Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Nat Rev Gastroenterol Hepatol. 2012 Sep;9(9):550-4. doi: 10.1038/nrgastro.2012.136. Epub 2012 Aug 21.
Several studies have raised warnings about the limited effectiveness of colonoscopy for the prevention of colorectal cancer (CRC), especially of the proximal colon. Two major categories of factors might be responsible for the development of interval cancers, namely technical, endoscopist-dependent factors and biological characteristics of the cancer that lead to more rapid tumour progression. Recognition of endoscopist-dependent factors is critical, as these factors are probably amenable to correction through improved awareness and education of endoscopists, using quality metrics (such as adenoma detection rates and cecal intubation rates) for objective evaluation and feedback. In this article, the current literature regarding the incidence of, and potential explanations for, interval CRCs is outlined. Although there is probably an interaction between technical and biology-related factors--and an attempt to dissect the biology from the technology might be fraught with difficulties--a structured analysis of individual cases of interval cancer might help in the continuous monitoring of the quality of colonoscopy, and ultimately might reduce the number of interval CRCs.
一些研究对结肠镜检查预防结直肠癌（CRC）的效果有限提出了警告，特别是对近端结肠。有两大类因素可能导致间期癌的发生，即技术相关、依赖内镜医生的因素和导致肿瘤更快进展的癌症生物学特征。认识到内镜医生依赖的因素至关重要，因为这些因素可能通过提高内镜医生的意识和教育水平得到纠正，使用质量指标（如腺瘤检出率和盲肠插管率）进行客观评估和反馈。本文概述了结直肠癌间期发生率以及可能的解释。尽管技术相关因素和生物学相关因素之间可能存在相互作用——并且试图从技术中分离生物学可能困难重重——对间期癌个别病例的系统分析可能有助于持续监测结肠镜检查的质量，并最终可能减少间期结直肠癌的数量。
