BACKGROUND AND AIMS: The purpose of this study was to evaluate the utility of easily measured clinical variables at flexible sigmoidoscopy (FS) screening that might predict a proximal advanced neoplasm (PAN). METHODS: We studied 1833 subjects with biopsy verified adenomas at FS who subsequently underwent full colonoscopy. RESULTS: A total of 387 (21%) subjects had proximal colonic neoplasms (PCN) and 85 (5%) had PAN. In univariate comparison, the risk of PAN increased more than threefold in the presence of a distal adenoma measuring either > or =10 mm in diameter or containing villous components. Multiplicity of distal adenomas, severe dysplasia, or age > or =60 years increased the risk of PAN more than twofold. In the multivariate model, the presence of a distal adenoma > or =10 mm, villousness, and multiplicity maintained their significance as predictive variables for increased risk of proximal neoplasms, whereas sex and severe dysplasia lost their significance. By recommending colonoscopy only to individuals with multiple (>1) adenomas or any high risk adenoma at FS, we would have reduced the number of colonoscopies by 1209 (66%) but would have missed 32 (38%) participants with PAN and 217 (56%) with PCN. By using a 60 cm endoscope instead of an ordinary colonoscope at FS, nine (2%) participants with advanced neoplasms, including three patients with cancer, would have been missed. CONCLUSION: The present study supports the concept of defining "any adenoma" as a positive FS, qualifying for colonoscopy. We recommend the use of an ordinary colonoscope instead of a 60 cm sigmoidoscope for FS screening examinations.
BACKGROUND AND AIMS: The purpose of this study was to evaluate the utility of easily measured clinical variables at flexible sigmoidoscopy (FS) screening that might predict a proximal advanced neoplasm (PAN). METHODS: We studied 1833 subjects with biopsy verified adenomas at FS who subsequently underwent full colonoscopy. RESULTS: A total of 387 (21%) subjects had proximal colonic neoplasms (PCN) and 85 (5%) had PAN. In univariate comparison, the risk of PAN increased more than threefold in the presence of a distal adenoma measuring either > or =10 mm in diameter or containing villous components. Multiplicity of distal adenomas, severe dysplasia, or age > or =60 years increased the risk of PAN more than twofold. In the multivariate model, the presence of a distal adenoma > or =10 mm, villousness, and multiplicity maintained their significance as predictive variables for increased risk of proximal neoplasms, whereas sex and severe dysplasia lost their significance. By recommending colonoscopy only to individuals with multiple (>1) adenomas or any high risk adenoma at FS, we would have reduced the number of colonoscopies by 1209 (66%) but would have missed 32 (38%) participants with PAN and 217 (56%) with PCN. By using a 60 cm endoscope instead of an ordinary colonoscope at FS, nine (2%) participants with advanced neoplasms, including three patients with cancer, would have been missed. CONCLUSION: The present study supports the concept of defining "any adenoma" as a positive FS, qualifying for colonoscopy. We recommend the use of an ordinary colonoscope instead of a 60 cm sigmoidoscope for FS screening examinations.
Authors: R E Schoen; D Corle; L Cranston; J L Weissfeld; P Lance; R Burt; F Iber; M Shike; J W Kikendall; M Hasson; K J Lewin; H D Appelman; E Paskett; J V Selby; E Lanza; A Schatzkin Journal: Gastroenterology Date: 1998-09 Impact factor: 22.682
Authors: Øyvind Holme; Magnus Løberg; Mette Kalager; Michael Bretthauer; Miguel A Hernán; Eline Aas; Tor J Eide; Eva Skovlund; Jørn Schneede; Kjell Magne Tveit; Geir Hoff Journal: JAMA Date: 2014-08-13 Impact factor: 56.272
Authors: Maria Tzouvala; Andreas C Lazaris; George V Papatheodoridis; Chariklia Kouvidou; Thomas G Papathomas; Nikos Kavantzas; Ioannis Elemenoglou; Demetrios G Karamanolis; Emmanouil Agapitos Journal: Dig Dis Sci Date: 2007-06-12 Impact factor: 3.199
Authors: Kjetil Søreide; Einar Gudlaugsson; Ivar Skaland; Emiel A M Janssen; Bianca Van Diermen; Hartwig Körner; Jan P A Baak Journal: Int J Colorectal Dis Date: 2008-04 Impact factor: 2.571