Rectosigmoid polyps as markers of proximal colonic neoplasms : a cost benefit analysis of different diagnostic protocols.
The predictive value of hyperplastic polyps of the rectosigmoid for neoplastic lesions in the proximal colon is controversial.
Some authors who deny predictive value have proposed a protocol which entails initially biopsying rectosigmoid polyps, and only in the case of adenomas then proceeding to total colonoscopy (protocol 1).
The diagnostic and economic efficiency of this protocol, and of an alternative which entailed the full exploration of the colon during the initial examination in the case of rectosigmoid polyps (protocol 2), were evaluated by retrospectively simulating their application to 216 patients who had undergone total colonoscopy.
A proximal neoplastic pathology was present in 49.5% of patients with rectosigmoid adenoma, 27.3% of patients with distal non neoplastic polyps alone (33.3% if only distal hyperplastic polyps were considered) and 11% of patients with no distal polyps.
Protocol 1 gave rise to a higher cost ($58,413), not only compared to protocol 2 ($50,276), but also compared to total colonoscopy in all patients ($57,008) ; there was also a larger number of patients who eluded diagnosis (29%, against 16% in protocol 2).
The latter management, however, should not be ruled out, since it has a better diagnostic yield and lower cost per lesion detected and per cancer prevented.
Mots-clés Pascal : Tumeur maligne, Tumeur bénigne, Côlon, Proximal, Homme, Diagnostic, Polype, Rectosigmoïde, Colonoscopie, Analyse avantage coût, Economie santé, Appareil digestif pathologie, Intestin pathologie, Endoscopie, Valeur prédictive
Mots-clés Pascal anglais : Malignant tumor, Benign neoplasm, Colon, Proximal, Human, Diagnosis, Polyp, Rectosigmoid, Colonoscopy, Cost benefit analysis, Health economy, Digestive diseases, Intestinal disease, Endoscopy, Predictive value
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0409770
Code Inist : 002B13B01. Création : 01/03/1996.