Alimentary TractIs colonoscopy needed for the nonadvanced adenoma found on sigmoidoscopy?☆
Section snippets
Study population
A detailed description of the determination of eligibility and randomization of participants in the PPT has been reported.42 Participants were recruited from academic and community hospitals in the vicinity of eight regional clinical centers: Bowman Gray School of Medicine, State University of New York at Buffalo, Edward Hines, Jr. Veterans Affairs Hospital, Kaiser Foundation Research Institute, Memorial Sloan-Kettering Cancer Center, University of Pittsburgh, University of Utah, and the Walter
Results
The derivation of the 981 patients used in this analysis is presented in Figure 1. Of the 2079 individuals enrolled in the PPT, 618 had previous adenomatous polyps and were excluded. Of the remaining 1461, 1123 had a confirmed distal adenoma. Additional 142 (12.6%) were excluded because of missing information. The missing data consisted of 137 patients with an adenoma of unknown size and 5 patients with an adenoma of unknown location (Figure 1).
In Table 1, the
Discussion
Adenomatous polyps are neoplastic precursors of colorectal cancer.3 The incidence of adenomatous polyps, however, far exceeds the incidence of colorectal cancer. Although data are limited, studies suggest that individuals without advanced distal adenomas, or adenomas with villous histology, high-grade dysplasia, or ≥1 cm in size, are at average risk for colorectal cancer.27, 31 This engenders an important question pertinent to screening for colorectal cancer: should individuals with a
References (71)
Targeting colonoscopy
Gastroenterology
(1994)- et al.
Hyperplastic polyps seen at sigmoidoscopy are markers for additional adenomas seen at colonoscopy
Gastroenterology
(1991) - et al.
Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects
Gastroenterology
(1992) - et al.
Prevalence of proximal colonic polyps in average-risk asymptomatic patients with negative fecal occult blood tests and flexible sigmoidoscopy
Gastrointest Endosc
(1996) - et al.
Colonoscopic screening of persons with suspected risk factors for colon cancer: II. Past history of colorectal neoplasms
Gastroenterology
(1989) - et al.
Are hyperplastic rectosigmoid polyps associated with an increased risk of proximal colonic neoplasms?
Gastrointest Endosc
(1993) - et al.
The significance of diminutive colonic polyps found at flexible sigmoidoscopy
Gastrointest Endosc
(1989) - et al.
Do characteristics of adenomas on flexible sigmoidoscopy predict advanced lesions on baseline colonoscopy?
Gastroenterology
(1994) - et al.
Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests
Gastroenterology
(1991) - et al.
Potential costs of flexible sigmoidoscopy–based colorectal cancer screening
Gastroenterology
(1996)
Natural history of untreated colonic polyps
Gastroenterology
Colorectal polyps and the risk of subsequent carcinoma
Mayo Clin Proc
Treatment of small colorectal polyps: a population-based study of the risk for subsequent carcinoma
Mayo Clin Proc
Prevention of colorectal cancer by once-only sigmoidoscopy
Lancet
The national polyp study: patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas
Gastroenterology
Colorectal cancer screening: clinical guidelines and rationale
Gastroenterology
Colon cancer screening: beyond efficacy
Gastroenterology
The pathologic measurement of polyp size is preferable to the endoscopic estimate
Gastrointest Endosc
Neoplasia distal to the splenic flexure in patients with proximal colon cancer
Gastrointest Endosc
Sensitivity of screening sigmoidoscopy for proximal colorectal tumours
Lancet
Detection of colorectal polyps by computed tomographic colography: feasibility of a novel technique
Gastroenterology
Vir tual colonoscopy with magnetic resonance imaging: in vitro evaluation of a new concept
Gastroenterology
Screening colonoscopy: the cost of common sense
Lancet
Anatomical extent of fiberoptic sigmoidoscopy
Gastroenterology
The role of colonoscopy in the management of patients with colonic polyps
Gastrointest Endosc
How should we screen for colon cancer?
JAMA
Polyp guideline: diagnosis, treatment, and surveillance for patients with nonfamilial colorectal polyps
Ann Intern Med
Polyp guideline
Am J Gastroenterol
Small polyps found during fiberoptic sigmoidoscopy in asymptomatic patients
Ann Intern Med
Univariate and multivariate analyses of the relationship between adenocarcinoma and solitary and multiple adenomas in colorectal adenoma patients
Am J Cancer
Flexible sigmoidoscopy may be ineffective for secondary prevention of colorectal cancer in asymptomatic, average-risk men
Dig Dis Sci
Synchronous neoplasms in patients with diminutive colorectal adenomas
Cancer
Risk for colon adenomas in patients with rectosigmoid hyperplastic polyps
Ann Intern Med
Small rectosigmoid polyps as markers of proximal neoplasms
Dis Colon Rectum
Clinical significance of diminutive polyps of the rectum and sigmoid colon
Dis Colon Rectum
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