Yoon Jin Young, Cha Jae Myung, Jeen Yoon Tae
Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea.
Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2018 Jan 25;71(1):3-9. doi: 10.4166/kjg.2018.71.1.3.
Colonoscopy is currently regarded as the gold standard and preferred method of screening for colorectal cancer (CRC). However, the benefit of colonoscopy screening may be blunted by low participation rate in population-based screening program. Harmful effects of population-based colonoscopy screening may include complications induced by colonoscopy itself and by sedation, psychosocial distress, potential over-diagnosis and socioeconomic burden. In addition, harmful effect of colonoscopy may increase with age and comorbidity. As the adverse event risk in population-based colonoscopy screening may offset benefit of the screening colonoscopy, the adverse events associated with screening colonoscopy should be well managed and monitored. To adopt population-based colonoscopy screening, consensus for the risk and benefits of screening colonoscopy should be formed for its potential harms, patient preference, socioeconomic considerations, quality improvement of colonoscopy as well as its efficacy for CRC prevention. As the suboptimal colonoscopy quality is a major pitfall of population-based colonoscopy screening, adequate training and provider regulation for screening colonoscopists should be the first step to minimize the variation of quality between colonoscopists. Gastroenterologists should lead quality improvement, auditing, and training associated with colonoscopy in a population-based colonoscopy screening program.
结肠镜检查目前被视为结直肠癌（CRC）筛查的金标准和首选方法。然而，基于人群的筛查项目中参与率较低可能会削弱结肠镜检查筛查的益处。基于人群的结肠镜检查筛查的有害影响可能包括结肠镜检查本身及镇静引起的并发症、心理社会困扰、潜在的过度诊断以及社会经济负担。此外，结肠镜检查的有害影响可能会随着年龄和合并症的增加而增加。由于基于人群的结肠镜检查筛查中的不良事件风险可能会抵消筛查结肠镜检查的益处，因此与筛查结肠镜检查相关的不良事件应得到妥善管理和监测。为了采用基于人群的结肠镜检查筛查，应就筛查结肠镜检查的风险和益处达成共识，包括其潜在危害、患者偏好、社会经济因素、结肠镜检查质量的改善以及其对CRC预防的效果。由于结肠镜检查质量欠佳是基于人群的结肠镜检查筛查的一个主要缺陷，对筛查结肠镜检查医师进行充分培训并规范其执业应是尽量减少结肠镜检查医师之间质量差异的第一步。胃肠病学家应在基于人群的结肠镜检查筛查项目中引领与结肠镜检查相关的质量改进、审核和培训工作。
