Detection of Proximal Adenomatous Polyps With Screening Sigmoidoscopy

Lewis, James D.; Ng, Kimmie; Hung, Kenneth E.; Bilker, Warren B.; Berlin, Jesse A.; Brensinger, Colleen M.; Rustgi, Anil K.

doi:10.1001/archinte.163.4.413

Cited by 101 publications

(28 citation statements)

References 38 publications

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“…The clinical implications of this concept include the need for colonoscopy in patients with adenoma detected on flexible sigmoidoscopy (increased risk of synchronous lesions) or previous colonoscopy (metachronous lesions). 20 There have been numerous markers of field carcinogenesis in the predysplastic mucosa, including proteomic, 21 genomic, 22 methylation 23 and microRNA. 24 The most common markers for chemoprevention studies have been the reversal of the diffuse increase in proliferation and inhibition of apoptosis.…”

Section: Significance Of This Studymentioning

confidence: 99%

Spectral biomarkers for chemoprevention of colonic neoplasia: a placebo-controlled double-blinded trial with aspirin

Roy

Turzhitsky

Wali

et al. 2015

Gut

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Objective A major impediment to translating chemoprevention to clinical practice has been lack of intermediate biomarkers. We previously reported that rectal interrogation with low-coherence enhanced backscattering spectroscopy (LEBS) detected microarchitectural manifestations of field carcinogenesis. We now wanted to ascertain if reversion of two LEBS markers spectral slope (SPEC) and fractal dimension (FRAC) could serve as a marker for chemopreventive efficacy. Design We conducted a multicentre, prospective, randomised, double-blind placebo-controlled, clinical trial in subjects with a history of colonic neoplasia who manifested altered SPEC/FRAC in histologically normal colonic mucosa. Subjects (n=79) were randomised to 325 mg aspirin or placebo. The primary endpoint changed in FRAC and SPEC spectral markers after 3 months. Mucosal levels of prostaglandin E2 (PGE2) and UDP-glucuronosyltransferase (UGT) 1A6 genotypes were planned secondary endpoints. Results At 3 months, the aspirin group manifested alterations in SPEC (48.9%, p=0.055) and FRAC (55.4%, p=0.200) with the direction towards non-neoplastic status. As a measure of aspirin's pharmacological efficacy, we assessed changes in rectal PGE2 levels and noted that it correlated with SPEC and FRAC alterations (R=−0.55, p=0.01 and R=0.57, p=0.009, respectively) whereas there was no significant correlation in placebo specimens. While UGT1A6 subgroup analysis did not achieve statistical significance, the changes in SPEC and FRAC to a less neoplastic direction occurred only in the variant consonant with epidemiological evidence of chemoprevention. Conclusions We provide the first proof of concept, albeit somewhat underpowered, that spectral markers reversion mirrors antineoplastic efficacy providing a potential modality for titration of agent type/dose to optimise chemopreventive strategies in clinical practice. Trial Number NCT00468910

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Section: Significance Of This Studymentioning

confidence: 99%

Spectral biomarkers for chemoprevention of colonic neoplasia: a placebo-controlled double-blinded trial with aspirin

Roy

Turzhitsky

Wali

et al. 2015

Gut

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“…In addition, individuals without adenomas in the distal colon, as shown by sigmoidoscopy, frequently do not receive a follow-up colonoscopy. The percentage of asymptomatic individuals with isolated advanced proximal adenomas or cancer who undergo a colonoscopy is 1.3–5% [58,59]. Atkin et al [60] reported that sigmoidoscopy screening reduces the mortality from CRC.…”

Section: Discussionmentioning

confidence: 99%

A Questionnaire-Based Survey on Screening for Gastric and Colorectal Cancer by Physicians in East Asian Countries in 2010

et al. 2012

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Background: The incidence of gastric cancer (GC) is high, and colorectal cancer (CRC) has significantly increased in Asian countries. Aim: To examine the current screening for GC and CRC within East Asia by means of a questionnaire survey. Methods: Representative members of the Committee of the International Gastrointestinal Consensus Symposium provided a questionnaire to physicians in six East Asian countries. Results: A total of 449 physicians participated in this survey. In all countries, more than 70% of physicians started GC screening between 40 and 59 years. The most popular method to screen for GC was endoscopy (92.7%), but combination methods such as Helicobacter pylori (HP) antibody, barium X-ray, and tumor marker with endoscopy differed by country. For HP-positive individuals, most physicians screened every year by endoscopy, and for individuals post-HP eradication, about half of physicians (56.3%) thought there was a need to follow-up with GC screening. Among all physicians, the most common age to start CRC screening was in the 40s (39.8%) and 50s (40.9%). Based on the American Cancer Society Recommendations, a fecal occult blood test every year was the most popular method for CRC screening overall. However, among each country, this test was most popular in only Japan (76.9%) and Indonesia. In other countries, sigmoidoscopy every 5 years and total colonoscopy every 10 years were the most popular methods. Conclusion: There are similarities and differences in the screening of GC and CRC among East Asian countries.

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“…Existe una asociación clara entre la presencia de adenomas distales y adenomas proximales. Dicha asociación puede variar en función del tamaño de la muestra cribada, en la inclusión de pacientes con historia familiar de cán-cer de colon (27) y, fundamentalmente, si se define el colon distal como la porción intestinal que puede visualizarse mediante una sigmoidoscopia o bien el segmento de colon cuyo límite superior es el ángulo esplénico (28,29). La prevalencia de neoplasias avanzadas proximales en nuestros pacientes y la probabilidad de tener adenomas en el colon distal son similares a los descritos en los estudios mencionados.…”

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Hallazgos colonoscópicos del estudio piloto de cribado de cáncer colorrectal realizado en Cataluña

Navarro

Peris

Binefa

et al. 2008

Rev. esp. enferm. dig.

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RESUMEN Objetivo: evaluar las lesiones detectadas en las dos rondas ya finalizadas del Programa Piloto de Cribado en Cáncer Colorrectal (CCR) llevado a cabo en L'Hospitalet de Llobregat (Barcelona).Material y métodos: el programa de cribado de CCR se inició en el año 2000. La población, comprendida entre 50 y 69 años residentes en el área, fue invitada a participar a través de la determinación bienal de sangre oculta en heces mediante el test guaiaco y colonoscopia en los participantes con test positivo. Se realizó polipectomía de las lesiones detectadas o biopsias cuando no era posible la extirpación. Los pólipos se clasificaron según criterios de la Organización Mundial de la Salud.Resultados: se realizaron 442 colonoscopias de los 495 test positivos. En 213 individuos, se detectaron: 36 cánceres invasivos, 121 adenomas de alto riesgo, 29 adenomas de bajo riesgo y 27 pólipos hiperplásicos. En el 25,8% de los casos, el tamaño de los adenomas fue < 10 mm. La mayoría de las lesiones diagnosticadas (37,2%) estaban localizadas en el colon distal, el 5,7% a nivel proximal y ambas localizaciones en el 5,2%. Las neoplasias avanzadas se asociaron significativamente al sexo masculino y la localización distal. La prevalencia de neoplasias avanzadas a nivel proximal entre los pacientes sin pólipos distales fue del 5,1%.Conclusiones: los adenomas de alto riesgo de localización distal han sido las lesiones detectadas con mayor frecuencia. El cribado poblacional mediante la determinación de sangre oculta en heces es un método factible para detectar pequeñas lesiones precancerosas, factor clave para disminuir la incidencia de CCR.Palabras clave: Cáncer colorrectal. Programa de cribado. Riesgo poblacional. Test de sangre oculta en heces. Test guaiaco. Neoplasia avanzada. ABSTRACTObjective: to evaluate lesions detected in two screening rounds performed in a pilot screening program for colorectal cancer in Catalonia, Spain.Material and methods: a colorectal cancer screening program was initiated in 2000. The target population included men and women aged 50-69 years. Screening consisted of biennial guaiac-based fecal occult blood testing (FOBT), and colonoscopy for participants with a positive FOBT. Any polyps found were removed, and biopsies were performed for any masses.Results: Colonoscopies were performed in 442 of 495 people with positive FOBT. In 213 (48.2%), 36 invasive cancers, 121 high-risk adenomas, 29 low-risk adenomas, and 27 hyperplastic polyps were diagnosed. Lesion size was smaller than 10 mm in 25.8% of cases. Most detected lesions (37.2%) were located in the distal colon, followed by the proximal colon (5.7%) and both locations (5.2%). Advanced neoplasm was significantly associated with male gender and distal location. The prevalence of advanced proximal neoplasms among patients with no distal polyps was 5.1%.Conclusions: the most common lesions detected by colonoscopy were high-risk adenomas located in the distal colon. FOBT is a suitable method for detecting small precancer lesions during population screening, ...

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Detection of Proximal Adenomatous Polyps With Screening Sigmoidoscopy

Cited by 101 publications

References 38 publications

Spectral biomarkers for chemoprevention of colonic neoplasia: a placebo-controlled double-blinded trial with aspirin

Spectral biomarkers for chemoprevention of colonic neoplasia: a placebo-controlled double-blinded trial with aspirin

A Questionnaire-Based Survey on Screening for Gastric and Colorectal Cancer by Physicians in East Asian Countries in 2010

Hallazgos colonoscópicos del estudio piloto de cribado de cáncer colorrectal realizado en Cataluña

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