Triantafillidis John K, Vagianos Constantine, Malgarinos George
Inflammatory Bowel Disease Unit, "IASO General" Hospital, Holargos, 15562 Athens, Greece.
2nd Propedeutic Department of Surgery, Laiko Hospital, University of Athens, Medical School, Athens, Greece.
Indian J Surg Oncol. 2015 Sep;6(3):237-50. doi: 10.1007/s13193-015-0410-3. Epub 2015 Apr 12.
Colonoscopy represents a very important diagnostic modality for screening for colorectal cancer, because it has the ability to both detect and effectively remove pro-malignant and malignant lesions. It is recommended by almost all international and national gastroenterology and cancer societies, as an initial screening modality or, following a positive fecal occult blood test, to be performed every 10 years in individuals of average risk starting from the age of 50. However, a significant problem is the so-called post-screening (interval) polyps and cancers found some years after the index colonoscopy. In order to reduce the rate of interval cancers it is extremely necessary to optimize the quality and effectiveness of colonoscopy. Bowel preparation is of paramount importance for both accurate diagnosis and subsequent treatment of lesions found on colonoscopy. The quality of bowel preparation could be significantly improved by splitting the dose regimens, a strategy that has been shown to be superior to single-dose regimen. A good endoscopic technique and optimal withdrawal time offering adequate time for inspection, would further optimize the rate of cecal intubation and the number of lesions detected. During the last years, sophisticated devices have been introduced that would further facilitate cecal intubation. The percentage of total colonoscopies is now super-passing the level of 95 % allowing the adenoma detection rate to be greater than the suggestive level of 25 % in men and 15 % in women. This review aims to provide the reader with the current knowledge concerning indications, usefulness, limitations and future perspectives of this probably most important screening technique for colorectal cancer available today.
结肠镜检查是结直肠癌筛查的一种非常重要的诊断方式，因为它既能检测又能有效切除癌前病变和恶性病变。几乎所有国际和国家的胃肠病学及癌症协会都推荐，作为初始筛查方式，或在粪便潜血试验呈阳性后，从50岁起，平均风险个体每10年进行一次结肠镜检查。然而，一个重大问题是在首次结肠镜检查后的几年发现的所谓筛查后（间隔期）息肉和癌症。为了降低间隔期癌症的发生率，优化结肠镜检查的质量和有效性极其必要。肠道准备对于结肠镜检查中发现的病变的准确诊断和后续治疗至关重要。通过分剂量方案可以显著提高肠道准备的质量，这一策略已被证明优于单剂量方案。良好的内镜技术和提供足够检查时间的最佳退镜时间，将进一步优化盲肠插管率和检测到的病变数量。在过去几年中，已经引入了先进的设备，这将进一步便于盲肠插管。目前全结肠镜检查的比例已超过95%，使腺瘤检出率在男性中大于25%、女性中大于15%这一提示水平。本综述旨在为读者提供有关当今可能是最重要的结直肠癌筛查技术的适应证、效用、局限性及未来展望的当前知识。
