Likelihood of missed and recurrent adenomas in the proximal versus the distal colon

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• 作者：Adeyinka O. Laiyemo MD ; MPH^a ; ^b ; ; Chyke Doubeni MD ; MPH^g ; Andrew K. Sanderson II MD^a ; Paul F. Pinsky PhD^c ; Dilhana S. Badurdeen MD^a ; V. Paul Doria-Rose DVM ; PhD^d ; Pamela M. Marcus PhD^b ; Robert E. Schoen MD ; MPH^h ; Elaine Lanza PhD^e ; Arthur Schatzkin MD ; DrPH^f ; Amanda J. Cross PhD^f
• 刊名：Gastrointestinal Endoscopy
• 出版年：2011
• 出版时间：August 2011
• 年：2011
• 卷：74
• 期：2
• 页码：253-261
• 全文大小：260 K

文摘

Background

Colonoscopy may be less efficacious in reducing colorectal cancer mortality in the proximal compared with the distal colon. A greater likelihood for missed and recurrent adenomas in the proximal colon may contribute to this phenomenon.

Objective

To examine whether a proximal adenoma is associated with the risk and location of missed and recurrent adenomas.

Design

Prospective.

Setting

Polyp Prevention Trial.

Participants

A total of 1864 patients with an adenoma at baseline underwent a follow-up colonoscopy 4 years later (adenoma recurrence). Of these, 1731 underwent a clearing colonoscopy 1 year after the baseline examination (missed adenoma).

Main Outcome Measurements

Association of baseline adenoma location with the risk and location of adenomas found at colonoscopy performed 1 year and 4 years later.

Results

At the year 1 colonoscopy, 598 patients (34.6 % ) had an adenoma (missed adenoma). Compared with those with a distal-only adenoma at baseline, patients with a proximal-only adenoma at baseline were more likely to have any missed adenomas (relative risk [RR] 1.28; 95 % CI, 1.09-1.49) and a proximal-only missed adenoma (RR 2.05; 95 % CI, 1.49-2.80). At the year 4 colonoscopy, 733 patients (39.3 % ) had adenoma recurrence. Patients with a baseline proximal-only adenoma were more likely to have any adenoma recurrence (RR 1.14; 95 % CI, 1.00-1.31) and a proximal-only adenoma recurrence (RR 1.52; 95 % CI, 1.15-2.02). Sensitivity analyses involving missed adenomas did not materially affect the risk or location of recurrent adenomas at year 4 colonoscopy.

Limitation

Lesions may still be missed on repeated colonoscopies.

Conclusions

Missed and recurrent adenomas are more likely to be in the proximal colon.