期刊文献+

Different standards for healthy screenees than patients in routine clinics? 被引量:1

Different standards for healthy screenees than patients in routine clinics?
下载PDF
导出
摘要 Less than 5%of colorectal adenomas will become malignant,but we do not have sufficient knowledge about their natural course to target removal of these5%only.Thus,95%of polypectomies are a waste of time exposing patients to a small risk of complications.Recently,a new type of polyps,sessile serrated polyps,has attracted attention.Previously considered innocuous,they are now found to have molecular similarities to cancer and some guidelines recommend to have them removed.These lesions are often flat,covered by mucous,not easily seen and situated in the proximal colon where the bowel wall is thinner.Thus,polypectomy carries a higher risk of perforation than predominantly left-sided,stalked adenomas-and we do not know what is gained in terms of cancer prevention.Screening is a neat balance between harms and benefit for presumptively healthy participants not interested in risk exposure to obtain confirmation of being healthy.The situation is quite different for patient worried about symptom.Thus,the standards set for evidence-based practice may be higher for screening than for routine clinics-a mechanism which may benefit patients in the long run. Less than 5% of colorectal adenomas will become malignant, but we do not have sufficient knowledge about their natural course to target removal of these 5% only. Thus, 95% of polypectomies are a waste of time exposing patients to a small risk of complications. Recently, a new type of polyps, sessile serrated polyps, has attracted attention. Previously considered innocuous, they are now found to have molecular similarities to cancer and some guidelines recommend to have them removed. These lesions are often flat, covered by mucous, not easily seen and situated in the proximal colon where the bowel wall is thinner. Thus, polypectomy carries a higher risk of perforation than predominantly left-sided, stalked adenomas - and we do not know what is gained in terms of cancer prevention. Screening is a neat balance between harms and benefit for presumptively healthy participants not interested in risk exposure to obtain confirmation of being healthy. The situation is quite different for patient worried about symptom. Thus, the standards set for evidence-based practice may be higher for screening than for routine clinics - a mechanism which may benefit patients in the long run.
作者 Geir Hoff
出处 《World Journal of Gastroenterology》 SCIE CAS 2013年第46期8527-8530,共4页 世界胃肠病学杂志(英文版)
关键词 COLONOSCOPY Screening Quality ASSURANCE STANDARDS Colonoscopy, Screening, Quality assurance, Standards
  • 引文网络
  • 相关文献

参考文献26

  • 1M. Kaminski,M. Bretthauer,A. Zauber,E. Kuipers,H.-O. Adami,M. van Ballegooijen,J. Regula,M. van Leerdam,T. Stefansson,L. P?hlman,E. Dekker,M. Hernán,K. Garborg,G. Hoff.The NordICC Study: Rationale and design of a randomized trial on colonoscopy screening for colorectal cancer[J]. Endoscopy . 2012 (07)
  • 2V. Panteris,J. Haringsma,E. Kuipers.Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy[J]. Endoscopy . 2009 (11)
  • 3J. Ferlay,D.M. Parkin,E. Steliarova-Foucher.Estimates of cancer incidence and mortality in Europe in 2008[J]. European Journal of Cancer . 2009 (4)
  • 4Victoria S.Benson,JuliettaPatnick,Anna K.Davies,Marion R.Nadel,Robert A.Smith,Wendy S.Atkin.Colorectal cancer screening: A comparison of 35 initiatives in 17 countries[J]. Int. J. Cancer . 2008 (6)
  • 5A Sieg,H Brenner.Kosten-Nutzen-Analyse der pr?ventiven Koloskopie in Deutschland[J]. Z Gastroenterol . 2007 (09)
  • 6Sidney J. Winawer.Colorectal cancer screening[J]. Best Practice & Research Clinical Gastroenterology . 2007 (6)
  • 7G. Imperiali,G. Minoli,G. M. Meucci,G. Spinzi,E. Strocchi,V. Terruzzi,F. Radaelli.Effectiveness of a continuous quality improvement program on colonoscopy practice[J]. Endoscopy . 2007 (04)
  • 8Geir Hoff,Michael Bretthauer,Gert Huppertz-Hauss,Eirik Kittang,Asbj?rn Stallemo,Ole H?ie,Stein Dahler,Sverre Nyhus,Fred-Arne Halvorsen,Jens Pallenschat,K?re Vetvik,Per Kristian Sandvei,Joachim Friestad,Reidar Pytte,Peter Coll.The Norwegian Gastronet project: Continuous quality improvement of colonoscopy in 14 Norwegian centres[J]. Scandinavian Journal of Gastroenterology . 2006 (4)
  • 9W. Heldwein,M. Dollhopf,T. R?sch,A. Meining,G. Schmidtsdorff,J. Hasford,P. Hermanek,R. Burlefinger,B. Birkner,W. Schmitt.The Munich Polypectomy Study (MUPS): Prospective Analysis of Complications and Risk Factors in 4000 Colonic Snare Polypectomies[J]. Endoscopy . 2005 (11)
  • 10Anthony Greisinger,Sarah T. Hawley,Judy L. Bettencourt,Catherine A. Perz,Sally W. Vernon.Primary care patients’ understanding of colorectal cancer screening[J]. Cancer Detection and Prevention . 2005 (1)

同被引文献2

引证文献1

二级引证文献11

;
使用帮助 返回顶部