Yoon Jin Young, Cha Jae Myung, Jeen Yoon Tae
Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 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.
Intest Res. 2018 Jan;16(1):48-54. doi: 10.5217/ir.2018.16.1.48. Epub 2018 Jan 18.
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 rates in population-based screening programs. 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 effects of colonoscopy may increase with age and comorbidities. As the risk of adverse events in population-based colonoscopy screening may offset the benefit, the adverse events should be managed and monitored. To adopt population-based colonoscopy screening, consensus on the risks and benefits should be developed, focusing on potential harm, patient preference, socioeconomic considerations, and quality improvement of colonoscopy, as well as efficacy for CRC prevention. As suboptimal colonoscopy quality is a major pitfall of population-based screening, adequate training and regulation of screening colonoscopists should be the first step in minimizing variations in quality. Gastroenterologists should promote quality improvement, auditing, and training for colonoscopy in a population-based 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不良事件的风险可能会抵消其益处，因此应对不良事件进行管理和监测。为了采用基于人群的结肠镜检查筛查，应就风险和益处达成共识，重点关注潜在危害、患者偏好、社会经济因素、结肠镜检查质量的改善以及预防CRC的效果。由于结肠镜检查质量欠佳是基于人群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和监管应是最大限度减少质量差异的第一步。胃肠病学家应在基于人群的筛查项目中促进结肠镜检查的质量改进、审核和培训。
