title: Risk of proximal colorectal neoplasia among asymptomatic patients with distal hyperplastic polyps.
abstract: OBJECTIVE
  Many guidelines on colorectal cancer screening do not consider distal hyperplastic polyps to be a marker for proximal neoplasia. However, 11 of 17 published studies have shown an increased risk of proximal neoplasia in patients with distal hyperplastic polyps. Our goal is to assess the risk of proximal neoplasia in asymptomatic patients with distal hyperplastic polyps, compared to those with distal tubular adenomas or no distal polyps.
  
  
  METHODS
  We assessed proximal (cecum, ascending, transverse colon and splenic flexure) and distal polyps in patients undergoing screening colonoscopy, classifying them into 3 groups: distal hyperplastic polyps only; distal adenomas with or without hyperplastic polyps; no distal polyps. The prevalence of proximal neoplasia and advanced neoplasia (polyps > or =1 cm, villous adenomas, or cancer) was compared among these groups.
  
  
  RESULTS
  Of 2357 patients, 427 (18%) had neoplasia, including 103 (4%) with advanced neoplasia. Proximal neoplasia occurred in 175 (9%) of 1896 patients with no distal polyps, compared with 28 (12%) of 237 with distal hyperplastic polyps (P = 0.20) and 64 (29%) of 224 with distal adenomas (P <0.0001). Proximal advanced neoplasia occurred in 39 (2%) patients with no distal polyps, compared with 4 (2%) with distal hyperplastic polyps (P = 0.70) and 9 (4%) with distal adenomas (P = 0.13).
  
  
  CONCLUSIONS
  Patients with distal hyperplastic polyps, unlike those with distal adenomas, do not exhibit an increased risk for proximal neoplasia or proximal advanced neoplasia compared to those with no distal polyps. The discovery of hyperplastic polyps on screening sigmoidoscopy should not prompt colonoscopy.
authors.affiliation: Gastroenterology Section, Virginia Mason Medical Center, Seattle, Wash 98101, USA. otto.lin@vmmc.org
authors.forename: Otto S
authors.initials: OS
authors.lastname: Lin
authors.forename: Drew B
authors.initials: DB
authors.lastname: Schembre
authors.forename: Susan E
authors.initials: SE
authors.lastname: McCormick
authors.forename: Michael
authors.initials: M
authors.lastname: Gluck
authors.forename: David J
authors.initials: DJ
authors.lastname: Patterson
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Jiranek
authors.forename: Maw-Soan
authors.initials: MS
authors.lastname: Soon
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kozarek
mesh_terms: D000236:Adenoma / Q000453:epidemiology*; D000367:Age Factors; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000453:epidemiology; D007417:Intestinal Polyps / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D011230:Precancerous Conditions / Q000453:epidemiology*; D012007:Rectum / Q000473:pathology*; D012306:Risk; D012737:Sex Factors; D014861:Washington / Q000453:epidemiology