Advanced proximal neoplasia of the colon in average-risk adults

作者：Rabeneck Linda^*; Paszat Lawrence F; Hilsden Robert J; McGregor S Elizabeth; Hsieh Eugene; Tinmouth Jill M; Baxter Nancy N; Saskin Refik; Ruco Arlinda; Stock David

来源：Gastrointestinal Endoscopy, 2014, 80(4): 660-667.

DOI：10.1016/j.gie.2014.02.001

Background: Estimating risk for advanced proximal neoplasia (APN) based on distal colon findings can help identify asymptomatic persons who should undergo examination of the proximal colon after flexible sigmoidoscopy (FS) screening. %26lt;br%26gt;Objective: We aimed to determine the risk of APN by most advanced distal finding among an average-risk screening population. %26lt;br%26gt;Design: Prospective, cross-sectional study. %26lt;br%26gt;Setting: Teaching hospital and colorectal cancer screening center. %26lt;br%26gt;Patients: A total of 4651 asymptomatic persons at average risk for colorectal cancer aged 50 to 74 years (54.4% women [n = 2529] with a mean [+/- standard deviation] age of 58.4 +/- 6.2 years). %26lt;br%26gt;Interventions: All participants underwent a complete colonoscopy, including endoscopic removal of all polyps. %26lt;br%26gt;Main Outcome Measurements: We explored associations between several risk factors and APN. Logistic regression was used to identify independent predictors of APN. %26lt;br%26gt;Results: A total of 142 persons (3.1%) had APN, of whom 85 (1.8%) had isolated APN (with no distal findings). APN was associated with older age, a BMI %26gt;27 kg/m(2), smoking, distal advanced adenoma and/or cancer, and distal non-advanced tubular adenoma. Those with a distal advanced neoplasm were more than twice as likely to have APN compared with those without distal lesions. %26lt;br%26gt;Limitations: Distal findings used to estimate risk of APN were derived from colonoscopy rather than FS itself. %26lt;br%26gt;Conclusion: In persons at average risk for colorectal cancer, the prevalence of isolated APN was low (1.8%). Use of distal findings to predict APN may not be the most effective strategy. However, incorporating factors such as age (%26gt;65 years), sex, BMI (%26gt;27 kg/m(2)), and smoking status, in addition to distal findings, should be considered for tailoring colonoscopy recommendations. Further evaluation of risk stratification approaches in other asymptomatic screening populations is warranted.

• 出版日期2014-10