Supplementary Material for: Consensus on the Prevention, Screening, Early Diagnosis and Treatment of Colorectal Tumors in China: Chinese Society of Gastroenterology, October 14-15, 2011, Shanghai, China

<b><i>Background:</i></b> Colorectal cancer (CRC) is steadily increasing in China. Colorectal adenoma (CRA) is the most important precancerous disease of CRC. Screening for colorectal tumors can aid early diagnosis. Advances in endoscopic mucosal resection and endoscopic submucosal dissection can aid the early treatment of colorectal tumors. Furthermore, because of high risk of recurrence after removal of adenomas under endoscopy, factors contributing to recurrence, the follow-up mode and the interval established, and the feasibility of application and the time of various chemical preventions should be concerned. However, a relevant consensus on the screening, early diagnosis and treatment, and prevention of colorectal tumors in China is lacking. <b><i>Summary:</i></b> The consensus recommendations include epidemiology, pathology, screening, early diagnosis, endoscopic treatment, monitoring and follow-up, and chemoprevention of colorectal tumors in China. <b><i>Key Message:</i></b> This is the first consensus on the prevention, screening, early diagnosis and treatment of CRA and CRC in China based on evidence in the literature and on local data. <b><i>Practical Implications:</i></b> Through reviewing the literature, regional data and passing the consensus by an anonymous vote, gastroenterology experts from all over China launch the consensus recommendations in Shanghai. The incidence and mortality of CRC in China has increased, and the incidence or detection rate of CRA has increased rapidly. Screening for colorectal tumors should be performed at age 50-74 years. Preliminary screening should be undertaken to find persons at high risk, followed by colonoscopy. A screening cycle of 3 years is recommended for persistent interventions. Opportunistic screening is a mode suitable for the current healthcare system and national situation. Colonoscopy combined with pathological examination is the standard method for the diagnosis of colorectal tumors. CRA removal under endoscopy can prevent CRC to some extent, but CRA has an obvious recurrence trend. The follow-up interval after the removal or surgery of colorectal tumors should be different with lesions. Primary prevention of CRA includes improved diet with more fiber, supplements containing calcium and vitamin D, supplements containing folic acid for those with low hemoglobin levels, and cessation of tobacco smoking. Non-steroidal anti-inflammatory drugs and selective cyclooxygenase-2 inhibitors have been recognized to prevent recurrence after adenoma removal.

**背景：**
结直肠癌（Colorectal cancer, CRC）在我国的发病率呈持续上升趋势。结直肠腺瘤（Colorectal adenoma, CRA）是结直肠癌最重要的癌前病变。结直肠肿瘤筛查有助于实现早期诊断。内镜黏膜切除术（endoscopic mucosal resection）与内镜黏膜下剥离术（endoscopic submucosal dissection）的技术进展，可为结直肠肿瘤的早期治疗提供支持。此外，由于内镜下腺瘤切除后复发风险较高，需关注复发相关影响因素、随访模式与间隔时长、各类化学预防手段的应用可行性及实施时机。但目前国内尚缺乏针对结直肠肿瘤筛查、早期诊疗及预防的相关共识。
**总结：**
本共识建议涵盖我国结直肠肿瘤的流行病学、病理学、筛查、早期诊断、内镜治疗、监测随访及化学预防等内容。
**核心要点：**
这是国内首部基于文献证据与本土数据制定的结直肠腺瘤（CRA）与结直肠癌预防、筛查、早期诊疗共识。
**实践意义：**
来自全国各地的消化病学专家通过系统回顾文献与区域数据，并经匿名投票达成共识，于上海发布本共识建议。当前我国结直肠癌的发病率与死亡率均呈上升态势，结直肠腺瘤的发病率或检出率亦快速升高。推荐50~74岁人群开展结直肠肿瘤筛查：先通过初筛识别高危人群，再行结肠镜检查；对于持续筛查人群，推荐每3年为一个筛查周期。机会性筛查模式适配我国当前的医疗体系与国情。结肠镜联合病理检查是结直肠肿瘤诊断的标准方法。内镜下切除结直肠腺瘤可在一定程度上预防结直肠癌，但腺瘤存在显著的复发倾向。结直肠肿瘤切除或手术后的随访间隔需根据病灶情况个体化调整。结直肠腺瘤的一级预防措施包括：增加膳食纤维摄入、补充钙剂与维生素D、对血红蛋白水平偏低者补充叶酸，以及戒烟。非甾体类抗炎药与选择性环氧合酶-2抑制剂已被证实可预防腺瘤切除后的复发。