title: Screening colonoscopy in the initial workup of bariatric surgery patients: guidelines are needed.
abstract: BACKGROUND
  Cancer is one of the most common causes of death among morbidly obese individuals. Obese individuals have a well-documented increased risk of colon cancer. No guidelines are available for the workup of bariatric surgery patients in relation to colon cancer.
  
  
  METHODS
  The indications for screening colonoscopy at the Bariatric and Metabolic Institute Abu Dhabi (BMI Abu Dhabi) include all patients older than 50 years [40 years if patients are United Arab Emirates (UAE) nationals] with unexplained abdominal symptoms, anemia of unknown cause, or a family or personal history of colonic pathology. This study retrospectively reviewed the charts of all the patients who had colonoscopy during the period January 2009 to January 2013. The patients were divided into two groups: group A [patients with a body mass index (BMI) > 30 kg/m(2)] and group B (patients with a BMI < 30 kg/m(2)). The demographics and the prevalence of polyps and cancer in the two groups were compared.
  
  
  RESULTS
  During the study period, 341 colonoscopies were performed: 137 for patients with a BMI higher than 30 kg/m(2) (mean age, 44 years) and 204 for patients with a BMI lower than 30 kg/m(2) (mean age, 46 years) (P > 0.05). The overall prevalence of adenomatous polyps was 6.74 % and that of cancer was 1.75 %. Further analysis showed that the prevalences of adenomatous polyps and cancer were respectively 12.4 and 2.1 % for the patients with a BMI higher than 30 kg/m(2), whereas the prevalences were respectively 2.9 and 0.9 % for the patients with BMI lower than 30 kg/m(2) (P < 0.001).
  
  
  CONCLUSIONS
  The risk for the development of colonic adenomatous polyps and cancer is high among young obese individuals in the Middle East. Guidelines are needed to establish criteria for screening in this group of individuals.
authors.affiliation: Division of General, Thoracic, and Vascular Surgery, Sheikh Khalifa Medical City Managed by Cleveland Clinic, Abu Dhabi, UAE.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Hadad
authors.forename: Nidal
authors.initials: N
authors.lastname: Dehni
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alakhras
authors.forename: Yalda
authors.initials: Y
authors.lastname: Ziaei
authors.forename: Nicolas P
authors.initials: NP
authors.lastname: Turrin
authors.forename: Abdelrahman
authors.initials: A
authors.lastname: Nimeri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050110:Bariatric Surgery; D015992:Body Mass Index; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D003111:Colonic Polyps / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D003113:Colonoscopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014479:United Arab Emirates / Q000453:epidemiology; D055815:Young Adult