TY - JOUR
T1 - Likelihood of missed and recurrent adenomas in the proximal versus the distal colon
AU - Laiyemo, Adeyinka O.
AU - Doubeni, Chyke
AU - Sanderson, Andrew K.
AU - Pinsky, Paul F.
AU - Badurdeen, Dilhana S.
AU - Doria-Rose, V. Paul
AU - Marcus, Pamela M.
AU - Schoen, Robert E.
AU - Lanza, Elaine
AU - Schatzkin, Arthur
AU - Cross, Amanda J.
PY - 2011/8
Y1 - 2011/8
N2 - 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.
AB - 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.
KW - PPT
KW - Polyp Prevention Trial
KW - RR
KW - relative risk
UR - http://www.scopus.com/inward/record.url?scp=79960944854&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79960944854&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2011.02.023
DO - 10.1016/j.gie.2011.02.023
M3 - Article
C2 - 21549375
AN - SCOPUS:79960944854
SN - 0016-5107
VL - 74
SP - 253
EP - 261
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 2
ER -