Sieg A
Praxis für Gastroenterologie und Medizinische Fakultät der Universität Heidelberg.
Z Gastroenterol. 2003 Nov;41(11):1077-82. doi: 10.1055/s-2003-44305.
In Germany screening colonoscopy was introduced into the National program on colorectal cancer prevention in Oktober 2002. The prevalence of neoplasia in patients with and without familiar risk was determined together with patient satisfaction with screening colonoscopy.
Asymptomatic subjects from 50 to 60 years underwent screening colonoscopy and were stratified in two groups with and without familiar risk (first-degree relatives with CRC) in a multicenter trial among German gastroenterologists. Advanced neoplasia was defined as an adenoma at least 1 cm in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. After recovery from sedation all subjects were asked if they would agree to a control colonoscopy and the pain score was recorded on a scale from 0 to 6.
A total of 557 subjects (322 at average risk and 235 with familiar risk) underwent screening colonoscopy. The prevalence of advanced neoplasia in subjects without/with familiar risk was not significantly different in persons from 50 to 54 years (9 vs. 15 %) in contrast to persons from 55 to 60 years (10 vs. 22 %, p = 0.004) where the relative risk was doubled. Compared to younger patients, the prevalence of all neoplasia (including small adenomas) was significantly different only for older patients with familiar risk (44 vs. 23 %, p < 0.0001). The mean value of the pain-score was 0.76 + 1.0. Subjects examined without medication had significantly higher pain scores than subjects under medication. Colonoscopy performed under disoprivan resulted in similar pain-scores compared to midazolam at dosages > 5 mg. All patients agreed to a control colonoscopy.
Screening colonoscopy is an effective and well-accepted method. The high prevalence of advanced neoplasia even in persons from 50 to 54 years suggests that screening should start at the age of 50.
2002年10月，德国将结肠镜筛查纳入国家结直肠癌预防计划。对有家族风险和无家族风险患者的瘤变患病率以及患者对结肠镜筛查的满意度进行了测定。
在德国胃肠病学家开展的一项多中心试验中，对50至60岁的无症状受试者进行结肠镜筛查，并根据有无家族风险（结直肠癌一级亲属）分为两组。高级别瘤变定义为直径至少1厘米的腺瘤、绒毛状腺瘤、高级别异型增生腺瘤或浸润性癌。镇静恢复后，询问所有受试者是否同意进行对照结肠镜检查，并记录0至6分的疼痛评分。
共有557名受试者（322名平均风险受试者和235名有家族风险受试者）接受了结肠镜筛查。50至54岁人群中，无家族风险/有家族风险受试者的高级别瘤变患病率无显著差异（分别为9%和15%），而55至60岁人群中该患病率有显著差异（分别为10%和22%，p = 0.004），相对风险翻倍。与年轻患者相比，所有瘤变（包括小腺瘤）的患病率仅在有家族风险的老年患者中存在显著差异（分别为44%和23%，p < 0.0001）。疼痛评分的平均值为0.76 + 1.0。未用药检查的受试者疼痛评分显著高于用药受试者。使用丙泊酚进行结肠镜检查与使用剂量>5毫克的咪达唑仑相比，疼痛评分相似。所有患者均同意进行对照结肠镜检查。
结肠镜筛查是一种有效且被广泛接受的方法。即使在50至54岁人群中高级别瘤变患病率也较高，这表明筛查应从50岁开始。
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