PillCam结肠胶囊内镜检查结肠病变作用的评估：首次多中心、前瞻性、比较研究结果

结直肠癌是发达国家第二常见的恶性肿瘤,发病率和病死率较高。有效的筛查措施可预防结直肠癌,目前指南推荐具有中等结直肠癌患病风险的患者应行筛查。多数专家认为传统结肠镜检查是筛查结直肠癌和发现结肠病变的最理想的方式,但其具有侵入性、部分患者存在禁忌证,且操作过程存在一定风险,如麻醉意外等：尽管越来越多的证据支持传统结肠镜检查对筛查结直肠癌具有明显优势,但大多数符合条件的、具有中等患病风险的人群并未接受任何筛查．包括传统结肠镜检查,可能与患者对检查感到恐惧、     

重视通过改变环境因素预防结直肠癌的研究

绝大多数结直肠癌是由腺瘤发展而来,环境因素在腺瘤的发生、发展过程中起重要作用。近年来与结直肠肿瘤发生相关的饮食、运动等生活方式的流行病学调查和药物干预研究证实,上述环境因素的改变影响着结直肠癌的发生、发展。筛查、内镜下腺瘤摘除和定期随访是目前结直肠癌预防的主要手段,但其效果仍不能令人满意,因此应重视通过改变环境因素预防结直肠癌的研究。临床工作中需对诸多干预手段有所侧重,发现和开拓因地制宜、个体化的预防策略。     

《消化系统疾病进展》继续教育学习班开班通知

<正> 由上海交通大学医学院附属仁济医院消化内科、上海市消化疾病研究所主办的2010年《消化系统疾病进展》学习班(国家级继续教育项目,项目编号:2010-03-03-129,I类学分10分)将于2010年8月13～16日举办,为期4天。本次学习班专题为胃肠疾病临床与基础进展——结直肠癌的发生、筛查、早期诊断、治疗和预防,由国内消化学科知名专家授课,内容新颖(包括结直肠癌及其癌前疾病的流行病学、早期结直肠癌的内镜和实验室诊断、结直肠癌腹腔镜下微创处理等),结合临床。欢迎消化内外     

中国早期结直肠癌筛查流程专家共识意见（2019，上海）

中国结直肠癌负担沉重,严重威胁人民群众的生命健康。为改变我国结直肠癌高发病率、高死亡率和低早期诊断率的现状,推进我国的结直肠癌筛查计划,2019年由国家消化系统疾病临床医学研究中心（上海）牵头,依托国家消化道早癌防治中心联盟,联合多个相关学会,组织我国消化、内镜、肿瘤、健康管理和内镜质控等多学科专家联合制定本共识意见,以期确立并细化适合我国实际情况的早期结直肠癌筛查流程,为筛查工作提供指导和参考。     

中国结直肠癌癌前病变和癌前状态处理策略专家共识

随着饮食结构持续改变和人口老龄化,结直肠癌不仅已成为我国常见恶性肿瘤之一,且发病率仍不断攀升,疾病负担沉重,严重威胁人民生命健康。尽早发现和处理结直肠癌癌前病变与状态,特别是结直肠腺瘤,有助于降低结直肠癌发病率和死亡率,实现预防关口前移和重心下移。鉴于此,国家消化系统疾病临床医学研究中心（上海）牵头,并联合中华医学会消化内镜学分会等多个学会,组织我国消化、内镜、肿瘤和健康管理等多学科专家共同制定了本共识,内容涵盖结直肠癌癌前病变与状态的定义、预防、筛查与诊断、治疗与随访等多个部分,以期为我国结直肠癌癌前病变和状态的科学管理提供参考。     

结直肠癌诊治和预防研究的热点问题

结直肠癌是我国及全球发病率和病死率较高的恶性肿瘤, 其发生、发展与环境因素和遗传因素相互作用有关。本文就结直肠癌领域国内外学者在基础研究以及结直肠癌筛查、预防和治疗、人工智能、免疫治疗等方面进展和热点问题进行综述。     

国内外结直肠癌筛查的对比分析及启示

我国结直肠癌的发病率和死亡率在逐年升高,严重威胁人民群众的健康,亟待采取行之有效并且适合我国国情的结直肠癌筛查策略,从而降低结直肠癌的疾病负担。目前面临的突出问题是,我国人群结直肠癌筛查项目覆盖尚不广泛,方法并不统一,有待形成完善的国家结直肠癌筛查体系。建立筛查体系的作用在于发现癌前病变和早期病例,从而降低发病率并提高早期病例构成比,具有很重要的卫生经济学意义。本文结合国内外最新指南共识,阐述国内外结直肠癌筛查的历程和现状,比较了结直肠癌筛查常用的方法,并对我国筛查的发展提出了展望,以期未来能够建立具有我国特色的结直肠癌筛查策略。     

上消化道肿瘤的预防和内镜下早期癌的发现与治疗

世界范围内,上消化道肿瘤具有高患病率和高死亡率的特点,由此产生的医疗费用也相当惊人,尤其是在高发病率的亚洲地区。因此上消化道肿瘤的预防以及内镜下早期癌的发现和治疗就显得非常重要,受到许多国家胃肠病学专家的关注。本文摘录了第六届上海国际胃肠病学会议期间欧美和亚太地区胃肠病学专家在这些方面的专题报告,分为致癌原、化学预防、癌前疾病、内镜下早期癌的发现和治疗等几方面进行介绍。     

结肠胶囊内镜最新研究进展

结直肠癌是最常见的恶性肿瘤之一,近年来,美国和一些发达国家的结直肠癌的发病率和病死率有所降低,这部分得益于结直肠癌的筛查和早期病变切除。目前结直肠癌筛查金标准是结肠镜检查,但此项检查为有创检查,检查舒适度差,部分受检者无法完成检查,有约3‰的并发症发生率,对设备和检查者技术依赖性也较高。因此,结肠镜检查筛查结直肠癌的完成率远低于客观需要。     

肠道准备质量评估量表应用现状

结肠镜检查已经成为结直肠癌筛查和预防的标准工具。通过结肠镜检查,医生可以及时发现并同步切除结直肠癌的癌前病变——腺瘤性息肉,从而达到预防结直肠癌发生的目的。随着设备和技术的不断进步,结肠镜检查发现息肉,尤其是小息肉的能力不断提升。     

自然人群序贯粪隐血试验连续性结直肠癌普查的队列研究：19年结果分析

筛查是早期发现结直肠癌（CRC）的重要手段。目的：评价自然人群序贯粪隐血试验（SFOBT）连续性CRC普查在提高早期CRC检出率、患者长期生存率和降低CRC发生率方面的作用。方法：于1987～2005年，应用SFOBT对一组基本固定的中老年人群（初次普查人群3002例）行连续性CRC普查。每1～2年接受一次普查者计入普查组，连续3年或3年以上未接受普查者计入未普查组。FOBT阳性者行结肠镜检查。于北京军区总医院行手术治疗的1033例CRC患者作为对照组。结果：19年中普查人群共发生CRC52例，总CRC发生率为90．4／10万人·年。普查组共检出CRC25例，漏诊7例，CRC检出率为57．6／10万人·年，发生率为73．8／10万人·年；未普查组发生CRC20例，发生率为141．4／10万人·年。普查组DukesA／B期患者比例（95．5％对31．2％和43．9％，P〈0．05）和5年生存率（77．8％对33．3％和39．8％，P〈0．05）显著高于未普查组和对照组。SFOBT筛查CRC的19年总敏感性为90．6％，特异性为98．0％，阳性预测值为3．2％，阴性预测值为99．99％。结论：SFOBT应用于自然人群连续性普查可提高早期CRC检出率和患者5年生存率。切除普查中发现的腺瘤可明显降低CRC发生率。该筛查方案具有较高的敏感性和特异性，但仍需高度关注其结肠镜检查的依从性.     

结直肠癌的临床病理特征及其与血清25羟基维生素D相关性的分析

背景:近年结直肠癌(CRC)的发病率和死亡率呈上升趋势,熟悉临床病理特征有助于提高CRC诊断水平。目的:总结CRC的临床病理特征并分析其与血清25羟基维生素D[25(OH)D]的相关性。方法:回顾性分析249例经结肠镜活检或术后病理证实的CRC患者的临床资料,以ELISA法检测血清25(OH)D水平,并分析其与CRC临床病理特征的相关性。结果:CRC好发于60岁的老年人(69.5%),男女之比为1.33∶1;直肠为最常见的发病部位(40.4%),便血为最常见的症状(41.0%),肿瘤大体类型以溃疡浸润型(54.9%)为主,病理类型主要为管状腺癌(75.1%)。与非老年组相比,老年组直肠癌发生率明显降低,右半结肠癌发生率明显上升,浸润型CRC少见,Ⅱ期CRC明显升高,排便习惯和性状改变更常见,细胞中分化率明显升高,差异均有统计学意义(P0.05)。老年、右半结肠和分期较晚的CRC患者血清25(OH)D水平明显降低(P0.05)。结论:老年CRC的发病部位、肿瘤类型、临床分期、临床表现和分化程度与非老年患者均有明显差异。血清25(OH)D水平可能与CRC患者年龄、发病部位、临床分期有关     

Effect of faecal occult blood testing on colorectal cancer mortality in the surveillance of subjects at moderate risk of colorectal neoplasia: a case-control study

Colonoscopy is the established method of surveillance of subjects at high risk of developing colorectal neoplasia. Its role in the surveillance of a population at moderate risk is less clear, however, as the procedure is expensive, time consuming and occasionally hazardous. The aim of this study was to estimate by case-control methods the effect of faecal occult blood (FOB) screening on colorectal cancer (CRC) mortality in a population at moderate risk of developing CRC. Screening by FOB testing prior to diagnosis in patients over the age of 45 years who died of CRC diagnosed in 1989-1998 was compared with screening in controls matched with the case for age and sex. Information about episodes of FOB testing and potential confounders was obtained from the data collection system of the screening programme. Cases were less likely than controls to have ever been screened, with an odds ratio of 0.64 (95% confidence interval 0.34-1.15) for exposure to at least one FOB testing. There was no significant difference between the sub-groups according to gender, age at diagnosis or location of the cancer. The inverse association between screening for faecal occult blood and fatal colorectal cancer suggests that screening in a population at moderate risk of CRC can reduce mortality from CRC in this group.     

Utility valuations for outcome states of colorectal cancer

OBJECTIVE: Utilities for the outcome states of colorectal cancer (CRC) must be measured to evaluate the cost-utility of screening and surveillance strategies for this disease. We sought to measure utilities for stage-dependent outcome states of CRC. METHODS: We identified persons who had previously undergone removal of colorectal adenoma. We conducted individual interviews in which these participants were presented with stage-dependent outcome states and were asked to assess utilities for them using the standard gamble technique. RESULTS: A total of 90 participants were interviewed; nine were excluded, leaving 81 for analysis. We obtained the following utility valuations: stage I rectal or stage I/II colon cancer (mean 0.74, median 0.75); stage III colon cancer (mean 0.67, median 0.75); stage II/III rectal cancer without ostomy (mean 0.59, median 0.60), stage II/III rectal cancer with ostomy (mean 0.50, median 0.55), stage IV rectal or colon cancer (mean 0.25, median 0.20). These valuations were statistically different from each other. CONCLUSIONS: We measured utilities for stage-dependent outcome states of CRC in a sample of persons who had previously undergone removal of colorectal adenoma. We found that our participants were able to differentiate between the presented outcome states and assigned lower utility to increasingly morbid states. Our results show that stage-dependent morbidity is an important consideration in CRC and should be incorporated into any decision analysis model evaluating the cost-effectiveness of CRC screening or surveillance.     

Colorectal cancer in young adults: A difficult challenge

Sporadic colorectal cancer(CRC) is traditionally diagnosed after the sixth decade of life,and current recommendations for surveillance include only patients older than 50 years of age. However,an increasing incidence of CRC in patients less than 40 years of age has been reported. This occurrence has been attributed to different molecular features and low suspicion of CRC in young symptomatic individuals. When confronting young-onset CRC with older patients,issues such as biological aggressiveness,stage at diagnosis and clinical outcomes seem to differ in many aspects. In the future,the identification of the molecular profile underlying the early development of sporadic CRC will help to plan tailored screening recommendations and improve management. Besides that,differential diagnosis with CRC linked with hereditary syndromes is necessary to provide adequate patient treatment and family screening. Until we find the answers to some of these doubts,doctors should raise suspicion when evaluating an young adult and be aware of this risk and consequences of a late diagnosis.     

Screening and surveillance methods for dysplasia in inflammatory bowel disease patients: Where do we stand?

Patients with long-standing ulcerative colitis(UC) and extensive Crohn's colitis(CC) are at increased risk for dysplasia and colorectal cancer(CRC). Several studies have shown that UC extending proximal to the rectum, CC involving at least 1/3 of the colon, co-existence of primary sclerosing cholangitis, undetermined or unclassified colitis, family history of CRC and young age at diagnosis appear to be independent risk factors for inflammatory bowel disease(IBD)-related CRC. Therefore, screening and surveillance for CRC in IBD patients is highly recommended by international and national guidelines, whilst colonoscopy remains the unequivocal tool in order to detect potentially resectable dysplastic lesions or CRC at an early stage. Although the importance of screening and surveillance is widely proven, there is a controversy regarding the time of the first colonoscopy and the criteria of who should undergo surveillance. In addition, there are different recommendations among scientific societies concerning which endoscopic method is more efficient to detect dysplasia early, as well as the terminology for reporting visible lesions and the management of those lesions. This article concisely presents the main endoscopic methods and techniques performed for detecting dysplasia and CRC surveillance in patients with IBD focusing on their evidence-based accuracy and efficiency, as well as their cost-effectiveness. Finally, newer methods are mentioned, highlighting their applicability in daily endoscopic practice.     

大肠癌筛查方法研究新进展

大肠癌筛查能够有效降低大肠癌相关发病率及死亡率,现有多种基于人群的大肠癌筛查方法,本文对其筛查方法的研究进展进行概述,并展望未来发展趋势。     

国内医务人员大肠癌筛查认识现状分析及建议

目的了解我国医务人员对大肠癌筛查的认识现状,分析影响筛查的因素并提出建议。方法随机对300名来自不同地方、不同等级医疗机构的医务人员进行问卷调查并分析结果。结果147名医务人员填写调查表,应答率49.00%;55%～80%的被调查者不了解普通人群大肠癌筛查方式、起始年龄及频率;大肠肿瘤筛查的了解程度与被调查医务人员的专业、学历、工作年限、医院等级无明显关系;76.87%的被调查者推荐高危人群定期行大肠癌筛查并能指出正确的筛查方法。结论我国医务人员对大肠癌筛查的相关知识不甚清楚且重视程度不够;对高危人群大肠癌筛查有一定认识但对普通人群筛查知识了解较少。     

Screening for colorectal cancer: medical and economic aspects

BACKGROUND: Colorectal cancer (CRC) is the second commonest cause of cancer death in the Western world. In The Netherlands, CRC causes about 4400 deaths per year, and its diagnosis and treatment make up for a large share of health-care costs. METHODS: Review and discussioN. RESULTS: Experts in the field presently assume that screening for CRC and its precursor lesions, colorectal adenomas (CRAs), could prevent death from colorectal neoplasia by more than 80%. Additionally, there is increasing acknowledgement that CRC screening programmes can save lives at a cost similar to, or even less than, the generally accepted breast cancer or cervical cancer screening programmes. Nonetheless, while neighbouring countries have taken vigorous measures to fight CRC, the Dutch are still hesitating in this matter. This is partly due to some yet unanswered questions concerning the acceptability of screening for CRC in the general population, the starting age and the frequency of screening, the type of screening tests to be used, and the programme organization. In this commentary, general epidemiological and pathogenetic aspects of CRC are addressed. In addition, some frequently asked questions (FAQ) and (very subjective) answers about screening for CRC are offered, as potential substrate for further in-depth discussions. CONCLUSION: The emerging message for the community is that an effective national screening programme is urgently required to reduce the substantial morbidity and mortality from this disease.     

Colorectal cancer screening and surveillance in the elderly patient

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Older age is associated with a rise in colorectal cancer and adenomas, necessitating the need for CRC screening in older patients. However, decisions about CRC screening and surveillance in older adults are often difficult and challenging. The decision requires an individualized assessment that incorporates factors unique to performing colonoscopy in older adults in order to weigh the risks and benefits for each patient according to their overall health and preferences. This review addresses the factors unique to colorectal cancer and performing colonoscopy in older adults that are relevant in weighing the risks and benefits of screening and surveillance in this population.