{"id":20859,"date":"2021-03-08T12:25:10","date_gmt":"2021-03-08T11:25:10","guid":{"rendered":"https:\/\/www.mgc.es\/?p=20859"},"modified":"2021-03-08T12:25:11","modified_gmt":"2021-03-08T11:25:11","slug":"la-colonoscopia-cada-cop-mes-necessaria-pero-cada-cop-mes-confortable","status":"publish","type":"post","link":"https:\/\/www.mgc.es\/ca\/blog\/la-colonoscopia-cada-cop-mes-necessaria-pero-cada-cop-mes-confortable\/","title":{"rendered":"La colonosc\u00f2pia, cada cop m\u00e9s necess\u00e0ria per\u00f2 cada cop m\u00e9s confortable"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_82_2 counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\"><p class=\"ez-toc-title\" style=\"cursor:inherit\">\u00cdndex de continguts<\/p>\n<\/div><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.mgc.es\/ca\/blog\/la-colonoscopia-cada-cop-mes-necessaria-pero-cada-cop-mes-confortable\/#Prevenir_abans_que_es_desenvolupi\" >Prevenir abans que es desenvolupi<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.mgc.es\/ca\/blog\/la-colonoscopia-cada-cop-mes-necessaria-pero-cada-cop-mes-confortable\/#Programes_de_cribat\" >Programes de cribat<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.mgc.es\/ca\/blog\/la-colonoscopia-cada-cop-mes-necessaria-pero-cada-cop-mes-confortable\/#Colonoscopia_preventiva\" >Colonoscopia preventiva<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.mgc.es\/ca\/blog\/la-colonoscopia-cada-cop-mes-necessaria-pero-cada-cop-mes-confortable\/#Dieta_els_dies_previs_a_la_prova\" >Dieta els dies previs a la prova<\/a><\/li><\/ul><\/nav><\/div>\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"880\" height=\"585\" src=\"https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colon.-redujpg-880x585.jpg\" alt=\"\" class=\"wp-image-20870\" srcset=\"https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colon.-redujpg-880x585.jpg 880w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colon.-redujpg-440x292.jpg 440w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colon.-redujpg-768x510.jpg 768w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colon.-redujpg-600x400.jpg 600w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colon.-redujpg.jpg 1024w\" sizes=\"auto, (max-width: 880px) 100vw, 880px\" \/><\/figure>\n\n\n\n<p>Segons dades del Pla Director d\u2019Oncologia de Catalunya, el c\u00e0ncer de c\u00f2lon i recte, tamb\u00e9 dit colorectal o simplement de c\u00f2lon, \u00e9s un tumor molt freq\u00fcent a Catalunya. Ocupa el tercer lloc, darrere del c\u00e0ncer de pr\u00f2stata i del de pulm\u00f3, en el homes i el segon, darrere del de mama, en les dones.<sup>1<\/sup>La superviv\u00e8ncia \u00e9s del 55% en els homes i del 58% en les dones, molt per sota dels altres c\u00e0ncers m\u00e9s habituals, com el de pr\u00f2stata i el de mama. Segons la Direcci\u00f3 General de Salut i Seguretat dels Aliments de la Comissi\u00f3 Europea, s\u2019espera que el 2025 augmenti el c\u00e0ncer de c\u00f2lon en un 10,8% arreud&#8217;Espanya.<sup>2<\/sup>Paral\u00b7lelament a aquesta informaci\u00f3,s\u2019han publicat diferents estudis d\u2019abast mundial que mostren un despla\u00e7ament de la forquilla d&#8217;edat pel que fa a la incid\u00e8ncia del c\u00e0ncer colorectal: fins no fa gaire se situava entre els 50 i els 70 anys, i ara afecta una poblaci\u00f3 m\u00e9s jove. <sup>3,4,5 <\/sup>A Europa el creixement del risc de teniraquest c\u00e0ncer \u00e9s m\u00e9s alt entre els m\u00e9s joves.<sup>6 <\/sup>En resum, els anys vinents s\u2019espera que augmenti el nombre de casos de c\u00e0ncer de c\u00f2lon en persones m\u00e9s joves. La Societat Americanacontra el C\u00e0ncer (ACS) recomana d&#8217;en\u00e7\u00e0 del 2018 d&#8217;avan\u00e7ar el cribratge als 45 anys,<sup>7<\/sup> en comptes de fer-lo als 50 anys com era habitual. Per fer front a aquest problema, la majoria de pa\u00efsos occidentals ha endegat programes de cribratge del c\u00e0ncer de c\u00f2lon.<sup><\/sup><\/p>\n\n\n\n<p>Els programes de cribratge de c\u00e0ncer, tan si \u00e9s de c\u00f2lon, de mama com de pr\u00f2stata, persegueixen la detecci\u00f3 del c\u00e0ncer en una fase incipient, abans que se&#8217;n manifestin s\u00edmptomes, perqu\u00e8 el c\u00e0ncer \u00e9s m\u00e9s diminut. L\u00f2gicament, com m\u00e9s petit \u00e9s el tumor, m\u00e9s bon pron\u00f2stic t\u00e9. Aix\u00f2 \u00e9s v\u00e0lid per als programes de cribratge del c\u00e0ncer de c\u00f2lonque es basen en tests de sang oculta en la femta, els qual pretenende detectar c\u00e0ncers de c\u00f2lon en les fases m\u00e9s primerenques.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Prevenir_abans_que_es_desenvolupi\"><\/span>Prevenir abans que es desenvolupi<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Ara b\u00e9, el c\u00e0ncer de c\u00f2lon t\u00e9 una peculiaritat que no tenen els altres c\u00e0ncers. De fet, el c\u00e0ncer de c\u00f2lon es pot prevenir i impedir que es desenvolupi. No cal esperar que es diagnostiqui quan ja s&#8217;ha format, encara que sigui diminut. El 95% dels c\u00e0ncers de c\u00f2lon creixen al damunt d\u2019una lesi\u00f3 pr\u00e8via benigna: el p\u00f2lip de c\u00f2lon.<sup>8 <\/sup>Hi ha diversos tipus de p\u00f2lip, i no tots evolucionen cap a tumors malignes. L\u2019adenoma, tal com s&#8217;anomena en terminologia m\u00e8dica, \u00e9s el p\u00f2lip sobre el qual es desenvolupa el c\u00e0ncer. L\u2019adenoma de c\u00f2lon \u00e9s molt freq\u00fcent. Fa trenta anys es va trobar que una quarta part de la poblaci\u00f3 del nostre entorn<sup>9<\/sup>de m\u00e9s de cinquanta anys era portadora d\u2019adenomes de c\u00f2lon. \u00c9s evident amb aquesta dada que no tots els adenomes acaben en un c\u00e0ncer, per\u00f2 cal recordar, a la inversa, que la majoria de c\u00e0ncers de c\u00f2lon creixen sobre els adenomes. No es pot predir encara quin adenoma evolucionar\u00e0 capa un c\u00e0ncer. Per tant, la tend\u00e8ncia actual \u00e9s mirard&#8217;extirpar tots els adenomes que apareixen. L\u2019extirpaci\u00f3 d\u2019un p\u00f2lip, sigui del tipus que sigui, rep el nom gen\u00e8ric de polipectomia (del grecamb el mateix significat).<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"880\" height=\"598\" src=\"https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/tubo-heces-redu-880x598.jpg\" alt=\"\" class=\"wp-image-20879\" srcset=\"https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/tubo-heces-redu-880x598.jpg 880w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/tubo-heces-redu-440x299.jpg 440w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/tubo-heces-redu-768x522.jpg 768w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/tubo-heces-redu.jpg 1500w\" sizes=\"auto, (max-width: 880px) 100vw, 880px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Programes_de_cribat\"><\/span>Programes de cribat<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Avui dia hi ha dos tipus de programa de cribratge de c\u00e0ncer de c\u00f2lon.El m\u00e9s utilitzat pels Serveis de Salut es basa en la detecci\u00f3 de sang oculta a la femta. Un resultat positiuindica la pres\u00e8ncia d\u2019una lesi\u00f3 al c\u00f2lon.Aleshores cal fer una exploraci\u00f3 f\u00edsica per saber de quina lesi\u00f3 es tracta.Es diagnostica un c\u00e0ncer en menys d\u2019un 10% dels casos.<sup>10<\/sup> La resta s\u00f3n lesions benignes.L\u2019altre programa es basa a explorar directament el c\u00f2lon, iofereix alhora la possibilitat d\u2019identificar adenomes i d&#8217;extirpar-los.L&#8217;\u00fanica exploraci\u00f3 m\u00e8dica que agrupa totes dues possibilitats, el diagn\u00f2stic i el tractament, en una solaintervenci\u00f3 \u00e9s la colonosc\u00f2pia associada a la polipectomia. Tots dos programes de cribratge tenen la mateixa efic\u00e0cia a l&#8217;hora dedeterminar si es t\u00e9 c\u00e0ncer de c\u00f2lon, per\u00f2 la segona opci\u00f3 multiplica per cinc la detecci\u00f3 d\u2019adenomes<sup>11<\/sup> i ofereix una protecci\u00f3 contra el c\u00e0ncer del 77%.<sup>12<\/sup><\/p>\n\n\n\n<p>Per als ne\u00f2fits especificarem que, tant la colonosc\u00f2pia (del grec mirar el c\u00f2lon) com la polipectomia, es duen a terme amb un aparell m\u00e8dic que s\u2019anomena colonoscopi. El colonoscopi \u00e9s un tub flexible de 170cm de llargada i 13mm de gruix, que s&#8217;articula en l\u2019extrem m\u00e9s distal. Porta incorporat tot un sistema de guiatge, d&#8217;enregistrament electr\u00f2nic d\u2019imatge, d&#8217;il\u00b7luminaci\u00f3, d&#8217;aspiraci\u00f3 de l\u00edquid, de neteja i de canals per on es pot introduir instrumental de cirurgia menor. Cal considerar aquest instrument m\u00e8dic com un prodigi tecnol\u00f2gic. El colonoscopi explora el c\u00f2lon tot introduint-lo per l\u2019anus.Es tracta d\u2019una exploraci\u00f3 inc\u00f2moda i potencialment molt dolorosa. A m\u00e9s, com tota la resta d\u2019exploracions m\u00e8diques del c\u00f2lon, \u00e9s necessari que no hi hagi cap resta de femta per garantir la visi\u00f3 de tota la superf\u00edcie interna del c\u00f2lon, que \u00e9s on neixen els p\u00f2lips i creixen els c\u00e0ncers.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Colonoscopia_preventiva\"><\/span>Colonoscopia preventiva<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Fins als anys noranta dels segle passat les colonosc\u00f2pies tenien diversos inconvenients: el mal que feia la introducci\u00f3 del colonoscopi, el dolor persistent uncop acabada la prova i la incomoditat que representava la neteja del c\u00f2lon.<\/p>\n\n\n\n<p>La colonosc\u00f2pia en mans expertes \u00e9s molt segura i no causa lesions a les v\u00edsceres internes; el risc-benefici \u00e9s totalment assumible. El dolor \u00e9s fruit simplement delamanipulaci\u00f3 de les nanses del budell i de la inflor com a conseq\u00fc\u00e8ncia d&#8217;insuflar aire per dilatar el c\u00f2lon. Inicialment les exploracions endosc\u00f2piques digestives es feien amb una sedaci\u00f3 m\u00ednima o sense. Moltes exploracions no es podien acabar per dolor. El record del dolor feia que una part important dels pacients que se\u2019n havien de fer diverses les rebutgessin. Quan es van desplegar els programes de cribratge,va caldredur a terme colonosc\u00f2pies indolores. Des de llavors totes les colonosc\u00f2pies es fan sota els efectes de la sedaci\u00f3, sigui controlada pel mateix metge endoscopista o per un anestesi\u00f2leg. El record que deixa la sedaci\u00f3 actualment \u00e9s fins i tot agradable i facilita que els pacients acceptin, si cal, colonosc\u00f2pies repetides de seguiment.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"880\" height=\"587\" src=\"https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colonoscopia-redu-880x587.jpg\" alt=\"\" class=\"wp-image-20881\" srcset=\"https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colonoscopia-redu-880x587.jpg 880w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colonoscopia-redu-440x293.jpg 440w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colonoscopia-redu-768x512.jpg 768w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colonoscopia-redu-600x400.jpg 600w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/colonoscopia-redu.jpg 1500w\" sizes=\"auto, (max-width: 880px) 100vw, 880px\" \/><\/figure>\n\n\n\n<p>El budell gestiona molt malamentl&#8217;aire perqu\u00e8 dif\u00edcilment \u00e9s absorbit i cal expulsar-lo per l\u2019anus. La gent que pateix d\u2019exc\u00e9s de gasos ho sap prou b\u00e9. Normalment el c\u00f2lon est\u00e0 encorbati s\u2019had\u2019inflar per dilatar-lo i poder-lo estudiar en tota l&#8217;extensi\u00f3. Quan s\u2019utilitzava aire per estirar el c\u00f2lon,l\u2019aire romanent dins del budell, despr\u00e9s de la prova, podia causar un dolor intens que no remetia fins que no era expulsat. Aquest problema s\u2019ha solucionat substituint l\u2019aire perl\u2019anh\u00eddrid carb\u00f2nic, que permet tamb\u00e9 d&#8217;explorar perfectament el c\u00f2lon. El budell absorbeix totalment l\u2019anh\u00eddrid carb\u00f2nic cent vegades m\u00e9s r\u00e0pidament que l\u2019aire ambient. Quan s\u2019acaba la prova, el pacient no nota ni dolor ni inflor abdominal.<\/p>\n\n\n\n<p>La neteja del c\u00f2lon presenta diversos problemes. \u00c9s inc\u00f2moda, complicada i cal fer-la a hores intempestives. A m\u00e9s a m\u00e9s, se n&#8217;han d\u2019eliminar totes les restes fecals, perqu\u00e8 una neteja insuficientcomporta exploracions m\u00e9s llargues, repeticions de proves i,encara pitjor, errors diagn\u00f2stics. En els pacients provoca angoixa, abstenci\u00f3 laboral i, en alguns casos,malnutrici\u00f3.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"880\" height=\"587\" src=\"https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/dieta-l\u00edquida-redu-880x587.jpg\" alt=\"\" class=\"wp-image-20883\" srcset=\"https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/dieta-l\u00edquida-redu-880x587.jpg 880w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/dieta-l\u00edquida-redu-440x293.jpg 440w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/dieta-l\u00edquida-redu-768x512.jpg 768w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/dieta-l\u00edquida-redu-600x400.jpg 600w, https:\/\/www.mgc.es\/wp-content\/uploads\/2021\/03\/dieta-l\u00edquida-redu.jpg 1500w\" sizes=\"auto, (max-width: 880px) 100vw, 880px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Dieta_els_dies_previs_a_la_prova\"><\/span>Dieta els dies previs a la prova<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>La pres\u00e8ncia de restes fecals pot ocultar lesions importants, fins i tot malignes. Per evitar aquesta possibilitat, s\u2019han projectat una s\u00e8rie d\u2019estrat\u00e8gies per aconseguir una neteja del c\u00f2lon \u00f2ptima. La primera fita \u00e9s fer-ne desapar\u00e8ixer les restes fecals. Les restes que arriben al c\u00f2lon s\u00f3n integrades per fibra vegetal no absorbible.El costum d&#8217;eliminar la fibra de la dieta durant els quatre dies previs a la prova t\u00e9 una tradici\u00f3 que es remunta a cent anys enrere, amb la preparaci\u00f3 de les proves radiol\u00f2giques del c\u00f2lon. El dia anterior a la prova es proposa, a m\u00e9s,de fer una dieta \u00fanicament a base de l\u00edquids.Els pacients passen gana i, si estan debilitats, poden tenir problemes de desnutrici\u00f3.Curiosament aquesta pauta de dieta, universalment acceptada, no t\u00e9 una base cient\u00edfica que l\u2019avali. D&#8217;altra banda, molt recentmenthem accedit a dues publicacionsen revistes internacionals de dos hospitals catalans que exposen que cal modificar totalment la dieta perpreparar la colonosc\u00f2pia. El primer estudi demostra que la dieta de tres dies sense fibra no millora la neteja del c\u00f2lon.<sup>13<\/sup>El segon estudi demostra que, amb una dieta lliure els quatre dies previs i una dieta s\u00f2lida especial, \u00e9s a dir normocal\u00f2rica i sense fibra, el dia anterior,s\u2019obt\u00e9 una depuraci\u00f3 m\u00e9s profunda que amb la dieta l\u00edquida cl\u00e0ssica.<sup>14<\/sup> Aquesta dieta que ha estat dissenyada per endocrin\u00f2legs i dietistes mant\u00e9 l\u2019estat nutricional, la sensaci\u00f3 de sacietat i permet que el pacient toleri millor la quantitat de l\u00edquid que s\u2019associa a la presa dels laxants necessaris per fer la preparaci\u00f3. Els autors de&nbsp;l&#8217;article l&#8217;hanbatejat amb el nom de Dieta Barcelona. Ja l&#8217;hem adoptada a la nostra unitat.Els resultats s\u00f3n molt satisfactoris tant per als pacients com per nosaltres, els endoscopistes.<\/p>\n\n\n\n<p>Per conclouredirem que, d&#8217;una banda, tenim previsions que creixer\u00e0 el risc de patir c\u00e0ncer de c\u00f2lon els anys vinents i, en conseq\u00fc\u00e8ncia, caldr\u00e0 fer m\u00e9s colonosc\u00f2pies preventives a un major nombre de gent; d&#8217;altra banda, per\u00f2, la bona not\u00edcia \u00e9s que les colonosc\u00f2pies, si no hi ha cap altra t\u00e8cnica diagn\u00f2stica que les substitueixi, seran cada cop m\u00e9s agradables.<\/p>\n\n\n\n<p><strong>Agust\u00ed Panad\u00e8s Aran<\/strong> (<strong>Institut de Malalties Digestives<\/strong> &#8211; <strong>Cl\u00ednica Sagrada Fam\u00edlia<\/strong>)<\/p>\n\n\n\n<p><strong>Bibliografia<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>1 &#8211; Pla Director d&#8217;Oncologia (Catalunya). Pla contra el C\u00e0ncer a Catalunya 2015-2020. Barcelona: Departament de Salut, 2015.<\/li><li>2 &#8211; Cancerscreening in theEuropean Union (2017). Screening Group. International Agency for Research on Cancer. World Health Organization.<\/li><li>3 &#8211; Araghi M., Soerjomataram I. et al. \u201cChanges in colorectal cancerincidence in sevenhigh-income countries: a population-basedstudy\u201d. www.thelancet.com\/gastrohep Published online May 16, 2019.<\/li><li>4 &#8211; Lui R.N., Tsoi K.K.F. et al. \u201cGlobal increasingincidence of young-onset colorectal canceracross 5 continents: A joinpointregressionanalysis of 1,922,167 cases\u201d. CancerEpidemiolBiomarkers. 2019 Aug28(8):1275-1282.<\/li><li>5 &#8211; Loomans-Kropp H.A.,Umar A. \u201cIncreasingIncidenceofColorectal CancerinYoungAdults\u201d.Journal of CancerEpidemioly.2019 Nov 11;2019: 1-9.<\/li><li>6 &#8211; Vuik F., Nieuwenburg S. et al. \u201cIncreasingincidenceof colorectal cancer in young adults in Europe over thelast 25 years\u201d.Gut 2019;68:1820-1826.<\/li><li>7 &#8211; Wolf A.M.D., et al.\u201cColorectal cancerscreening for average-risk adults: 2018 guidelineupdatefromthe American CancerSociety\u201d.CA: CancerJournal for Clinics. 2018.<\/li><li>8 &#8211; Bujanda L.,Cosme A., Gil I.\u201cMalignant colorectal polyps\u201d. WorldJournalof Gastroenteroly.2010 Jul 7;16(25):3103-11.<\/li><li>9 &#8211; Bombi J.A. \u201cPolyps of the colon in Barcelona, Spain. Anautopsystudy\u201d.Cancer. 1988 Apr 1;61(7):1472-6.<\/li><li>10 &#8211; Courtier R.,Casamitjana M.,Maci\u00e0 F., Panad\u00e8s A., Castells X.,Gil M.J.,Par\u00e9s D., S\u00e1nchez-Ortega J.M.,Grande L. \u201cResultados de un estudio de cribado poblacional de neoplasiacolorrectal\u201d. Cirurg\u00eda Espa\u00f1ola.2009 Mar;85(3):152-7.<\/li><li>11 &#8211; Quintero E., Castells A., Bujanda L., COLONPREV StudyInvestigators. \u201cColonoscopy versus fecal immunochemicaltesting in colorectal-cancerscreening\u201d.The New EnglandJournal of Medicine. 2012 Feb 23;366(8):697-706.<\/li><li>12 &#8211; Brenner H.,Chang-Claude J.,Seiler C.M.,Rickert A.,Hoffmeister M.\u201cProtectionfrom colorectal canceraftercolonoscopy: a population-based, case-control study\u201d.Annals of InternalMedicine.2011 Jan 4;154(1):22-30.<\/li><li>13 &#8211; Machlab S., Mart\u00ednez-Bauer E., L\u00f3pez P., Piqu\u00e9 N., Puig-Div\u00ed V., JunqueraF., Lira A., Brullet E., Selva A., Garc\u00eda-Iglesias P., Calvet X., Campo R. \u201cComparable quality of bowelpreparationwith single-day versus three-daylow-residuediet: Randomizedcontrolled trial\u201d.DigestiveEndoscopy. 2020 Oct5.Online ahead of print.<\/li><li>14 &#8211; \u00c1lvarez-Gonz\u00e1lez M.A., Pantale\u00f3n M.A., Flores-Le Roux J.A. \u201cRandomizedClinical Trial: A NormocaloricLow-FiberDietthe Day BeforeColonoscopy Is the Most EffectiveApproach to BowelPreparation in Colorectal CancerScreeningColonoscopy\u201d.Diseases of the ColonRectum. 2019 Apr;62(4):491-497.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Segons dades del Pla Director d\u2019Oncologia de Catalunya, el c\u00e0ncer de c\u00f2lon i recte, tamb\u00e9 dit colorectal o simplement de c\u00f2lon, \u00e9s un tumor molt freq\u00fcent a Catalunya. 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