Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
J Natl Compr Canc Netw. 2010 Jan;8(1):67-76; quiz 77. doi: 10.6004/jnccn.2010.0004.
Through its impact on the adenoma-carcinoma sequence, colonoscopy has a central role in the detection and prevention of colorectal cancer (CRC). Observational data support a protective effect of colonoscopy and polypectomy on CRC incidence and mortality. However, recent studies suggest that the degree of CRC protection afforded by colonoscopy is dependent on the effectiveness of identification of prevalent cancers or their precursors, particularly in the proximal colon. Biologic variation in tumor genetics and growth likely contribute to diminished protection in the proximal colon. Operator variability is known to be a key factor predicting adenoma detection. Evidence supports the immediate adoption of specific quality improvement initiatives to reduce the failure rate of colonoscopy. Further interventions should target individual, organizational, and health system factors which influence physician behavior.
结肠镜检查通过对腺瘤-癌序列的影响，在结直肠癌（CRC）的检测和预防中起着核心作用。观察性数据支持结肠镜检查和息肉切除术对 CRC 发病率和死亡率的保护作用。然而，最近的研究表明，结肠镜检查对 CRC 的保护程度取决于对现有癌症或其前体的识别效果，特别是在近端结肠。肿瘤遗传学和生长的生物学变异性可能导致近端结肠的保护作用减弱。操作人员的变异性是预测腺瘤检出率的关键因素。有证据支持立即采取具体的质量改进措施，以降低结肠镜检查的失败率。进一步的干预措施应针对影响医生行为的个体、组织和卫生系统因素。
