Hyperplastic polyps seen at sigmoidoscopy are markers for additional adenomas seen at colonoscopy

Blue, Mark; Sivak, Michael; Achkar, Edgar; Matzen, Richard N.; Stahl, Robert R.

doi:10.1016/0016-5085(91)90232-a

Cited by 52 publications

(20 citation statements)

References 9 publications

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“…Most studies of the association between distal and proximal neoplasia are compromised by selection bias, including specific subgroups. [22][23][24][25][26][27][28][29][30][31][32][33][34][35] Only studies wherein colonoscopy is offered as a primary screening procedure can appropriately address this issue. Currently, such data that are available derive from 3 studies that comprise relatively few cases [36][37][38] and two large studies carried out in the United States.…”

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confidence: 99%

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Ibáñez

Muñoz-Navas

Duque

et al. 2004

Gastrointestinal Endoscopy

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BACKGROUNDFor colorectal cancer screening, the predictive value of distal findings in the ascertainment of proximal lesions is not fully established. The aims of this study were to assess distal findings as predictors of advanced proximal neoplasia and to compare the predictive value of endoscopy alone vs. combined endoscopic and histopathologic data. METHODSPrimary colonoscopy screening was performed in 2210 consecutive, average-risk adults. Age, gender, endoscopic (size, number of polyps), and histopathologic distal findings were used as potential predictors of advanced proximal neoplasms (i.e., any adenoma ≥1 cm in size, and/or with villous histology, and/or with severe dysplasia or invasive cancer). Polyps were defined as distal if located in the descending colon, the sigmoid colon, or the rectum. Those in other locations were designated proximal. RESULTSNeoplastic lesions, including 11 invasive cancers, were found in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not associated with any distal polyp. Older age, male gender, and distal adenoma were independent predictors of advanced proximal neoplasms. The predictive ability of a model with endoscopic data alone did not improve after inclusion of histopathologic data. In multivariate logistic regression analysis, the predictive ability of models that use age, gender, and any combination of distal findings was relatively low. The proportion of advanced proximal neoplasms identified if any distal polyp was an indication for colonoscopy was only 62%. CONCLUSIONSA strategy in which colonoscopy is performed solely in patients with distal colonic findings is not effective screening for the detection of advanced proximal neoplasms in an average-risk population.Reprint requests: Maite Betés Ibáñez, MD, PhD, Departamento de Digestivo, Clínica Universitaria de Navarra, 31080 Pamplona, Spain. INTRODUCTIONMost colorectal cancers (CRC) develop from adenomas, 1-3 which have a long, asymptomatic phase during which they are detectable and curable. Excision of colorectal adenomas reduces the incidence and the mortality of CRC. 2,4-11 Therefore, CRC fulfills the criteria for benefit from screening. 12 In 1996, the United States Preventive Services Task Force recommended screening of asymptomatic adults over 50 years of age with either flexible sigmoidoscopy (FS) or fecal occult blood tests (FOBT). 13 These recommendations now are endorsed by the American Cancer Society, 14 the World Health Organization, 15 and by virtually all medical and surgical professional societies concerned with digestive diseases. 16,17 A positive FS or FOBT result is an indication for colonoscopy. The continuing high mortality rates for patients with CRC, together with two large studies that demonstrate that FS fails to identify a substantial proportion of proximal lesions, 18,19 have led many specialists to regard reliance on FS or FOBT alone as screening tests would be as wrong as mammography o...

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confidence: 99%

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Ibáñez

Muñoz-Navas

Duque

et al. 2004

Gastrointestinal Endoscopy

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“…Studies reported that prevalence of advanced proximal adenoma is related to sigmoidoscopic findings in total colonoscopy [18][19][20][21][22][23][24][25][26][27][28][29][30][31] . According to these studies, the prevalence of advanced proximal adenoma increases with rectosigmoid findings.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies reported that hyperplastic polyps are a marker of proximal colon neoplasms [23,25,27] , whereas other studies showed that hyperplastic polyps in the rectosigmoid colon have no relation with proximal colon neoplasms [24,26,30] . In the present study, patients with hyperplastic polyps in the rectosigmoid colon were considered normal.…”

Section: Discussionmentioning

confidence: 99%

“…Sigmoidoscopy is simpler, faster, and better tolerable than total colonoscopy, but the scope cannot reach the proximal colon segment and therefore, may miss proximal colon cancer. Previous studies reported that polyps in rectosigmoid colon are associated with advanced proximal neoplasms [18][19][20][21][22][23][24][25] . Thus, examination of the proximal colon is recommended for patients with adenomas detected by sigmoidoscopy [13] .…”

Section: Introductionmentioning

confidence: 99%

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Rectosigmoid findings are not associated with proximal colon cancer: Analysis of 6196 consecutive cases undergoing total colonoscopy

Okamoto

Kawabe²,

Yamaji³

et al. 2005

WJG

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AIM:To review the risk of proximal colon cancer in patients undergoing colonoscopy. METHODS:We estimated the risk of advanced proximal adenomas and cancers in 6 196 consecutive patients that underwent colonoscopy (mean age 60 years, 65% males, without prior history of colorectal examination). Neoplasms were classified as diminutive adenoma (5 mm or less), small adenoma (6-9 mm), advanced adenoma (10 mm or more, with villous component or high-grade dysplasia) and cancer (invasive adenocarcinoma). The sites of neoplasms were defined as rectosigmoid (rectum and sigmoid colon) and proximal colon (from cecum to descending colon). RESULTS:The trend of the prevalence of advanced proximal adenoma was to increase with severe rectosigmoid findings, while the prevalence of proximal colon cancer did not increase with severe rectosigmoid findings. Among the 157 patients with proximal colon cancer, 74% had no neoplasm in the rectosigmoid colon. Multivariate logisticregression analysis revealed that age was the main predictor of proximal colon cancer and existence of rectosigmoid adenoma was not a predictor of proximal colon cancer. CONCLUSION:Sigmoidoscopy is inadequate for colorectal cancer screening, especially in older populations.

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“…To date, 13 trials have been conducted on the proposed topic and target population. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Although the authors of seven [5][6][7][8][9][10][11] of these studies have concluded that distal HPs do predict the presence of SPNs and necessitate colonoscopy, the authors of the remaining six [12][13][14][15][16][17] have reported that no such increased risk exists, thus nullifying the need for colonoscopy. Moreover, beyond these visible discrepancies within the published literature, there are also tangible inconsistencies among the formal recommendations made for patients with distal HPs discovered by screening FS.…”

Section: Risk Of Proximal Colonic Neoplasms In Asymptomatic Adults Olmentioning

confidence: 99%

Risk of Proximal Colonic Neoplasms in Asymptomatic Adults Older Than 50 Years Found to Have Distal Hyperplastic Polyps on Routine Colorectal Cancer Screening

Collins¹

2010

TPJ

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Hyperplastic polyps seen at sigmoidoscopy are markers for additional adenomas seen at colonoscopy

Cited by 52 publications

References 9 publications

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Rectosigmoid findings are not associated with proximal colon cancer: Analysis of 6196 consecutive cases undergoing total colonoscopy

Risk of Proximal Colonic Neoplasms in Asymptomatic Adults Older Than 50 Years Found to Have Distal Hyperplastic Polyps on Routine Colorectal Cancer Screening

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