Original articleClinical endoscopyEndoscopic appearance of proximal colorectal neoplasms and potential implications for colonoscopy in cancer prevention
Section snippets
Study design
Before beginning this study, all endoscopists at the Division of Gastroenterology and Hepatology of the Maastricht University Medical Center in the Netherlands were trained to familiarize them with the detection, classification, and management of nonpolypoid colorectal lesions, as previously described.19, 20 This training consisted of (1) lectures by an experienced colonoscopist (S.S.), (2) video training by using American Society for Gastrointestinal Endoscopy educational programs,21, 22 and
Study population
From February 2008 to February 2010, a total of 4753 patients underwent 5246 colonoscopies at the Maastricht University Medical Center. We excluded patients younger than 18 years of age (n = 18), patients having a hereditary CRC syndrome (n = 43) or inflammatory bowel disease (n = 356), and patients having undergone previous CRC (n = 168) or colon resection (n = 80), and patients with inadequate bowel preparation (n = 368).
Finally, a total of 3720 consecutive patients (mean age 58.9 years,
Discussion
This study shows that proximal colorectal neoplasms with advanced histology are more likely to have a diminutive size or nonpolypoid endoscopic appearance than the distal ones. As summarized in Figure 1, approximately three fourths of the proximal adenomas with HGD or early cancer were diminutive or nonpolypoid, endoscopic features that have been highly associated with missed lesions during colonoscopy.11, 12 These findings may offer a possible explanation for the disparity between the proximal
Acknowledgments
We are grateful to all endoscopists, faculty, trainees, and nurses at the endoscopy unit of the Maastricht University Medical Center for their enthusiastic participation in this study and contribution to building up this cohort.
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DISCLOSURE: The following author disclosed a financial relationship relevant to this publication: Dr Rondagh, unrestricted educational grant from Pentax B.V. Pentax B.V. had no role in the design of the study; data collection, analysis, and interpretation; writing of the manuscript; or the decision to submit for publication. The other authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Sanduleanu at [email protected].
See CME section; p. 1243.