Small polyps found during fiberoptic sigmoidoscopy in asymptomatic patients.
OBJECTIVE
To determine the prevalence of small polyps in the rectosigmoid in an asymptomatic group and the likelihood of finding synchronous neoplastic polyps proximally at colonoscopy.


METHODS
Asymptomatic patients with polyps 9 mm or less found at screening fiberoptic sigmoidoscopy were referred for colonoscopy, at which time all polyps were removed.


METHODS
Screening fiberoptic sigmoidoscopy unit.


METHODS
Referral from Executive Health Wellness Clinic and large multispeciality clinic.


RESULTS
From 3923 sigmoidoscopic examinations, 258 asymptomatic subjects (7%) were identified who had polyps 9 mm or smaller. One hundred and eighty-nine patients (73%) had colonoscopy. In 179 patients, the target lesion noted at sigmoidoscopy was identified at colonoscopy. Based on histology of the target lesion, patients were divided into three groups: Group 1 (72 patients) had only hyperplastic polyps; Group 2 (69 patients) had at least one neoplastic polyp; and Group 3 (31 patients) had polyps with normal histology. Seven patients were not classified. Neoplastic polyps were found proximally in 21 patients in Group 1 (29%; 95% CI, 19 to 39), 23 patients in Group 2 (33%; 95% CI, 22 to 44), and 4 patients in Group 3 (13%; 95% CI, 4 to 30). There was no difference in mean age between groups. The results were similar when only polyps 5 mm or smaller were analyzed.


CONCLUSIONS
Because small polyps of any histologic type in the rectosigmoid indicate a high risk for having neoplastic polyps proximally, the guidelines of both the American College of Physicians and the American Society of Gastrointestinal Endoscopy may need to be revised. Colonoscopy seems justified in any patient in whom a small polyp is discovered at sigmoidoscopy.
Achkar
E
E
Cleveland Clinic, Ohio.
Carey
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000453:epidemiology* / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D006965:Hyperplasia; D007417:Intestinal Polyps / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology*; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000453:epidemiology* / Q000473:pathology; D012812:Sigmoidoscopy