Is Colonoscopy Indicated for Small Adenomas Found by Screening Flexible Sigmoidoscopy?

Wallace, Michael B.; Kemp, James Alan; Trnka, Yvona M.; Donovan, Joanne M.; Farraye, Francis A.

doi:10.7326/0003-4819-129-4-199808150-00002

Cited by 90 publications

(55 citation statements)

References 20 publications

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“…Results differ when the predictive value of different characteristics of distal adenomas were studied in multivariate anal yses. [24][25][26][27]29,[33][34][35]46,58,[60][61][62][63][64] The results of the current study are consistent with those of previous studies that demonstrate the importance of advanced distal neoplasms as a marker of APN. In fact, pooling of our results with those of previous studies 18,19 shows homogeneity for tubular adenoma (combined OR 2.96: 95% CI [2.16, 4.05]) and advanced neoplasms (combined OR 6.43: 95% CI[4.34, 9.52]).…”

Section: Discussionsupporting

confidence: 90%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

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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“…Os programas de rastreamento para essa doença têm grande importância no prognóstico, pois podem detectar lesões pré-cancerosas, como o pólipo adenomatoso, que ao serem retiradas previnem a instalação do câncer (2,3,6,22) . Apesar de ainda não ser possível determinar quais adenomas irão progredir para o câncer, algumas de suas características patológicas estão relacionadas com o risco de progressão para CCR: tamanho maior ou igual a 10 mm, tubuloviloso ou viloso na histologia e displasia moderada ou alta (8,14,18,21) . Mesmo quando já houve a transformação maligna, o tratamento do câncer inicial pode curar ou aumentar a sobrevida.…”

Section: Introductionunclassified

Achados colonoscópicos em pessoas sem quadro clínico de doença colorretal

Petroianu

Alberti

Lima³

et al. 2009

Arq. Gastroenterol.

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RESUMO -Contexto -O câncer colorretal é causa de morte frequente e sua prevenção deve fazer parte dos programas de rastreamento em indivíduos assintomáticos. Objetivo -Avaliar os achados colonoscópicos de pessoas assintomáticas submetidas a colonoscopia. pólipos em 64,28%, doença diverticular em 27,92%, alterações inflamatórias em 9,74%, melanose colônica em 2,6% e angioectasias em 7,8%. Houve incidência maior de pólipos em indivíduos acima de 50 anos. A análise de regressão logística mostrou a idade e sexo como fatores preditores para a presença de pólipos (RR = 1,69; 1,23

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“…In this context, the term "advanced neoplasia" has been used to refer mainly to lesions on the spectrum of the adenoma-carcinoma sequence, including invasive cancer and advanced adenomas (size ≥ 10 mm or presence of high-grade dysplasia or significant villous components on histology). Indeed, the studies which supported this approach [12][13][14][15] were performed at a time when it was thought that the great majority of colon cancers arose from precursor conventional adenomas via the chromosomal instability pathway. However, it is now recognized that nearly one-third of CRCs arise through the serrated pathway, which is characterized by mutations in the BRAF gene, high levels of methylation of promoter CpG islands (CIMP-high), and in which the sessile serrated adenoma/polyp (SSA/P) is the principle precursor lesion [16][17][18] .…”

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confidence: 99%

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

Kahi¹,

Vemulapalli²,

Snover³

et al. 2015

Clinical Gastroenterology and Hepatology

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Is Colonoscopy Indicated for Small Adenomas Found by Screening Flexible Sigmoidoscopy?

Abstract: Among patients undergoing screening sigmoidoscopy, those with single tubular adenomas of 5 mm or less had a low prevalence of advanced proximal polyps. These patients may not benefit from colonoscopy.

Cited by 90 publications

References 20 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

Achados colonoscópicos em pessoas sem quadro clínico de doença colorretal

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

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