Appropriateness of endoscopic surveillance recommendations in organised colorectal cancer screening programmes based on the faecal immunochemical test
Appropriateness of endoscopic surveillance recommendations in organised colorectal cancer screening programmes based on the faecal immunochemical test
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DOI：
10.1136/gutjnl-2015-310139
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发表时间：
2016-11-01
期刊：
影响因子：
24.5
通讯作者：
Hassan, Cesare
中科院分区：
文献类型：
--
作者：
Zorzi, Manuel;Senore, Carlo;Hassan, Cesare
目的评估基于粪便免疫化学试验（FIT）的有组织结直肠癌（CRC）筛查方案中内镜监测建议的适宜性。设计74意大利CRC筛查规划提供了2011年和2013年fitt阳性结肠镜检查后建议的汇总数据。指数结肠镜检查分为阴性/无腺瘤和低危、中危和高危腺瘤。结肠镜检查后的建议包括恢复筛查（2年或5年后FIT）， 6个月或1年、3年或5年后进行内镜监测，手术或其他。我们评估了2011年和2013年与欧洲指南结肠镜检查后建议的偏差，以及2011年过度使用内窥镜监测与2013年内窥镜工作量相关的过程指标之间的相关性。结果分析49 704例结肠镜检查建议。高危、中危、低危性腺瘤和无性腺瘤的发生率分别为5.9%、19.3%、15.3%和51.5%。低风险和无腺瘤的病例中，内镜下监测推荐率分别为67.4%和7%。总体而言，37%的内镜监测建议是不适当的（6696/ 17860）。过度使用内窥镜监测与邀请的延伸呈正相关(相关系数（cc） 0.29；p值为0.03)，与fit +结肠镜检查后的依从性相关（cc为0.25，p值为0.05），与结肠镜总等待时间大于60天负相关（cc为-0.26，p值为0.05）。结论：在有组织的筛查方案中，对低风险或无腺瘤患者的不适当推荐率很高，影响了三分之一的内窥镜监测需求。
Objectives To assess the appropriateness of recommendations for endoscopic surveillance in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT).Design 74 Italian CRC screening programmes provided aggregated data on the recommendations given after FIT-positive colonoscopies in 2011 and 2013. Index colonoscopies were divided into negative/no adenoma and low-risk, intermediate-risk and high-risk adenomas. Postcolonoscopy recommendations included a return to screening (FIT after 2 years or 5 years), an endoscopic surveillance after 6 months or after 1 year, 3 years or 5 years, surgery or other. We assessed the deviation from the postcolonoscopy recommendations of the European Guidelines in 2011 and 2013 and the correlation between overuse of endoscopic surveillance in 2011 and the process indicators associated with the endoscopic workload in 2013.Results 49 704 postcolonoscopy recommendations were analysed. High-risk, intermediate-risk and low-risk adenomas, and no adenomas were reported in 5.9%, 19.3%, 15.3% and 51.5% of the cases, respectively. Endoscopic surveillance was inappropriately recommended in 67.4% and 7%, respectively, of cases with low-risk and no adenoma. Overall, 37% of all endoscopic surveillance recommendations were inappropriate (6696/17 860). Overuse of endoscopic surveillance was positively correlated with the extension of invitations (correlation coefficient (cc) 0.29; p value 0.03) and with compliance with post-FIT+ colonoscopy (cc 0.25; p value 0.05), while it was negatively correlated with total colonoscopy waiting times longer than 60 days (cc -0.26; p value 0.05).Conclusions In organised screening programmes, a high rate of inappropriate recommendations for patients with low risk or no adenomas occurs, affecting the demand for endoscopic surveillance by a third.