Likelihood of missed and recurrent adenomas in the proximal versus the distal colon
Department of Family Medicine and Community Health; Meyers Primary Care Institute
Adenoma; Aged; Colon, Ascending; Colon, Descending; Colon, Sigmoid; Colon, Transverse; Colonic Neoplasms; Colonoscopy; False Negative Reactions; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Prospective Studies; Regression Analysis; Risk Factors
Community Health and Preventive Medicine | Preventive Medicine | Primary Care
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.
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. Published by Mosby, Inc. All rights reserved.
DOI of Published Version
Gastrointest Endosc. 2011 Aug;74(2):253-61. Epub 2011 May 6. Link to article on publisher's site
Laiyemo AO, Doubeni CA, Sanderson AK, Pinsky PF, Badurdeen DS, Doria-Rose VP, Marcus PM, Schoen RE, Lanza E, Schatzkin A, Cross AJ. (2011). Likelihood of missed and recurrent adenomas in the proximal versus the distal colon. Family Medicine and Community Health Publications. https://doi.org/10.1016/j.gie.2011.02.023. Retrieved from https://escholarship.umassmed.edu/fmch_articles/170