Is the distal hyperplastic polyp a marker for proximal neoplasia?

Abstract

CONTEXT: The current literature is unclear about the association between distal hyperplastic polyps and synchronous neoplasia (adenomatous polyps and cancer) in the proximal colon. OBJECTIVE:To estimate the prevalence of proximal neoplasia associated with distal hyperplastic polyps.DATA SOURCES: Database searches (MEDLINE and EMBASE from 1966 to 2001) and manual search of the bibliographies of included and excluded studies, case reports, editorials, review articles, and textbooks of Gastroenterology. STUDY SELECTION:Studies describing the prevalence of proximal neoplasia in persons with distal hyperplastic polyps. DATA EXTRACTION:Demographics, clinical variables, study design, and prevalence of proximal neoplasia associated with various distal colorectal findings. DATA SYNTHESIS:Of 18 included studies, 12 involved asymptomatic individuals in which the pooled absolute risk of any proximal neoplasia associated with distal hyperplastic polyps was 25% (95% confidence interval [95% CI], 21% to 29%). In 4 studies where colonoscopy was performed irrespective of distal findings, the absolute risk was 21% (95% CI, 14% to 28%). The relative risk of finding any proximal neoplasia in persons with distal hyperplastic polyps was 1.3 (95% CI, 0.9 to 1.8) compared to those with no distal polyps. Among 6 studies of patients with symptoms or risk factors for neoplasia, the absolute risk of proximal neoplasia was 35% (95% CI, 32% to 39%) in persons with distal hyperplastic polyps. In 2 studies of screening colonoscopy, advanced proximal neoplasia (cancer, or a polyp with villous histology or severe dysplasia, or a tubular adenoma 1 cm) was present in 4% to 5% of persons with distal hyperplastic polyps, which was 1.5 to 2.6 times greater than in those with no distal polyps. CONCLUSIONS:In asymptomatic persons, a distal hyperplastic polyp is associated with a 21% to 25% risk for any proximal neoplasia and a 4% to 5% risk of advanced proximal neoplasia, and may justify examination of the proximal colon. Further study is needed to determine the risk of advanced proximal neoplasia associated with size and number of distal hyperplastic polyps.

Epidemiology of colorectal polyps

“…In 2003, Dave et al [3] reviewed the literature regarding the association of distal hyperplastic polyps and synchronous neoplasia (adenomatous polyps and cancer) in the proximal colon.…”

“…Of 18 included studies, 12 involved asymptomatic individuals in which the pooled absolute risk of any proximal neoplasia associated with distal hyperplastic polyps was 25% [3]. In 4 studies where colonoscopy was performed irrespective of distal findings, the absolute risk was 21% (95% confidence interval (CI), 14-28%).…”

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

“…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.…”

“…18,19 In contrast, the American Cancer Society, the Agency for Health Care Policy and Research, and the US Preventive Services Task Force believe that there is not enough substantial evidence to make a sound recommendation either way; therefore, these organizations have offered no explicit suggestions for this subgroup of patients. 4 This unfortunately has culminated in an enduring and persisting knowledge gap. Consequently, many physicians and clinicians currently do not order any additional testing when HPs are the only significant finding on an FS.…”

Association between Non-Diminutive Hyperplastic Polyps and Synchronous Advanced Colorectal Neoplasms

“…In many studies, the main focus was on the association between distal HPs and synchronous, proximal, advanced adenomas because of colorectal cancer (CRC) screening practices [8,9,10,11,12,13]; however, the results of these studies are conflicting. Some studies have shown that the risk of proximal advanced adenomas was increased in patients with distal HPs [9,12].…”