Do patients with rectosigmoid adenomas 5 mm or less in diameter need total colonoscopy?
BACKGROUND
The need for colonoscopy in the care of patients with rectosigmoid adenoma 5 mm or less in diameter is still debatable.


METHODS
We estimated the prevalence of proximal adenomas among 3052 consecutive subjects undergoing total colonoscopy. Rectosigmoid adenoma was classified as diminutive (5 mm), small (6 to 10 mm), or large (>/=11 mm). Advanced proximal adenoma was 10 mm in diameter or larger, or with a villous component, severe dysplasia, or infiltrating adenocarcinoma.


RESULTS
Proximal adenoma was found in 212 of 2483 patients (8.5%, 95% CI [7.5, 9.7]) without distal neoplastic polyps, 49 of 214 (22.9%, 95% CI [17.6, 29.2]) with diminutive, 44 of 174 (25.3%, 95% CI [19.1, 32.5] with small, and 70 of 181 (38.7%, 95% CI [31.6, 46.2]) with large distal adenoma. Advanced proximal adenoma was found in 49 (2.0%, 95% CI [1.5, 2.6]), 8 (3.7%, 95% CI [1.7, 7.5]), 17 (9.8%, 95% CI [6.0, 15.4]), and 29 patients (16.0%, 95% [11.2, 22.4]), respectively. In patients with distal adenoma risk for proximal lesions increased with increasing age, size, and number of distal adenomas (p = 0.01). Size of distal adenoma was the strongest predictor of the presence of proximal advanced adenoma (multivariate analyses).


CONCLUSIONS
In a clinical setting, the decision to perform colonoscopy should take into account proximal lesions of clinical interest, life expectancy, costs, and risks associated with the procedure. When detection of advanced proximal adenoma is the goal, presence of distal diminutive adenoma alone might not be an indication for total colonoscopy.
Sciallero
S
S
Unit of Cinical Epidemiology and Trials, National Institute for Cancer Research, Genoa, Italy.
Bonelli
L
L
Aste
H
H
Casetti
T
T
Bertinelli
E
E
Bartolini
S
S
Parri
R
R
Castiglione
G
G
Mantellini
P
P
Costantini
M
M
Naldoni
C
C
Bruzzi
P
P
D018256:Adenomatous Polyps / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012811:Sigmoid Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D012812:Sigmoidoscopy / Q000379:methods / Q000706:statistics & numerical data; D019564:Unnecessary Procedures