Elwood J M, Ali G, Schlup M M, McNoe B, Barbezat G O, North F, Sutton K, Parry B, Chadwick V S
Hugh Adam Cancer Epidemiology Unit, University of Otago, Dunedin, New Zealand.
Cancer Detect Prev. 1995;19(4):337-47.
In a randomized clinical trail to assess acceptability, yields, costs, and unwanted effects of screening procedures, 232 subjects (137 with family history of colorectal carcinoma or adenoma, 95 without) were offered either flexible sigmoidoscopy or colonoscopy. Subjects with polyps found on sigmoidoscopy were followed up by colonoscopy. The two procedures were similar in compliance (65%) and yield (19% adenoma, 15% hyperplastic polyps). Polyps of either type were more common in those with a family history (prevalence: 41% compared with 24% without family history, p = 0.04). Costs per procedure were 60% lower for sigmoidoscopy, but follow-up colonoscopy reduced this cost advantage to 20% per subject. The subjects found the preparation for sigmoidoscopy easier, but the procedure more uncomfortable and embarrassing, as colonoscopy was performed under sedation. In this hospital-based study, colonoscopy was as acceptable to subjects, and only slightly more costly than sigmoidoscopy. Advantages of sigmoidoscopy would be greater for use outside hospitals and with less intensive follow up.
在一项评估筛查程序的可接受性、检出率、成本和不良反应的随机临床试验中，232名受试者（137名有结直肠癌或腺瘤家族史，95名无家族史）被提供了乙状结肠镜检查或结肠镜检查。在乙状结肠镜检查中发现息肉的受试者接受了结肠镜检查随访。两种检查方法在依从性（65%）和检出率（腺瘤19%，增生性息肉15%）方面相似。两种类型的息肉在有家族史的人群中更为常见（患病率：41%，无家族史者为24%，p = 0.04）。乙状结肠镜检查的每次检查成本低60%，但后续的结肠镜检查使每位受试者的成本优势降至20%。受试者发现乙状结肠镜检查的准备工作更容易，但该检查过程更不舒服且令人尴尬，因为结肠镜检查是在镇静状态下进行的。在这项基于医院的研究中，结肠镜检查对受试者来说同样可以接受，且成本仅比乙状结肠镜检查略高。乙状结肠镜检查在院外使用且随访强度较低时优势会更大。
