Division of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy.
Cancer. 2012 Sep 15;118(18):4404-11. doi: 10.1002/cncr.27664. Epub 2012 Jun 15.
Specialty of the endoscopist has been related to the postcolonoscopy interval risk of colorectal cancer (CRC). However, the impact of such a difference on the long-term CRC prevention rate by screening colonoscopy is largely unknown.
A Markov model was constructed to simulate the efficacy and cost of colonoscopy screening according to the specialty of the endoscopist in 100,000 individuals aged 50 years until death. The postcolonoscopy interval CRC risk (0.02%) and the relative risk (1.4) of interval CRC between gastroenterologist (GI) endoscopists and non-GI endoscopists were extracted from the literature. Both efficacy and costs were projected over a steady-state US population. Eventual increase in endoscopic capacity when assuming all procedures to be performed by GI endoscopists was simulated.
According to the simulation model, screening colonoscopy performed by non-GI endoscopists resulted in a 11% relative reduction in the long-term CRC incidence prevention rate compared with the same procedure performed by GI endoscopists. When projected on the US population, the reduced non-GI efficacy resulted in an additional 3043 CRC cases and the loss of $200 million per year. When increasing the relative risk from 1.4 to 2.0, the difference in the prevention rate between GI endoscopists and non-GI endoscopists increased to 19%. It increased further to 38% when also assuming a 3-fold increase in the risk of interval CRC. An additional 165 screening colonoscopies per endoscopist per year would be required to shift all non-GI procedures to GI endoscopists.
When screening colonoscopy is performed by non-GI endoscopists, a substantial reduction in the long-term CRC prevention rate may be expected. Such difference appeared to be greater when a suboptimal efficacy of colonoscopy in preventing CRC was assumed. A 10-year saving of $2 billion may be expected when shifting all screening colonoscopies from non-GI endoscopists to GI endoscopists.
内镜医师的专业特长与结肠镜检查后的结直肠癌（CRC）风险间隔有关。然而，这种差异对筛查结肠镜检查的长期 CRC 预防率的影响在很大程度上是未知的。
根据内镜医师的专业特长，采用马尔可夫模型对 10 万名 50 岁个体直至死亡的结肠镜筛查效果和成本进行模拟。从文献中提取内镜医师为胃肠病学家（GI）和非胃肠病学家时，结肠镜检查后 CRC 风险（0.02%）和 CRC 间隔的相对风险（1.4）。在稳定的美国人群中预测疗效和成本。假设所有操作均由 GI 内镜医师进行，模拟内镜能力的最终增加。
根据模拟模型，与 GI 内镜医师进行相同的结肠镜筛查相比，非 GI 内镜医师进行的筛查结肠镜检查导致长期 CRC 发病率预防率降低 11%。当预测到美国人群时，非 GI 效果降低导致每年额外增加 3043 例 CRC 病例和损失 2 亿美元。当将相对风险从 1.4 增加到 2.0 时，GI 内镜医师和非 GI 内镜医师之间的预防率差异增加到 19%。当假设 CRC 间隔风险增加 3 倍时，差异进一步增加到 38%。每年每内镜医师增加 165 次筛查性结肠镜检查，将所有非 GI 操作转移到 GI 内镜医师手中。
当非 GI 内镜医师进行筛查结肠镜检查时，预计长期 CRC 预防率会大幅降低。当假设结肠镜检查预防 CRC 的效果不理想时，这种差异似乎更大。当将所有筛查结肠镜检查从非 GI 内镜医师转移到 GI 内镜医师时，预计可节省 20 亿美元的 10 年成本。
