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Related Experiment Videos

Do distal adenomas mandate total colonoscopy?

A Khan1, I Shrier, P H Gordon

  • 1Division of Colorectal Surgery, Sir Mortimer B. Davis-Jewish General Hospital, 3755 Cote Ste. Catherine Road, Montreal, Quebec H3T 1E2, Canada.

Surgical Endoscopy
|March 27, 2003
PubMed
Summary

The study found that patients with distal adenomas, regardless of size, require complete colon examination. Even small distal adenomas do not rule out proximal neoplasms, highlighting the need for full colonoscopies.

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Area of Science:

  • Gastroenterology
  • Colorectal Cancer Screening
  • Endoscopy

Background:

  • Distal adenomas are often considered indicators of proximal neoplasms.
  • Previous recommendations suggested that small distal adenomas might not necessitate proximal colon examination.
  • This study aimed to validate the recommendation regarding proximal examination for patients with small distal adenomas.

Purpose of the Study:

  • To determine the validity of not performing proximal examination in patients with small distal adenomas.
  • To assess the rate of synchronous proximal adenomas in patients with distal adenomas.
  • To evaluate the necessity of total colonoscopy in all patients with distal adenomas.

Main Methods:

  • Analysis of 2,260 colonoscopies performed between 1976 and 1999.

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  • Inclusion of patients with removed adenomas, excluding those with prior colon resections or incomplete cecal intubation.
  • Definition of proximal adenomas as those proximal to the sigmoid colon and advanced adenomas based on size, villous component, or dysplasia.

    • Main Results:

    • Out of 226 patients, 98 had distal adenomas, with a 23.4% rate of synchronous proximal adenomas.
    • Patients with single, small, rectosigmoid tubular adenomas showed a 28.8% rate of proximal adenomas.
    • Advanced distal adenomas were associated with an 18.9% rate of synchronous proximal adenomas, with 10.8% being advanced.

    Conclusions:

    • Total colonoscopy is necessary for all patients with distal adenomas, irrespective of their size.
    • The significant proportion of proximal neoplasia, even without distal markers, suggests that full colonoscopy is advisable for all patients.
    • These findings underscore the importance of comprehensive colorectal cancer screening protocols.