Quo Vadis

Karnam, Umaprasanna; Barkin, Jami S.; Johnson, David
January 2001
American Journal of Gastroenterology;Jan2001, Vol. 96 Issue 1, p245
Academic Journal
In the first prospective, multicenter Veterans Affairs (VA) cooperative study colonoscopy was performed to determine the prevalence and location of advanced colonic neoplasms and the risk of advanced proximal neoplasia in asymptomatic patients (age range 50-75 yr) with and without distal neoplasia. Three thousand one hundred twenty-one of the 3196 (97.7%) patients who enrolled in the study (mean age 62.9 yr, 96.8% men) underwent colonoscopy. Colonoscopy revealed one or more neoplastic lesions in 37.5% of the patients. This included an adenoma with a diameter of 1 cm or a villous adenoma in 7.9%, an adenoma with high-grade dysplasia in 1.6%, and invasive cancer in 1% of patients. In those patients in whom a screening flexible sigmoidoscopy performed even up to the splenic flexure, would have shown no polyps, 2.7% of these patients had advanced proximal neoplasms. Patients with large adenomas (≥ cm) or small adenomas (<1 cm) in the distal colon were more likely to have advanced proximal neoplasia than were patients with no distal adenomas (odds ratios of 3.4 and 2.6, respectively). However, 52% of the patients with advanced proximal neoplasms had no distal adenomas. In the second study, the colonoscopic findings of 1994 consecutive asymptomatic adults aged ≥50 yr were reported. The authors found that 3.1% of these patients had advanced lesions in the distal colon, and 2.5% had advanced proximal lesions. Interestingly, 46 of the patients with advanced proximal neoplasms had no distal polyps. The relative risk of advanced proximal neoplasia, adjusted for age and sex, was 2.6 for patients with distal hyperplastic polyps, 4.0 for those with distal tubular adenomas, and 6.7 for those with advanced distal polyps, as compared with patients who had no distal polyps. The relative risk of advanced proximal neoplasia, adjusted for age and sex, was 2.6 for patients with distal hyperplastic polyps, 4.0 for those with distal tubular adenomas, and 6.7 for those with advanced distal polyps, as compared with patients who had no distal polyps. Older age and gender (male) were two factors associated with an increased risk of advanced proximal neoplasia (relative risk 1.3 for every 5 yr of age and 3.3 for males). The prevalence of advanced proximal neoplasia in patients with no distal polyps was 1.5%.


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