Hyperplastic polyps seen at sigmoidoscopy are markers for additional adenomas seen at colonoscopy

Area of Science:

• Gastroenterology
• Endoscopy
• Colorectal Cancer Screening

Background:

• Flexible sigmoidoscopy is a common screening tool for colorectal cancer.
• Accurate polyp histology assessment during sigmoidoscopy is crucial for guiding further management.
• The presence of rectosigmoid polyps, particularly hyperplastic ones, may indicate a risk for proximal adenomas.

Purpose of the Study:

• To evaluate the accuracy of endoscopist's assessment of polyp histology during flexible sigmoidoscopy.
• To determine the prevalence of rectosigmoid adenomas and hyperplastic polyps in asymptomatic individuals.
• To investigate the association between rectosigmoid polyp findings and the presence of proximal adenomas.

Main Methods:

• Prospective study of asymptomatic individuals undergoing screening flexible sigmoidoscopy.
• Endoscopic assessment of rectosigmoid polyps, followed by colonoscopy and polypectomy for all subjects with polyps.
• Histopathological analysis of removed polyps to confirm diagnosis.

Main Results:

• 185 subjects had polyps; 54% had rectosigmoid adenomas, 37% had hyperplastic polyps.
• Endoscopist's histological opinion was correct for 61% of lesions.
• 29% of subjects with rectosigmoid adenomas had proximal adenomas; 28% with hyperplastic polyps also had proximal adenomas.

Conclusions:

• Visual assessment of polyp histology during sigmoidoscopy has limited accuracy.
• Patients with rectosigmoid hyperplastic polyps share a similar risk of proximal adenomas as those with rectosigmoid adenomas.
• These findings underscore the importance of complete colonoscopy in patients with rectosigmoid polyps, regardless of initial presumed histology.