SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gut
  2017/08  
 
  017 Aug;66(8):1434-1440.  
  doi: 10.1136/gutjnl-2015-311278.  
 
  Comparing CT colonography and flexible sigmoidoscopy: a randomised trial within a population-based screening programme  
 
  Regge D, Iussich G, Segnan N, Correale L, Hassan C, Arrigoni A, Asnaghi R, Bestagini P, Bulighin G, Cassinis MC, Ederle A, Ferraris A, Galatola G, Gallo T, Gandini G, Garretti L, Martina MC, Molinar D, Montemezzi S, Morra L, Motton M, Occhipinti P, Pinali L, Soardi GA, Senore C  
  https://www.ncbi.nlm.nih.gov/pubmed/27196588  
 
 

Abstract

IMPORTANCE AND AIMS:

The role of CT colonography (CTC) as a colorectal cancer (CRC) screening test is uncertain. The aim of our trial was to compare participation and detection rate (DR) with sigmoidoscopy (flexible sigmoidoscopy (FS)) and CTC in a screening setting.

DESIGN SETTING AND PARTICIPANTS:

We conducted two randomised clinical trials (RCTs). (1) Participation RCT: individuals, aged 58 years, living in Turin (Italy), were randomly assigned to be invited to FS or CTC screening; (2) detection RCT: residents in northern Italy, aged 58-60, giving their consent to recruitment, were randomly allocated to CTC or FS. Polyps ≥6 mm at CTC, or 'high-risk' distal lesions at FS, were referred for colonoscopy (TC).

MAIN OUTCOME MEASURES:

Participation rate (proportion of invitees examined); DR of advanced adenomas or CRC (advanced neoplasia (AN)).

RESULTS:

Participation was 30.4% (298/980) for CTC and 27.4% (267/976) for FS (relative risk (RR) 1.1; 95% CI 0.98 to 1.29). Among men, participation was higher with CTC than with FS (34.1% vs 26.5%, p=0.011). In the detection RCT, 2673 subjects had FS and 2595 had CTC: the AN DR was 4.8% (127/2673, including 9 CRCs) with FS and 5.1% (133/2595, including 10 CRCs) with CTC (RR 1.08; 95% CI 0.85 to 1.37). Distal AN DR was 3.9% (109/2673) with FS and 2.9% (76/2595) with CTC (RR 0.72; 95% CI 0.54 to 0.96); proximal AN DR was 1.2% (34/2595) for FS vs 2.7% (69/2595) for CTC (RR 2.06; 95% CI 1.37 to 3.10).

CONCLUSIONS AND RELEVANCE:

Participation and DR for FS and CTC were comparable. AN DR was twice as high in the proximal colon and lower in the distal colon with CTC than with FS. Men were more likely to participate in CTC screening.

TRIAL REGISTRATION NUMBER:

NCT01739608; Pre-results.

 
Question posée
 
Le dépistage par coloscanner est-il supérieur au dépistage par rectosigmoidoscopie ?
 
Question posée
 
La détection des adénomes avancés par coloscanner était meilleure dans le colon droit (RR 2,06) mais inférieure dans le colon gauche (0,72) par rapport à la sigmoidoscopie.
 
Commentaires

Le taux de participation est globalement identique mais l’acceptabilité du coloscanner était meilleure dans la population masculine. A prendre en compte…

 
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