Is colonoscopy needed for the nonadvanced adenoma found on sigmoidoscopy ?
Background & Aims
The need for colonoscopy when small tubular adenomas with low-grade dysplasia are found on sigmoidoscopy is uncertain.
The aim of this study was to examine the prevalence and characteristics of proximal adenomas in patients with distal adenomas.
We studied 981 subjects with distal adenomas found on the index colonoscopy before randomization in the Polyp Prevention Trial.
Four hundred sixty patients (46.9%) had =1 distal adenoma that was pathologically advanced (villous component, high-grade dysplasia, or = 1 cm) ; 21.5% (211 of 981) had any proximal adenoma ; and 4.3% (42 of 981) (95% confidence interval [CI], 3.0-5.5) had an advanced proximal adenoma.
A greater percentage of patients with an advanced distal adenoma (5.9%) (95% CI, 3.7-8.0) had an advanced proximal adenoma compared with those with a nonadvanced distal adenoma (2.9%) (95% Cl, 1.4-4.3) (OR, 2.1 ; 95% Cl, 1.1-4.3 ; P=0.03).
Not performing a colonoscopy in patients with a nonadvanced distal adenoma would have missed 36% (15 of 42) of the advanced proximal adenomas.
Patients with an advanced distal adenoma are twice as likely to have an advanced proximal adenoma as patients with a nonadvanced distal adenoma.
However, eschewing a colonoscopy in patients with a nonadvanced distal adenoma would result in not detecting a sizeable percentage of the prevalent advanced proximal adenomas. (...)
Mots-clés Pascal : Adénome, Côlon sigmoïde, Petite dimension, Hyperplasie, Histopathologie, Dépistage, Sigmoïdoscopie, Grade histologique, Faible, Colonoscopie, Indication, Diagnostic, Carcinome, Côlon, Rectum, Evaluation performance, Homme, Tumeur bénigne, Appareil digestif pathologie, Intestin pathologie, Côlon pathologie, Anatomopathologie, Endoscopie, Tumeur maligne, Rectum pathologie
Mots-clés Pascal anglais : Adenoma, Pelvic colon, Small dimension, Hyperplasia, Histopathology, Medical screening, Sigmoidoscopy, Histological grading, Low, Colonoscopy, Indication, Diagnosis, Carcinoma, Colon, Rectum, Performance evaluation, Human, Benign neoplasm, Digestive diseases, Intestinal disease, Colonic disease, Pathology, Endoscopy, Malignant tumor, Rectal disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0431182
Code Inist : 002B24E06. Création : 25/01/1999.