TY - JOUR
T1 - Endoscopic appearance of proximal colorectal neoplasms and potential implications for colonoscopy in cancer prevention
AU - Rondagh, E.J.A.
AU - Bouwens, M.W.E.
AU - Riedl, R.G.
AU - Winkens, B.
AU - de Ridder, R.
AU - Kaltenbach, T.
AU - Soetikno, R.M.
AU - Masclee, A.A.M.
AU - Sanduleanu, S.
PY - 2012/6
Y1 - 2012/6
N2 - BACKGROUND: In everyday practice, the use of colonoscopy for the prevention of colorectal cancer (CRC) is less effective in the proximal than the distal colon. A potential explanation for this is that proximal neoplasms have a more subtle endoscopic appearance, making them more likely to be overlooked. OBJECTIVE: To investigate the differences in endoscopic appearance, ie, diminutive size and nonpolypoid shape, of proximal compared with distal colorectal neoplasms. DESIGN: Cross-sectional, single-center study. SETTING: Endoscopists at the Maastricht University Medical Center in the Netherlands who were previously trained in the detection and classification of nonpolypoid colorectal lesions. PATIENTS: Consecutive patients undergoing elective colonoscopy. MAIN OUTCOME MEASUREMENTS: Endoscopic appearance, ie, diminutive size (<6 mm) or nonpolypoid shape (height less than half of the diameter) of colorectal adenomas and serrated polyps (SPs), with a focus on adenomas with advanced histology, ie, high-grade dysplasia or early CRC and SPs with dysplasia or large size. RESULTS: We included 3720 consecutive patients with 2106 adenomas and 941 SPs. We found that in both men and women, proximal adenomas with high-grade dysplasia/early CRC (n = 181) were more likely to be diminutive or nonpolypoid than distal ones (76.3% vs 26.2%; odds ratio [OR] 9.24; 95% CI, 4.45-19.2; P < .001). Of the proximal adenomas, 84.4% were diminutive or nonpolypoid compared with 68.0% of the distal ones (OR 2.66; 95% CI, 2.14-3.29; P < .001). Likewise, large/dysplastic SPs in the proximal colon were more often nonpolypoid than distal ones (66.2% vs 27.8%; OR 5.51; 95% CI, 2.79-10.9; P < .001). LIMITATIONS: Inclusion of both symptomatic and asymptomatic patients. CONCLUSIONS: Proximal colorectal neoplasms with advanced histology frequently are small or have a nonpolypoid appearance. These findings support careful inspection of the proximal colon, if quality of cancer prevention with the use of colonoscopy is to be optimized.
AB - BACKGROUND: In everyday practice, the use of colonoscopy for the prevention of colorectal cancer (CRC) is less effective in the proximal than the distal colon. A potential explanation for this is that proximal neoplasms have a more subtle endoscopic appearance, making them more likely to be overlooked. OBJECTIVE: To investigate the differences in endoscopic appearance, ie, diminutive size and nonpolypoid shape, of proximal compared with distal colorectal neoplasms. DESIGN: Cross-sectional, single-center study. SETTING: Endoscopists at the Maastricht University Medical Center in the Netherlands who were previously trained in the detection and classification of nonpolypoid colorectal lesions. PATIENTS: Consecutive patients undergoing elective colonoscopy. MAIN OUTCOME MEASUREMENTS: Endoscopic appearance, ie, diminutive size (<6 mm) or nonpolypoid shape (height less than half of the diameter) of colorectal adenomas and serrated polyps (SPs), with a focus on adenomas with advanced histology, ie, high-grade dysplasia or early CRC and SPs with dysplasia or large size. RESULTS: We included 3720 consecutive patients with 2106 adenomas and 941 SPs. We found that in both men and women, proximal adenomas with high-grade dysplasia/early CRC (n = 181) were more likely to be diminutive or nonpolypoid than distal ones (76.3% vs 26.2%; odds ratio [OR] 9.24; 95% CI, 4.45-19.2; P < .001). Of the proximal adenomas, 84.4% were diminutive or nonpolypoid compared with 68.0% of the distal ones (OR 2.66; 95% CI, 2.14-3.29; P < .001). Likewise, large/dysplastic SPs in the proximal colon were more often nonpolypoid than distal ones (66.2% vs 27.8%; OR 5.51; 95% CI, 2.79-10.9; P < .001). LIMITATIONS: Inclusion of both symptomatic and asymptomatic patients. CONCLUSIONS: Proximal colorectal neoplasms with advanced histology frequently are small or have a nonpolypoid appearance. These findings support careful inspection of the proximal colon, if quality of cancer prevention with the use of colonoscopy is to be optimized.
KW - HIGH-GRADE DYSPLASIA
KW - CLINICALLY IMPORTANT
KW - HYPERPLASTIC POLYPS
KW - NONPOLYPOID FLAT
KW - SERRATED POLYPS
KW - LONG-TERM
KW - MISS RATE
KW - ADENOMAS
KW - RISK
KW - QUALITY
U2 - 10.1016/j.gie.2012.02.010
DO - 10.1016/j.gie.2012.02.010
M3 - Article
SN - 0016-5107
VL - 75
SP - 1218
EP - 1225
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 6
ER -