Casas Maria A, Pereyra Lisandro, Angeramo Cristian A, Monrabal Lezama Manuela, Schlottmann Francisco, Rotholtz Nicolás A
Department of Surgery, Division of Colorectal Surgery, Hospital Alemán.
Gastroenterology Division, Hospital Alemán.
Surg Laparosc Endosc Percutan Tech. 2024 Dec 1;34(6):590-595. doi: 10.1097/SLE.0000000000001326.
The effectiveness of colonoscopy in preventing colorectal cancer (CRC) within opportunistic screening programs has not been clearly established. The aim of this study was to analyze the effectiveness of colonoscopy within an opportunistic screening program using nested case-control study.
Subjects who received a diagnosis of CRC (CG) between the ages of 50 and 90 years were included and matched by age and gender in a 1:5 ratio with patients without CRC diagnosis (COG) during the period 2015 to 2023. Using conditional regression analyses, we tested the association between screening colonoscopy and CRC. Subgroup analyses were then performed for CRC location, endoscopist specialty, and colonoscopy quality.
Of the 134 patients in CG, 19 (14.18%) had a colonoscopy in the preceding 5 years compared with 258 out of 670 (38.51%) in COG (AOR, 0.24; 95% CI: 0.14-0.41). Any colonoscopy was strongly associated with decreased odds for left-sided CRC (AOR, 0.09; 95% CI: 0.04-0.24) but not for right-sided CRC (AOR, 0.58; 95% CI: 0.29-1.17). Only complete colonoscopy (AOR, 0.41; 95% CI: 0.19-0.89) and colonoscopy with satisfactory bowel preparation (AOR, 0.38; 95% CI: 0.15-0.98) were associated with decreased odds for right-sided CRC. No significant differences in colonoscopy outcomes were found when stratifying by endoscopist specialty.
In the setting of an opportunistic screening program, exposure to any colonoscopy significantly reduced left-sided CRC incidence; however, only high-quality colonoscopy was associated with a lower incidence of right-sided CRC. Therefore, every possible effort should be made to optimize the quality and cost-effectiveness of colonoscopy within an opportunistic screening program.
在机会性筛查项目中，结肠镜检查预防结直肠癌（CRC）的有效性尚未明确确立。本研究的目的是使用巢式病例对照研究分析机会性筛查项目中结肠镜检查的有效性。
纳入年龄在50至90岁之间被诊断为CRC的受试者（病例组），并在2015年至2023年期间按年龄和性别以1:5的比例与未诊断为CRC的患者（对照组）进行匹配。使用条件回归分析，我们检验了筛查结肠镜检查与CRC之间的关联。然后针对CRC位置、内镜医师专业和结肠镜检查质量进行亚组分析。
病例组的134例患者中，19例（14.18%）在过去5年内进行了结肠镜检查，而对照组的670例中有258例（38.51%）进行了结肠镜检查（比值比[AOR]，0.24；95%置信区间[CI]：0.14 - 0.41）。任何结肠镜检查都与左侧CRC的发病几率降低密切相关（AOR，0.09；95% CI：0.04 - 0.24），但与右侧CRC无关（AOR，0.58；95% CI：0.29 - 1.17）。只有全结肠镜检查（AOR，0.41；95% CI：0.19 - 0.89）和肠道准备满意的结肠镜检查（AOR，0.38；95% CI：0.15 - 0.98）与右侧CRC的发病几率降低相关。按内镜医师专业分层时，结肠镜检查结果无显著差异。
在机会性筛查项目中，接受任何结肠镜检查可显著降低左侧CRC的发病率；然而，只有高质量的结肠镜检查与右侧CRC的较低发病率相关。因此，应尽一切可能努力优化机会性筛查项目中结肠镜检查 的质量和成本效益。
