Findings in the Distal Colorectum Are Not Associated With Proximal Advanced Serrated Lesions

Kahi, Charles J.; Vemulapalli, Krishna C.; Snover, Dale C.; Jawad, Khaled H. Abdel; Cummings, Oscar W.; Rex, Douglas K.

doi:10.1016/j.cgh.2014.07.044

Cited by 29 publications

(23 citation statements)

References 27 publications

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“…26 These lesions are most often proximal, and in one study, 52% of individuals with advanced proximal serrated polyps (defined as SSA/P ≥10 mm with dysplastic features, or traditional serrated adenomas) did not have a distal lesion that could be detected at flexible sigmoidoscopy and which would trigger a full colonoscopy. 7 In the same study, distal adenomas were associated with proximal adenomas, but not with proximal advanced serrated lesions. Thus, flexible sigmoidoscopy could be inadequate in detecting these polyps.…”

Section: Principal Findingsmentioning

confidence: 82%

“…To partly overcome this limitation, individuals with pathological findings in the distal colon are referred for colonoscopy, because they might have clinically significant pathology in the proximal colon. [7][8][9] The effect of flexible sigmoidoscopy screening in younger versus older individuals and in women versus men is currently unknown. There are reasons to believe that the effectiveness might differ in men and women.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of flexible sigmoidoscopy screening in men and women and different age groups: pooled analysis of randomised trials

Holme

Schoen

Senore

et al. 2017

BMJ

114

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Objective To compare the effectiveness of flexible sigmoidoscopy in screening for colorectal cancer by patient sex and age.Design Pooled analysis of randomised trials (the US Prostate, Lung, Colorectal and Ovarian cancer screening trial (PLCO), the Italian Screening for Colon and Rectum trial (SCORE), and the Norwegian Colorectal Cancer Prevention trial (NORCCAP)).Data sources Aggregated data were pooled from each randomised trial on incidence of colorectal cancer and mortality stratified by sex, age at screening, and colon subsite (distal v proximal).Eligibility criteria for selecting studies Invited individuals aged 55-74 (PLCO), 55-64 (SCORE), and 50-64 (NORCCAP). Individuals were randomised to receive flexible sigmoidoscopy screening once only (SCORE and NORCCAP) or twice (PLCO), or receive usual care (no intervention).Results 287 928 individuals were included in the pooled analysis; 115 139 randomised to screening and 172 789 to usual care. Compliance rates were 58%, 63%, and 87% in SCORE, NORCCAP, and PLCO, respectively. Median follow-up was 10.5 to 12.1 years. Screening reduced the incidence of colorectal cancer in men (relative risk 0.76; 95% confidence interval 0.70 to 0.83) and women (0.83; 0.75 to 0.92). No difference in the effect of screening was seen between men younger than 60 and those older than 60. Screening reduced the incidence of colorectal cancer in women younger than 60 (relative risk 0.71; 95% confidence interval 0.59 to 0.84), but not significantly in those aged 60 or older (0.90; 0.80 to 1.02). Colorectal cancer mortality was significantly reduced in both younger and older men, and in women younger than 60. Screening reduced colorectal cancer incidence to a similar extent in the distal colon in men and women, but there was no effect of screening in the proximal colon in older women with a significant interaction between sex and age group (P=0.04).Conclusion Flexible sigmoidoscopy is an effective tool for colorectal cancer screening in men and younger women. The benefit is smaller and not statistically significant for women aged over 60; alternative screening methods that more effectively detect proximal tumours should be considered for these women.

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Section: Principal Findingsmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Effectiveness of flexible sigmoidoscopy screening in men and women and different age groups: pooled analysis of randomised trials

Holme

Schoen

Senore

et al. 2017

BMJ

114

View full text Add to dashboard Cite

show abstract

“…As such, flexible sigmoidoscopy can detect some proximal cancers and advanced conventional adenomas, with the fraction of advanced proximal lesions detected generally low and dependent on the criteria by which colonoscopy is indicated 87 88. One study found that conventional adenomas in the distal colon did not predict advanced serrated neoplasms (SSPs≥1 cm) 89. Therefore, available evidence indicates that flexible sigmoidoscopy lacks value for identifying important proximal colon serrated lesions.…”

Section: Efficacy Of Other Techniques (Non-endoscopic) For Detection mentioning

confidence: 99%

Serrated lesions in colorectal cancer screening: detection, resection, pathology and surveillance

East

Vieth

Rex

2015

Gut

114

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“…In contrast, TSAs are often pedunculated or broad‐based and have villous morphology with classical dysplasia, making endoscopic detection less difficult . Recently, SSA/P with dysplasia or of ≥10 mm in diameter and TSAs are identified as advanced colorectal serrated lesions (ASLs) in the Western world . However, detailed information of ASLs in Asians has rarely been reported.…”

Section: Introductionmentioning

confidence: 99%

“…11 Recently, SSA/P with dysplasia or of ≥10 mm in diameter and TSAs are identified as advanced colorectal serrated lesions (ASLs) in the Western world. 22 However, detailed information of ASLs in Asians has rarely been reported.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological features of advanced colorectal serrated lesions: A single‐center study in China

Liu

Jin

Khan

et al. 2018

J of Digest Diseases

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Findings in the Distal Colorectum Are Not Associated With Proximal Advanced Serrated Lesions

Cited by 29 publications

References 27 publications

Effectiveness of flexible sigmoidoscopy screening in men and women and different age groups: pooled analysis of randomised trials

Effectiveness of flexible sigmoidoscopy screening in men and women and different age groups: pooled analysis of randomised trials

Serrated lesions in colorectal cancer screening: detection, resection, pathology and surveillance

Clinicopathological features of advanced colorectal serrated lesions: A single‐center study in China

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