Cubiella Joaquín, Marzo-Castillejo Mercè, Mascort-Roca Juan José, Amador-Romero Francisco Javier, Bellas-Beceiro Begoña, Clofent-Vilaplana Joan, Carballal Sabela, Ferrándiz-Santos Juan, Gimeno-García Antonio Z, Jover Rodrigo, Mangas-Sanjuán Carolina, Moreira Leticia, Pellisè María, Quintero Enrique, Rodríguez-Camacho Elena, Vega-Villaamil Pablo
Servicio de Aparato Digestivo, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Ourense, España.
Unitat de Suport Recerca Metropolitana Sud - IDIAP, Cornellà de Llobregat, Barcelona, España.
Gastroenterol Hepatol. 2018 Nov;41(9):585-596. doi: 10.1016/j.gastrohep.2018.07.012. Epub 2018 Sep 20.
This document updates the recommendations made by the Spanish Society of Family and Community Medicine and the Spanish Association of Gastroenterology for the diagnosis and prevention of colorectal cancer (CRC). In order to evaluate the quality of the evidence and determine the recommendation levels of the interventions, we used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. This document establishes optimal delay intervals based on symptoms and the faecal immunochemical test (FIT) and recommends reducing the barriers for diagnostic confirmation in symptomatic subjects. With regard to CRC screening in the average-risk population, we propose strategies to achieve the universal implementation of organised CRC screening programmes based on biennial FIT and to increase the participation of the target population, including the involvement of Primary Healthcare. This Clinical Practice Guideline recommends universal screening for Lynch syndrome with mismatch repair proteins immunohistochemistry or microsatellite instability in incident CRCs and the use of gene panels in patients with adenomatous polyposis. It also updates the strategies to reduce the incidence and mortality of both CRC and other tumours associated with hereditary syndromes. Regarding non-hereditary familial CRC and surveillance after resection of adenomas, serrated lesions or CRC, we established the recommendations based on the attributable risk and the risk reduction of the proposed intervention. Finally, the document includes recommendations regarding surveillance intervals in inflammatory bowel disease and the attitude towards dysplasia.
本文件更新了西班牙家庭与社区医学学会及西班牙胃肠病学协会针对结直肠癌（CRC）诊断与预防所提出的建议。为评估证据质量并确定干预措施的推荐等级，我们采用了推荐分级、评估、制定与评价（GRADE）方法。本文件基于症状和粪便免疫化学检测（FIT）确定了最佳延迟间隔，并建议减少有症状患者诊断确认过程中的障碍。关于一般风险人群的CRC筛查，我们提出了一些策略，以实现基于每两年一次FIT的有组织CRC筛查项目的普遍实施，并提高目标人群的参与度，包括初级医疗保健的参与。本临床实践指南建议对新发病例的CRC进行错配修复蛋白免疫组化或微卫星不稳定性的林奇综合征普遍筛查，并对腺瘤性息肉病患者使用基因检测板。它还更新了降低CRC及与遗传性综合征相关的其他肿瘤发病率和死亡率的策略。关于非遗传性家族性CRC以及腺瘤、锯齿状病变或CRC切除后的监测，我们根据归因风险和所提议干预措施的风险降低情况制定了相关建议。最后，该文件包括了关于炎症性肠病监测间隔以及对发育异常的处理态度的建议。
