Hewett David G, Rex Douglas K
School of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD 4108, Australia.
Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, 550 North University Boulevard, Indiana University Hospital #4100, Indianapolis, IN 46202, USA.
Gastrointest Endosc Clin N Am. 2015 Apr;25(2):403-13. doi: 10.1016/j.giec.2014.12.002. Epub 2015 Feb 7.
Colonoscopy for average-risk colorectal cancer screening has transformed the practice of gastrointestinal medicine in the United States. However, although the dominant screening strategy, its use is not supported by randomized controlled trials. Observational data do support a protective effect of colonoscopy and polypectomy on colorectal cancer incidence and mortality, but the level of protection in the proximal colon is variable and operator-dependent. Colonoscopy by high-level detectors remains highly effective, and ongoing quality improvement initiatives should consider regulatory factors that motivate changes in physician behavior.
用于平均风险结直肠癌筛查的结肠镜检查改变了美国胃肠医学的实践。然而，尽管它是主要的筛查策略，但随机对照试验并不支持其使用。观察性数据确实支持结肠镜检查和息肉切除术对结直肠癌发病率和死亡率的保护作用，但近端结肠的保护水平是可变的且依赖于操作者。由高水平操作者进行的结肠镜检查仍然非常有效，并且正在进行的质量改进计划应考虑促使医生行为改变的监管因素。
