SNFGE SNFGE
 
Thématique :
- Endoscopie - Imagerie
- Cancer colorectal (CCR)
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Patrice PIENKOWSKI
Coup de coeur :
 
 
Gut
  2018/02  
 
  2018 Feb;67(2):291-298.  
  doi: 10.1136/gutjnl-2016-312712  
 
  Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study.  
 
  Doubeni CA, Corley DA, Quinn VP, Jensen CD, Zauber AG, Goodman M, Johnson JR, Mehta SJ, Becerra TA, Zhao WK, Schottinger J, Doria-Rose VP, Levin TR, Weiss NS, Fletcher RH  
  https://www.ncbi.nlm.nih.gov/pubmed/27733426  
 
 

Abstract

OBJECTIVE:

Screening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average-risk people, receipt of screening colonoscopy reduces the risk of dying from both right-colon and left-colon/rectal cancers.

DESIGN:

We conducted a nested case-control study with incidence-density matching in screening-eligible Kaiser Permanente members. Patients who were 55-90 years old on their colorectal cancer death date during 2006-2012 were matched on diagnosis (reference) date to controls on age, sex, health plan enrolment duration and geographical region. We excluded patients at increased colorectal cancer risk, or with prior colorectal cancer diagnosis or colectomy. The association between screening colonoscopy receipt in the 10-year period before the reference date and colorectal cancer death risk was evaluated while accounting for other screening exposures.

RESULTS:

We analysed 1747 patients who died from colorectal cancer and 3460 colorectal cancer-free controls. Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53).

CONCLUSIONS:

Screening colonoscopy was associated with a substantial and comparably decreased mortality risk for both right-sided and left-sided cancers within a large community-based population.

 

 
Question posée
 
La coloscopie prévient-elle aussi bien le CCR proximal que CCR distal ?
 
Question posée
 
Par rapport aux patients n’ayant pas eu de coloscopie de dépistage, ceux qui en avaient bénéficié ont une diminution de risque de décès par CCR de 67% (RR=0.33 ; 0.21-0.52) ; pour le CCR distal la réduction de risque est de 75% (RR=0.25 ; 0.12-0.53) ; pour le CCR proximal, la réduction de risque est de 65% (RR=0.35 ;0.18-0.65). Les auteurs concluent que la différence de protection par coloscopie du CCR colon droit/colon gauche est relativement faible et non statistiquement significative.
 
Commentaires

L’étude de Doubeni et al. confirme donc l’efficacité de la coloscopie comme outil de prévention. Les excellents résultats obtenus au niveau du colon proximal sont probablement à mettre au crédit de l’amélioration des pratiques, notamment de la préparation colique, preuve qu’un niveau d’exigence élevé améliore les résultats.

 
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