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Likelihood of missed and recurrent adenomas in the proximal versus the distal colon.

About this Publication
Title
Likelihood of missed and recurrent adenomas in the proximal versus the distal colon.
Pubmed ID
21549375 (View this publication on the PubMed website)
Publication
Gastrointest. Endosc. 2011 Aug; Volume 74 (Issue 2): Pages 253-61
Authors
Laiyemo AO, Doubeni C, Sanderson AK, Pinsky PF, Badurdeen DS, Doria-Rose VP, Marcus PM, Schoen RE, Lanza E, Schatzkin A, Cross AJ
Affiliations
  • Department of Medicine, Howard University College of Medicine, Washington, DC, USA. adeyinka.laiyemo@howard.edu
Abstract

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.

DESIGN: Prospective.

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.

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