Is colonoscopy needed for the nonadvanced adenoma found on sigmoidoscopy?

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 115; no. 3; pp. 533 - 541
• Main Authors: Schoen ,∥, Robert E., Corle ‡, Don, Cranston §, Linda, Weissfeld ∥, Joel L., Lance ¶, Peter, Burt #, Randall, Iber, Frank, Shike ‡‡, Moshe, Kikendall §§, James W., Hasson §, Marsha, Lewin ∥∥, Klaus J., Appelman ¶¶, Henry D., Paskett ##, Electra, Selby, Joe V., Lanza ‡‡‡, Elaine, Schatzkin §§§, Arthur
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-1998; Elsevier
• Subjects: Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; PPT; CI; OR; Performance evaluation; Histological grading; Rectal disease; Carcinoma; Sigmoidoscopy; Indication; Hyperplasia; Adenoma; Pelvic colon; Histopathology; Colonoscopy; Intestinal disease; Endoscopy; Benign neoplasm; Colon; Diagnosis; Public health; Human; Small dimension; Malignant tumor; Medical screening; Colonic disease; Pathology; Low; Rectum; Digestive diseases
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1016/S0016-5085(98)70132-5

Background & Aims: The need for colonoscopy when small tubular adenomas with low-grade dysplasia are found on sigmoidoscopy is uncertain. The aim of this study was to examine the prevalence and characteristics of proximal adenomas in patients with distal adenomas.
Methods: We studied 981 subjects with distal adenomas found on the index colonoscopy before randomization in the Polyp Prevention Trial.
Results: Four hundred sixty patients (46.9%) had ≥1 distal adenoma that was pathologically advanced (villous component, high-grade dysplasia, or ≥1 cm); 21.5% (211 of 981) had any proximal adenoma; and 4.3% (42 of 981) (95% confidence interval [CI], 3.0–5.5) had an advanced proximal adenoma. A greater percentage of patients with an advanced distal adenoma (5.9%) (95% CI, 3.7–8.0) had an advanced proximal adenoma compared with those with a nonadvanced distal adenoma (2.9%) (95% CI, 1.4–4.3) (OR, 2.1; 95% CI, 1.1–4.3;
P = 0.03). Not performing a colonoscopy in patients with a nonadvanced distal adenoma would have missed 36% (15 of 42) of the advanced proximal adenomas.
Conclusions: Patients with an advanced distal adenoma are twice as likely to have an advanced proximal adenoma as patients with a nonadvanced distal adenoma. However, eschewing a colonoscopy in patients with a nonadvanced distal adenoma would result in not detecting a sizeable percentage of the prevalent advanced proximal adenomas. These data support performance of a colonoscopy in patients with a nonadvanced distal adenoma. Confirmation of these results in asymptomatic subjects undergoing screening sigmoidoscopy is advisable.
GASTROENTEROLOGY 1998;115:533-541