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1.
The Sentinel Hyperplastic Polyp: A Marker for Synchronous Neoplasia in the Proximal Colon 总被引:1,自引:0,他引:1
P. Gregory Foutch D.O. M.S. F.A.C.G. James A. DiSario M.D. Kathleen Pardy R.N. Hugh D. Mai M.D. R. K. Manne M.D. 《The American journal of gastroenterology》1991,86(10):1482-1485
We prospectively screened 129 asymptomatic subjects (mean age 64 yr) with flexible sigmoidoscopy. Colonoscopy was performed at a later date, regardless of the sigmoidoscopic result. Our intent was 1) to establish the prevalence of proximal neoplasms in patients with and without hyperplastic polyps within reach of the 60-cm sigmoidoscope and 2) to determine whether a distal (sentinel) hyperplastic polyp predicts the presence of synchronous neoplastic polyps higher up in the colon. Our results show that 15% of asymptomatic adult subjects without polyps on sigmoidoscopy have adenomas in proximal colonic segments that can be diagnosed only by colonoscopy. By comparison, proximal neoplasms were detected in 32% (p less than 0.05) and 37% (p less than 0.05) of patients when hyperplastic or adenomatous polyps, respectively, were present on the sigmoidoscopic examination. This finding suggests that a distal (sentinel) hyperplastic polyp by itself may be a marker for neoplastic polyps in proximal colonic segments. Also, the "index" adenoma and "sentinel" hyperplastic polyp may be equivalent for predicting the presence of proximal neoplasms. The observed detection rates for these polyps were both significantly higher than expected when compared to patients who did not have polyps in the distal colon or rectum. If these results can be confirmed by a larger prospective trial, then full colonoscopy for detection of proximal neoplasms may be indicated when either an index adenoma or sentinel hyperplastic polyp is detected by sigmoidoscopy. 相似文献
2.
Ullah N Qureshi K Yordanova V Hatfield J Sochacki P Lawson M Tobi M 《Digestive diseases and sciences》2005,50(4):708-713
We sought a correlation between site and morphology of colonic polyps by labeling with neoplastic and general Paneth cell markers, monoclonal antibodies Adnab-9 and anti--defensin 5, respectively. Proportions labeled by Adnab-9 and anti- -defensin 5 were, respectively, 42 and 85% for adenomas, 39 and 63% for early tubular adenomas, 41 and 44% for serrated, 34 and 20% for mixed, and 11 versus 2.7% for hyperplastic polyps. Compared with hyperplastic polyps, the proportion of other polyps labeled by Adnab-9 or anti--defensin 5 was higher but this difference was more significant for distal (P = 0.008 for Adnab-9 and P = 0.0001 for anti--defensin 5) than proximal (P = 0.645 and P = 0.154, respectively) polyps. While increased labeling of all proximal polyps compared to distal ones mirrored the colonic distribution of Paneth cells, distal adenomas tended to have a higher proportion labeled by Adnab-9, suggesting that Adnab-9 labels Paneth cells associated with increased neoplastic potential. 相似文献
3.
Flexible sigmoidoscopy may be ineffective for secondary prevention of colorectal cancer in asymptomatic,average-risk men 总被引:3,自引:0,他引:3
Dr. P. Gregory Foutch DO MS FACP Hugh Mai MD Kathleen Pardy RN James A. Disario MD R. K. Manne MD David Kerr MD 《Digestive diseases and sciences》1991,36(7):924-928
Asymptomatic men (N=114) 50 years of age or older had screening for colorectal neoplasia with flexible sigmoidoscopy followed by colonoscopy regardless of the sigmoidoscopic result. Our study objective was to determine the prevalence of patients having isolated adenomatous polyps in a proximal colonic segment in the absence of a distal index neoplasm within reach of the sigmoidoscope. Through the combined use of sigmoidoscopy and colonoscopy, adenomatous polyps were detected in 47 of 114 individuals (41%). A total of 88 adenomas was found. Seventeen patients had isolated neoplasms in proximal colonic segments in the absence of distal adenomas. These patients represented 15% of screened subjects (17 of 114) and 20% of individuals who lacked adenomas on sigmoidoscopy (17 of 84). The majority of proximal neoplasms were small (<1.0 cm), tubular adenomas. Flexible sigmoidoscopy may be ineffective for screening asymptomatic men for neoplasia. However, it remains to be determined if a 20% miss rate (for those with a normal sigmoidoscopic examination) is significant and whether small proximal adenomas are worth finding. 相似文献
4.
Collett JA Platell C Fletcher DR Aquilia S Olynyk JK 《Journal of gastroenterology and hepatology》1999,14(1):67-71
Flexible sigmoidoscopy has been recommended as a screening method to reduce the incidence of colorectal cancer in asymptomatic, average-risk subjects through the early detection and removal of polyps. However, the association between distal and proximal colonic neoplasia and, hence, the requirement for colonoscopic follow up of screen-detected distal neoplasms is unclear. Our aims were: (i) to evaluate the risk of having proximal neoplasms in those with distal colonic neoplasms; and (ii) to determine whether the risk was dependent on the number, size, histology or morphology of the distal lesions. We prospectively evaluated asymptomatic subjects in a flexible sigmoidoscopy based screening programme. Those with rectosigmoid neoplasia underwent colonoscopy. The number, size, histology and morphology of the polyps were recorded. Advanced lesions were defined as adenomas > 1 cm or with a villous component or severe dysplasia, carcinoma in situ or cancer. Adenomatous polyps were found in 17% (135) of screening flexible sigmoidoscopies. At colonoscopy, up to 30% of subjects with distal colonic neoplasms had synchronous proximal lesions at colonoscopy and up to 20% had advanced proximal lesions. The risk of proximal colonic neoplasia was increased in those with distal sessile colonic neoplasms but appeared independent of distal lesion size, number or morphology. In conclusion, distal colonic neoplasia predicts proximal neoplasia in up to 30% of subjects and these were advanced lesions in up to 20%. We recommend that all subjects with biopsy proven distal colonic neoplasia undergo colonoscopy. 相似文献
5.
Significance of serrated polyps of the colon 总被引:2,自引:0,他引:2
The fundamental view that colon adenocarcinomas arise only from conventional adenomas has been challenged by the now recognized
hyperplastic polyp-serrated adenoma-adenocarcinoma pathway. This article describes the history of the serrated adenoma (both
the traditional serrated adenoma and the sessile serrated adenoma) as well as the histology and endoscopic appearance of these
lesions in comparison with hyperplastic polyps and mixed polyps. Although the exact pathway is the subject of ongoing research,
compelling histologic associations and molecular phenotypes that define the model of the serrated polyp-carcinoma sequence,
including microsatellite instability, BRAF/KRAS mutations, and CpG island methylator phenotype, provide strong evidence that this is a genuine pathway. Management of serrated
neoplasia of the colon includes careful colonoscopy, complete removal of colonic polyps, sampling fields of diminutive polyps
of the rectosigmoid, and basing surveillance on histology of removed polyps. 相似文献
6.
Douglas K. Rex MD Amitabh Chak MD Rajeev Vasudeva MD Thomas Gross MD David Lieberman MD Ishan Bhattacharya MD Elizabeth Sack MD Maurits Wiersema MD Francis Farraye MD Michael Wallace MD Daniel Barrido MD Eileen Cravens MD Leonard Zeabart MD David Bjorkman MD Todd Lemmel MD Scott Buckley MD 《Gastrointestinal endoscopy》1999,49(6):727-730
7.
Carlos A. Rubio Margareta Rodensjö 《Journal of cancer research and clinical oncology》1995,121(9-10):571-576
The expression of the p53 protein was investigated in flat serrated neoplasias as well as in other histological phenotypes of flat or exophytic hyperplasias or neoplasias of the colorectal, mucosa. A total of 104 such lesions were analyzed: 24 were flat serrated neoplasias (22 flat serrated adenomas and 2 flat serrated adenocarcinomas), 26 flat tubular adenomas, 17 flat hyperplastic polyps, 29 exophytic tubular and/or villous neoplasias (23 adenomas and 6 exophytic adenocarcinomas) and the remaining 8, exophytic hyperplastic polyps. Deparaffinized, rehydrated sections were treated immunohistochemically to detect those overexpressing the p53 protein. Lesions having slight (+), moderate (++) or intense (+++) staining were considered immunoreactive. The results showed that 50% of the flat serrated adenomas with low-grade dysplasia (LGD) and 66.7% of those with high-grade dysplasia (HGD) had p53 immunoreactivity. None of the flat tubular or of the exophytic adenomas with LGD expressed p53, but immunoreactivity was present in 61.5% of the flat tubular adenomas with HGD and in 52.3% of the exophytic adenomas with HGD. All adenocarcinomas had an intense p53 reaction. Weak p53 expression was demonstrated by 11.7% of the flat hyperplastic polyps but none of the exophytic polyps reacted. The occurrence of p53 expression in flat serrated adenomas with LGD suggested that, despite its low histological profile, one-half of those lesions could be biologically already committed to independent growth. The occurrence of p53 expression in nearly 12% of the flat hyperplastic polyps was totally unexpected and deserves further investigation. Flat serrated adenoma emerges as a novel, independent histological entity among the various phenotypes of flat neoplasias of the colorectal mucosa. 相似文献
8.
Predictors of advanced proximal neoplasia in persons with abnormal screening flexible sigmoidoscopy. 总被引:5,自引:0,他引:5
Paul F Pinsky Robert E Schoen Joel L Weissfeld Robert S Bresalier Richard B Hayes John K Gohagan 《Clinical gastroenterology and hepatology》2003,1(2):103-110
BACKGROUND & AIMS: The relationship between distal and proximal colonic findings is uncertain. Thus, there is no consensus on which findings on screening flexible sigmoidoscopy should trigger colonoscopy. METHODS: We analyzed data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial to assess the relationship between distal and proximal colonic findings. RESULTS: A total of 8802 subjects had an abnormal baseline sigmoidoscopy and colonoscopy follow-up. Subjects with <10-mm single or multiple tubular adenomas had similar risks for advanced proximal neoplasia as subjects with hyperplastic polyps or other benign lesions (3%-5%). Subjects with large (>or=10 mm), villous, or severely dysplastic distal adenomas had similarly elevated risks for advanced proximal neoplasia (11%-12%). Multivariate logistic modeling showed a significantly increased risk for advanced proximal neoplasia associated with the presence of a large tubular (odds ratio [OR], 2.6; 95% confidence interval [CI], 2.0-3.4) or villous distal adenoma (OR, 2.7; 95% CI, 2.1-3.5) but not with the presence of one (OR, 1.05; 95% CI, 0.8-1.3) or multiple (OR, 0.8; 95% CI, 0.5-1.2) <10-mm tubular distal adenomas. CONCLUSIONS: Among subjects with a polypoid lesion on screening flexible sigmoidoscopy, those with small tubular distal adenomas are at similar risk for advanced proximal neoplasia as those without distal adenomas. Subjects with a large, villous, or dysplastic distal adenoma are at increased risk. A strategy that encourages individuals with small tubular adenomas on sigmoidoscopy to undergo follow-up colonoscopy and excludes those with nonadenomatous lesions is of questionable validity, because both groups are at similar risk for advanced proximal neoplasia. 相似文献
9.
Risk of proximal colorectal neoplasia among asymptomatic patients with distal hyperplastic polyps 总被引:4,自引:0,他引:4
Lin OS Schembre DB McCormick SE Gluck M Patterson DJ Jiranek GC Soon MS Kozarek RA 《The American journal of medicine》2005,118(10):1113-1119
PURPOSE: 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. 相似文献
10.
Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects. 总被引:7,自引:0,他引:7
The significance of distal colonic hyperplastic polyps was investigated in 482 asymptomatic average-risk subjects, aged 50-75 years, in whom fecal occult blood test results were negative and who underwent screening colonoscopy. The incidence of adenomas in the colon proximal to the sigmoid-descending colon junction in subjects with hyperplastic polyps distal to that point was 18% and was similar to the incidence of proximal colonic adenomas in subjects with no distal colonic polyps (15%). The incidence of proximal colonic adenomas in subjects with no distal colonic adenomas was 38% and was significantly greater than the incidence found in individuals with no distal colonic polyps or only hyperplastic polyps. Our data do not support distal colonic hyperplastic polyps as markers for proximal colonic adenomas in asymptomatic average-risk subjects. 相似文献
11.
CONTEXT: The current literature is unclear about the association between distal hyperplastic polyps and synchronous neoplasia (adenomatous polyps and cancer) in the proximal colon. OBJECTIVE: To estimate the prevalence of proximal neoplasia associated with distal hyperplastic polyps. DATA SOURCES: Database searches (medline and embase from 1966 to 2001) and manual search of the bibliographies of included and excluded studies, case reports, editorials, review articles, and textbooks of Gastroenterology. STUDY SELECTION: Studies describing the prevalence of proximal neoplasia in persons with distal hyperplastic polyps. DATA EXTRACTION: Demographics, clinical variables, study design, and prevalence of proximal neoplasia associated with various distal colorectal findings. DATA SYNTHESIS: Of 18 included studies, 12 involved asymptomatic individuals in which the pooled absolute risk of any proximal neoplasia associated with distal hyperplastic polyps was 25% (95% confidence interval [95% CI], 21% to 29%). In 4 studies where colonoscopy was performed irrespective of distal findings, the absolute risk was 21% (95% CI, 14% to 28%). The relative risk of finding any proximal neoplasia in persons with distal hyperplastic polyps was 1.3 (95% CI, 0.9 to 1.8) compared to those with no distal polyps. Among 6 studies of patients with symptoms or risk factors for neoplasia, the absolute risk of proximal neoplasia was 35% (95% CI, 32% to 39%) in persons with distal hyperplastic polyps. In 2 studies of screening colonoscopy, advanced proximal neoplasia (cancer, or a polyp with villous histology or severe dysplasia, or a tubular adenoma >/=1 cm) was present in 4% to 5% of persons with distal hyperplastic polyps, which was 1.5 to 2.6 times greater than in those with no distal polyps. CONCLUSIONS: In asymptomatic persons, a distal hyperplastic polyp is associated with a 21% to 25% risk for any proximal neoplasia and a 4% to 5% risk of advanced proximal neoplasia, and may justify examination of the proximal colon. Further study is needed to determine the risk of advanced proximal neoplasia associated with size and number of distal hyperplastic polyps. 相似文献
12.
Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and meta-analysis of screening colonoscopy 总被引:4,自引:0,他引:4
Lewis JD Ng K Hung KE Bilker WB Berlin JA Brensinger C Rustgi AK 《Archives of internal medicine》2003,163(4):413-420
BACKGROUND: The relative effectiveness of flexible sigmoidoscopy compared with colonoscopy to screen for colorectal cancer depends on the magnitude of the association between findings in the proximal and distal colon and the false-negative rate of screening sigmoidoscopy for proximal neoplasia. To address this, we performed a systematic review and meta-analysis of screening colonoscopy studies. METHODS: Published studies through July 31, 2000, of asymptomatic patients undergoing screening colonoscopy were identified from the MEDLINE database. We generated pooled estimates of the odds ratio for the association between findings in the distal and proximal colon and the prevalence of isolated proximal adenomatous neoplasia. RESULTS: Using the sigmoid-descending colon junction to identify the beginning of the distal colon, the pooled odds ratio for the association between distal adenomatous polyps and any proximal neoplasia was 2.40 (95% confidence interval [CI], 1.42-4.05). Diminutive distal adenomatous polyps were also associated with proximal neoplasia (odds ratio, 2.36; 95% CI, 1.30-4.29). Distal hyperplastic polyps were not associated with proximal neoplasia (odds ratio, 1.44; 95% CI, 0.79-2.62). The prevalence of isolated advanced proximal neoplasia in the 3 studies was 2%, 3%, and 5%. Using the sigmoid-descending colon junction to identify the beginning of the distal colon yields a pooled estimate of isolated proximal neoplasia of 16.3% (95% CI, 13.6%-19.1%). CONCLUSIONS: Distal adenomatous polyps, including diminutive distal adenomatous polyps, are associated with an increased prevalence of synchronous proximal neoplasia. Two percent to 5% of patients undergoing screening colonoscopy may have isolated advanced proximal neoplasia. Even more patients may have isolated nonadvanced proximal neoplasia. 相似文献
13.
Levin TR 《The American journal of gastroenterology》2003,98(10):2326-2327
The relative effectiveness of flexible sigmoidoscopy compared with colonoscopy to screen for colorectal cancer depends on the magnitude of the association between findings in the proximal and distal colon and the false-negative rate of screening sigmoidoscopy for proximal neoplasia. Lewis et al. performed a systematic review and meta-analysis of screening colonoscopy studies. Published studies through July 31, 2000 of asymptomatic patients undergoing screening colonoscopy were identified from the MEDLINE database. The authors generated pooled estimates of the odds ratio for the association between findings in the distal and proximal colon and the prevalence of isolated proximal adenomatous neoplasia. With the sigmoid–descending colon junction used to identify the beginning of the distal colon, the pooled odds ratio for the association between distal adenomatous polyps and any proximal neoplasia was 2.40 (95% confidence interval [Cl] = 1.42–4.05). Diminutive distal adenomatous polyps were also associated with proximal neoplasia (odds ratio = 2.36; 95% CI = 1.30–4.29). Distal hyperplastic polyps were not associated with proximal neoplasia (odds ratio = 1.44; 95% CI = 0.79–6.62). The prevalence of isolated advanced proximal neoplasia in the three studies was 2%, 3%, and 5%, respectively. When the sigmoid–descending colon junction is used to identify the beginning of the distal colon, this yields a pooled estimate of isolated proximal neoplasia of 16.3% (95% CI = 13.6%–19.1%). Distal adenomatous polyps, including diminutive distal adenomatous polyps, are associated with an increasing prevalence of synchronous proximal neoplasia. From 2% to 5% of patients undergoing screening colonoscopy might have isolated advanced proximal neoplasia. 相似文献
14.
Tatsumi N Mukaisho K Mitsufuji S Tatsumi Y Sugihara H Okanoue T Hattori T 《Digestive diseases and sciences》2005,50(9):1741-1746
The entity of serrated adenoma of the colorectum was first proposed in 1990, and it was characterized as epithelial neoplasia
combining the architectural features of a hyperplastic polyp with the cytological features of an adenoma. Over the past few
years, various clinicopathological studies on serrated adenoma have been reported, but its histogenesis remains unclear. Recently
the existence of a “serrated neoplasia pathway” leading to malignancy, which is different from the so-called adenoma–carcinoma
sequence, has been discussed. Yao et al. reported that hyperplastic polyps and serrated adenomas share a common cell lineage with gastric differentiation. To clarify
the existence of the serrated neoplasia pathway, we performed immunohistochemical staining of cytokeratin 7 (CK7) and cytokeratin
20 (CK20), which are commonly used to determine the primary site of a metastatic lesion, and we examined the pattern of CK7/CK20
expression in various colorectal lesions including 44 serrated adenomas, 25 hyperplastic polyps, 20 traditional adenomas,
and 48 carcinomas. An obvious difference existed in the pattern of CK7/CK20 expression between the serrated lesions (hyperplastic
polyps and serrated adenomas) and others. The majority of serrated adenomas and hyperplastic polyps presented a CK7+/CK20+
pattern, whereas most conventional adenomas and adenocarcinomas expressed CK7−/CK20+. Adenocarcinoma developing in serrated
adenoma also presented a CK7+/CK20+ pattern. There are several reports that CK7 is a possible marker of transient dedifferentiation
in the gastric carcinogenesis process. Taken together with the present results, a distinct pathway of colorectal carcinogenesis
must exist, which is different from the adenoma–carcinoma sequence. CK7 is a possible marker for the serrated neoplasia pathway
of colorectal carcinogenesis. 相似文献
15.
Prevalence of Proximal Neoplasms Among Asymptomatic Patients According to Distal Colorectal Findings
Elife Erarslan Cansel Turkay Ayse Isik Burak Uz Arif Kaya Nuket Bavbek 《Digestive diseases and sciences》2009,54(6):1312-1316
Colorectal cancer has been described in association with hyperplastic polyposis. Only half of proximal colon cancers are associated
with distal adenomas. To compare the prevalence of proximal and advanced neoplasia between patients with distal hyperplastic
polyps only; with distal adenomas with or without hyperplastic polyps; and with no distal polyps, we retrospectively analyzed
data of 1,064 adults who underwent colonoscopy. Of these patients, 3% had neoplasia. Proximal neoplasia occurred in 0.8% of
945 patients with no distal polyps, compared to none of 19 with distal hyperplastic polyps (P > 0.05) and 6% with distal adenomas (P > 0.05). Proximal advanced neoplasia occurred in 0.6% patients with no distal polyps, compared with none with distal hyperplastic
polyps (P > 0.05) and 6% with distal adenomas (P > 0.05). In conclusion, 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. 相似文献
16.
Binda V Pereira-Lima J Nunes CA Falkemberg LT Azambuja DB Cruz JV 《Arquivos de gastroenterologia》2007,44(1):2-7
BACKGROUND: Colonoscopy is the gold standard exam to investigate patients with colonic complaints. However, its availability is limited in developing countries. Sigmoidoscopy has been advocated as a first procedure in colorectal cancer screening strategies, in order to select those who need colonoscopy. AIM: To study the correlation between distal and proximal colonic neoplasias in symptomatic patients 50 years or older and patients 40 to 49 years old who underwent colonoscopy at a gastrointestinal endoscopy unit in 1999 and 2000 with the purpose to evaluate its role in a symptomatic population. METHODS: All colonoscopies performed in our Department in 1999-2000 were reviewed. The distal colon was defined as the colonic segment aboral to the splenic flexure. Advanced neoplasias were defined as adenomas larger than 10 millimeters and adenocarcinomas. RESULTS: Of the 2,701 colonoscopies retrieved, 1,125 were enrolled in this study. Prevalence rates for adenoma, advanced adenoma and carcinoma were 28.9%, 4.6% and 4% in the group of 830 patients 50 years or older (mean age 65 years, 491 women). The finding of one small (<10 mm) adenoma in the distal bowel doubled the likelihood of finding a proximal neoplasia (OR = 2.12, 95% CI, 1.27-3.54), and multiple (OR = 3.99, 95% CI, 1.72-9.28) or advanced (OR = 3.73, 95% CI, 1.81-7.7) adenomas increased this risk even further. Of the patients without adenoma or carcinoma in the distal colon, 1.93% had proximal advanced neoplasia. In the group of 40 to 49-year-old patients (n = 395; mean age 44.8 years, 208 women) the prevalence of adenomas (14.9%), advanced adenomas (3.4%), and carcinomas (1.7%) was lower. CONCLUSIONS: The likelihood of finding a proximal lesion is greater in patients with distal neoplasias. This likelihood is further increased when adenomas are multiple or larger than 10 mm. One out of 52 patients 50 years or older with an apparently normal distal colon has advanced proximal neoplasia. Sigmoidoscopy is not an adequate exam for symptomatic patients aged 50 years or older. 相似文献
17.
Dr. Mitchell S. Cappell M.D. Ph.D. Kenneth A. Forde M.D. 《Diseases of the colon and rectum》1989,32(8):641-652
Analysis of relative polyp locations in 426 consecutive patients with multiple colonic polyps found on colonoscopy showed
novel findings. First, synchronous and metachronous neoplastic polyps showed spatial clustering in individual patients. For
example, patients with their largest neoplasm in the cecum or proximal ascending colon, had 34.3 percent±4.6 percent (standard
error) of their other colonic neoplasms in the same location. Second, hyperplastic polyps showed spatial clustering in individuals
that was statistically significantly greater than expected from the increased hyperplastic polyp concentration in the rectum
and sigmoid. Third, hyperplastic polyps showed spatial clustering with neoplastic polyps; this clustering was similar in magnitude
to clustering for exclusively hyperplastic or neoplastic polyps. In contrast, lipomas were not spatially clustered with hyperplastic
and neoplastic polyps. The magnitude of clustering between hyperplas and neoplasia showed a closer association between these
histologic types than previously appreciated. Because of clustering, regions with prior polyps appear to merit closer surveillance.
These findings suggest clinical study, using a randomized controlled clinical trial, of whether a patient who had only rectal
and sigmoid adenomas on initial and follow-up colonoscopy should have surveillance with flexible sigmoidoscopy alternating
annually with colonoscopy. A patient with a prior cecal adenoma should have surveillance only with a complete colonoscopy
or adequate cecal views on barium enema. 相似文献
18.
OBJECTIVES: Our aim was to measure the prevalence and distribution of colonic neoplasia in Chinese adults, and to estimate the sensitivity of sigmoidoscopic screening strategies for detecting those with advanced neoplasia. METHODS: Asymptomatic, average-risk Chinese adults aged 50 years or older underwent screening colonoscopy. The prevalence and distribution of colonic neoplasia and advanced neoplasia (defined as an adenoma >or=10 mm or with villous, high-grade dysplastic, or malignant features) were reviewed retrospectively and the outcomes of various sigmoidoscopic screening strategies estimated. RESULTS: Of 1,382 individuals (833 men, 549 women; mean age 58.8 years) included, 243 (18%) had colorectal neoplasia and 72 (5.2%) had advanced neoplasia. Neoplasia prevalence was significantly higher in male and older patients. No significant differences were observed in neoplasia distribution between men and women. Overall, 24 patients had advanced neoplasia in the proximal colon, of whom four had synchronous distal neoplasia. The estimated sensitivity for detecting patients with advanced neoplasia was 72% if we assumed screening sigmoidoscopy was performed, with follow-up colonoscopy for those with distal neoplasia; 165 patients would need to undergo colonoscopy. If, instead, we assumed follow-up colonoscopy was done only for patients with distal advanced neoplasia, the estimated sensitivity would decrease slightly to 71%, but the number of colonoscopies would decrease substantially to 51. CONCLUSION: In average-risk Chinese adults, screening sigmoidoscopy is estimated to detect more than two-thirds of patients with advanced neoplasia. In Chinese societies with limited health-care resources, performing colonoscopy only on patients with distal advanced neoplasia is a screening approach that optimizes the return rate on colonoscopic capacity. 相似文献
19.
OBJECTIVE: To determine whether hyperplastic polyps found in the rectosigmoid area of the colon are associated with proximal adenomas, and to judge whether patients with distal hyperplastic polyps found during sigmoidoscopy might benefit from full colonoscopy. DESIGN: Data on patients having colonoscopy collected prospectively according to a set protocol. The size and location of all polyps were noted, and all polyps were biopsied. SETTING: Two university hospitals. PATIENTS: One thousand eight hundred and thirty-six consecutive patients referred for colonoscopy between 31 December 1987 and 31 August 1989. RESULTS: Of the 970 patients who met eligibility requirements, 274 (28.3%) had adenomas and 108 (11.1%) had hyperplastic polyps. The proportion of patients with distal hyperplastic polyps and proximal adenomas (31.9%) was similar to the proportion of those without distal hyperplastic polyps (23.0%) (crude odds ratio, 1.57; 95% CI, 0.77 to 3.06). After adjusting for age and sex, the results were unchanged (adjusted odds ratio, 1.53; CI, 0.82 to 2.88). Patients with distal adenomas, on the other hand, were three times more likely to have proximal adenomas than those without distal adenomas (adjusted odds ratio, 3.42; CI, 1.99 to 5.88). CONCLUSIONS: Distal hyperplastic polyps are not strong predictors of risk for proximal adenomas. Based on the magnitude of the risk difference, we do not believe that finding a hyperplastic polyp during sigmoidoscopy justifies doing a full colonoscopy to search for proximal adenomas. Because rectosigmoid adenomas are associated with proximal adenomas, however, small polyps seen during sigmoidoscopy should be biopsied to determine their type. Colonoscopy should be reserved for patients who are proved to have adenomas. 相似文献
20.
Shuling Chen Kaiyu Sun Kang Chao Yuli Sun Liru Hong Zijin Weng Yi Cui Minhu Chen Shenghong Zhang 《International journal of colorectal disease》2018,33(2):131-139