal neoplasia (odds ratio, 1.44; 95% CI, 0.79-2.62). The prevalence of isolated advanced proximal neoplasia in the 3 studies was 2%, 3%, and 5%. Using the sigmoid-descending colon junction to identify the beginning of the distal colon yields a pooled estimate of isolated proximal neoplasia of 16.3% (95% CI, 13.6%-19.1%).
Distal adenomatous polyps, including diminutive distal adenomatous polyps, are associated with an increased prevalence of synchronous proximal neoplasia. Two percent to 5% of patients undergoing screening colonoscopy may have isolated advanced proximal neoplasia. Even more patients may have isolated nonadvanced proximal neoplasia.
与结肠镜检查相比，柔性乙状结肠镜检查用于筛查结直肠癌的相对有效性取决于近端和远端结肠检查结果之间关联的强度以及筛查乙状结肠镜检查对近端肿瘤的假阴性率。为解决这一问题，我们对筛查结肠镜检查研究进行了系统评价和荟萃分析。
从MEDLINE数据库中识别出截至2000年7月31日发表的关于无症状患者接受筛查结肠镜检查的研究。我们汇总估计了远端和近端结肠检查结果之间关联的比值比以及孤立性近端腺瘤性肿瘤的患病率。
以乙状结肠-降结肠交界处作为远端结肠起始部位的标识，远端腺瘤性息肉与任何近端肿瘤之间关联的汇总比值比为2.40（95%置信区间[CI]，1.42 - 4.05）。微小远端腺瘤性息肉也与近端肿瘤相关（比值比，2.36；95%CI，1.30 - 4.29）。远端增生性息肉与近端肿瘤无关（比值比，1.44；95%CI，0.79 - 2.62）。三项研究中孤立性晚期近端肿瘤的患病率分别为2%、3%和5%。以乙状结肠-降结肠交界处作为远端结肠起始部位的标识，孤立性近端肿瘤的汇总估计患病率为16.3%（95%CI，13.6% - 19.1%）。
远端腺瘤性息肉，包括微小远端腺瘤性息肉，与同步近端肿瘤患病率增加相关。接受筛查结肠镜检查的患者中有2%至5%可能患有孤立性晚期近端肿瘤。甚至更多患者可能患有孤立性非晚期近端肿瘤。
