The association between distal and ...

The association between distal and proximal colorectal adenomas is undefined, and no preventive guidelines explicitly attract favor to colonoscopic examination for proximal lesions when a distal adenoma is plant on sigmoidoscopic examination. Dave and colleagues performed a systematic review to determine the absolute risk of synchronous proximal neoplasia in the personality of distal hyperplastic polyps. They also measured the relative risk of proximal neoplasia associated with distal hyperplastic polyp compared with no polyp and with distal adenomatous polyps

The authors performed a MEDLINE and EMBASE search of studies using proximal neoplasia and advanced neoplasia as issue variables. Twelve screening studies and six case-finding studies were ground In the latter, colonic evaluation was performed because of the personality of risk factors or symptoms.

In the screening studies, proximal neoplasia was not absent in 16 percent of individuals with no distal polyps, in 25 percent of those with distal hyperplastic polyp and in 36 percent of those with distal adenomatous polyp In a comparison subset of somebodys with no distal polyps, the absolute risk of finding proximal neoplasia was 21 percent for distal hyperplastic polyp and 40 to 47 percent for distal adenomatous polyp while the relative risk was 13 and 25 respectively. Among all 12 screening studies, the risk of proximal neoplasia in someones with distal adenomatous polyps was 15 compared with distal hyperplastic polyps

For case studies, the pond ed absolute risk of proximal neoplasia in association with distal hyperplastic polyp was 35 percent The prevalence of proximal neoplasia in human frames with distal adenomatous polyps ranged from 30 to 51 percent while the prevalence in those with no distal polyp varied from 3 to 23 percent

The authors infer that persons with distal hyperplastic polyp have a risk of proximal neoplasia that is intermediate between those ones with no distal polyps and those with distal adenomas. The risk of proximal neoplasia associated with distal hyperplastic polyp was lower in asymptomatic bodys who underwent colonoscopy after screening sigmoidoscopy compared with those who underwent diagnostic colonoscopy for symptoms or risk factors for colorectal neoplasia. Clinically, this conclusion does not lead to recommendations for colonoscopic examination for all distal polyp Further understanding of the neoplastic potential of distal hyperplastic polyp is necessary before deciding who requires colonoscopy after sigmoidoscopy.

Dave s et al. Is the distal hyperplastic polyp a marker for proximal neoplasia? J Gen Intern M February 2003; 18:128-37

CAROLINE WELLBERY, MD

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group