Prevalence and characteristics of colonic polyps and adenomas in 2654 colonoscopies in Saudi Arabia

Abstract

Background/Aims:Colorectal cancer (CRC) is the second most common malignancy in the Saudi population, with an increasing incidence over the past 20 years. We aim to determine the baseline polyp as well as adenoma prevalence in a large cohort of patients and to find the possible age in which, if deemed appropriate, a CRC screening program should be initiated.Patients and Methods:A retrospective cohort study was conducted using an endoscopic reporting database of individuals seen at a major tertiary care university hospital (King Khalid University Hospital) in Riyadh, Saudi Arabia. Consecutive Saudi patients who underwent a colonoscopy between August 2007 and April 2012 were included. Patients were excluded if the indication for the colonoscopy was colon cancer, colonic resection, active colitis, active diverticulitis, inflammatory bowel disease, or if the patient was referred for polypectomy.Results:2654 colonoscopies were included in the study. The mean age of the study population was 50.5 years [standard deviation (SD) 15.9] and females represented 57.7%. The polyp detection rate in completed colonoscopies was 20.8% (95% CI: 19.2-22.5). Adenomas were found in 8.1% (95% CI: 7.1-9.1), while advanced adenomas were found in only 0.5% (95% CI: 0.2-0.7). Adenomas were found in the left side of the colon in 33.9%, followed by the rectum in 14.6%, ascending colon and cecum in 14.2%, transverse colon in 8.7%, and in multiple locations in 28.7%. Those with a prior history of polyps or CRC were more likely to have an adenoma at colonoscopy than those who did not (14.3% vs. 6.6%; P < 0.01). The adenoma prevalence varied between age groups and ranged from 6.2% to 13.6% with a higher proportion in older individuals; this trend was seen both in males (6.0-14.5%) and females (6.4-14.6%) as well as in those who had screening colonoscopies (6.3-18.4%). No age could be found at which a CRC screening program would be appropriate to initiate.Conclusion:The prevalence of polyps and adenomas in this cohort is less than that reported in the Western populations. But as this cohort included younger and symptomatic patients with only a small proportion undergoing screening, further studies in an asymptomatic population are needed.

Yield of Screening Colonoscopy in Renal Transplant Candidates

“…We found that routine colonoscopy in patients with ESRD considered for renal transplantation with no other clinical indication for colonoscopy resulted in identification of polyps in 24% of cases. This is similar to the 22% polyp detection rate found in the general asymptomatic population in Saudi Arabia (11). In our study, one of 169 (0.59%) patients was found to have adenocarcinoma in the colon.…”

Effect of public knowledge, attitudes, and behavior on willingness to undergo colorectal cancer screening using the health belief model

“…Although CRC is one of the leading tumors in incidence in Saudi Arabia it appears that its age-adjusted rate is much less than that reported in North America and Western Europe,[ 19 ] and there is data that suggests that adenomas might be less prevalent in Saudi Arabia compared with those populations. [ 20 21 ] Nonetheless, CRC in Saudi Arabia tends to present at an earlier age and at advanced stages[ 22 ] and with a worse 5-year survival. [ 3 ] Whether a national CRC screening program would be able to improve outcomes remains undetermined.…”

Endoscopic Improvement of the Adenoma Detection Rate during Colonoscopy - Where Do We Stand in 2015?

“…Other data show an increased incidence in the left-sided colon as described in a Saudi Arabian cohort [17]. Data from Germany stress the likelihood of polyp detection in the left-sided colon [18], while data from the United States show advanced adenomas in the proximal colon in 20% of the cases [19].…”