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JAMA. 1999 May 5;281(17):1611-7.

Predicting advanced proximal colonic neoplasia with screening sigmoidoscopy.

Author information

1
Division of Research, Kaiser Permanente Medical Care Program, Oakland, Calif, USA. trl@itsa.ucsf.edu

Abstract

CONTEXT:

Indications are not well defined for follow-up colonoscopy for all patients with distal colonic tubular adenomas (TAs) found at screening sigmoidoscopy.

OBJECTIVE:

To determine whether distal adenoma size, number, and villous histology, along with family history and age, are predictors of advanced proximal colonic neoplasia.

DESIGN:

Cross-sectional analysis conducted between January 1, 1994, and December 31, 1995.

SETTING:

Large group-model health maintenance organization in northern California.

PATIENTS:

A total of 2972 asymptomatic subjects aged 50 years or older undergoing colonoscopy as follow-up to a screening sigmoidoscopy.

MAIN OUTCOME MEASURE:

Based on sigmoidoscopy, colonoscopy, and pathology reports, occurrence of advanced proximal neoplasia, defined as adenocarcinoma or TAs 1 cm or larger or with villous features or severe dysplasia located beyond sigmoidoscopic view.

RESULTS:

The prevalence of advanced proximal neoplasia was similar among patients with no TAs at sigmoidoscopy, those with TAs less than 1 cm in diameter, and those with TAs 1 cm in diameter or larger (prevalence, 5.3%, 5.5%, and 5.6%, respectively). Of patients with a distal tubulovillous or villous adenoma, 12.1% had advanced proximal neoplasia. In multivariate analyses, having a distal tubulovillous adenoma or villous adenoma was the strongest predictor of advanced proximal neoplasia (odds ratio, 2.30; 95% confidence interval, 1.69-3.14). Age of 65 years or older, having more than 1 adenoma, and a positive family history of colorectal cancer were also significant predictors. Distal adenoma size was not a significant predictor in any multivariate analyses.

CONCLUSIONS:

Advanced proximal neoplasia is not uncommon in subjects with or without distal TAs, but subjects with advanced distal histology and those older than 65 years are at increased risk. Age-specific screening using sigmoidoscopy starting at ages 50 to 55 years and colonoscopy after age 65 years may be justified.

PMID:
10235154
DOI:
10.1001/jama.281.17.1611
[Indexed for MEDLINE]

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