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Dis Colon Rectum. 2009 May;52(5):972-7. doi: 10.1007/DCR.0b013e3181a0aab4.

Flat adenomas of the large bowel: a single endoscopist study.

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Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.



Flat colorectal adenomas may not be recognized or they may be seen and dismissed as normal mucosa. As a result, the "true" incidence of flat lesions is unknown. The aim of this study was to report the incidence and character of flat adenomas in a large series of patients in the United States.


Details of colorectal polyps seen during colonoscopy are entered into a prospective database that was queried for flat adenomas. No magnification or dye spray was used. The colonoscopy completion rate was 96.8 percent. The flat adenoma detection rate of the senior author is in line with that of Japanese colonoscopists.


During 2,659 colonoscopies, 5,749 colorectal lesions were seen in 2,003 patients. Of these patients, 1,125 were men and 878 were women, with a mean age of 65 years (+/- 12 years). There were 3,115 adenomas (54 percent of lesions); 315 were flat (10.1 percent), 23 (0.8 percent) were depressed, 2,575 were sessile (82.7 percent), and 200 were pedunculated (6.4 percent). Two hundred twelve patients had flat adenomas (10.6 percent of patients); 172 patients had one and 40 had multiple (2 to 8) flat adenomas. Eight patients with flat adenomas had more flat adenomas on follow-up.


Colonoscopists in the United States must be aware of the existence of flat adenomas and sensitive to their appearance.

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