López-Kostner Francisco, Zárate Alejandro J, Ponce Alejandra, Kronberg Udo, Kawachi Hiroshi, Okada Takuya, Tsubaki Masahiro, Ito Takashi, Nishikage Tetsuro, Tanaka Koji, Kawano Tatsuyuki, Eishi Yoshinobu, Peñaloza Paulina, Estela Ricardo, Karelovic Stanko, Flores Sergio
Unidad de Coloproctología, Clínica Las Condes, Santiago, Chile.
Tokyo Medical and Dental University, Tokyo, Japón.
Rev Med Chil. 2018 Jun;146(6):685-692. doi: 10.4067/s0034-98872018000600685.
Colorectal Cancer Screening Programs (CRCSP) are widely accepted in developed countries. Unfortunately, financial restrictions, low adherence rate and variability on colonoscopy standardization hamper the implementation of CRCSP in developing countries.
To analyze a multicentric pilot model of CRCSP in Chile.
A prospective model of CRCSP was carried out in three cities, from 2012 to 2015. The model was based on CRC risk assessment and patient education. Health care personnel were trained about logistics and protocols. The endoscopy team was trained about colonoscopy standards. A registered nurse was the coordinator in each center. We screened asymptomatic population aged between 50 and 75 years. Immunological fecal occult blood test (FIT) was offered to all participants. Subjects with positive FIT underwent colonoscopy.
A total of 12,668 individuals were enrolled, with a FIT compliance rate of 93.9% and 2,358 colonoscopies were performed. Two hundred and fifty high-risk adenomas and 110 cancer cases were diagnosed. One patient died before treatment due to cardiovascular disease, 74 patients (67%) underwent endoscopic resection and 35 had surgical treatment. Ninety one percent of patients had an early stage CRC (0-I-II). Among colonoscopy indicators, 80% of cases had an adequate bowel preparation (Boston > 6), cecal intubation rate was 97.7%, adenoma detection rate was 36.5%, and in 94.5% of colonoscopies, withdrawal time was adequate (> 8 min).
This CRCS pilot model was associated to a high rate of FIT return and colonoscopy quality standards. Most CRCs detected with the program were treated by endoscopic resection.
结直肠癌筛查项目（CRCSP）在发达国家已被广泛接受。不幸的是，资金限制、低依从率以及结肠镜检查标准化的差异阻碍了CRCSP在发展中国家的实施。
分析智利CRCSP的多中心试点模式。
2012年至2015年在三个城市开展了CRCSP前瞻性模式。该模式基于CRC风险评估和患者教育。医护人员接受了后勤和方案方面的培训。内镜检查团队接受了结肠镜检查标准方面的培训。每个中心由一名注册护士担任协调员。我们对50至75岁的无症状人群进行了筛查。为所有参与者提供了免疫粪便潜血试验（FIT）。FIT呈阳性的受试者接受了结肠镜检查。
共纳入12668人，FIT依从率为93.9%，进行了2358例结肠镜检查。诊断出250例高危腺瘤和110例癌症病例。1例患者因心血管疾病在治疗前死亡，74例患者（67%）接受了内镜切除，35例接受了手术治疗。91%的患者患有早期CRC（0-I-II期）。在结肠镜检查指标中，80%的病例肠道准备充分（波士顿评分>6），盲肠插管率为97.7%，腺瘤检出率为36.5%，94.5%的结肠镜检查退镜时间充足（>8分钟）。
这种CRCSP试点模式与高FIT返回率和结肠镜检查质量标准相关。该项目检测出的大多数CRC通过内镜切除进行治疗。
