Document Detail


Do patients with rectosigmoid adenomas 5 mm or less in diameter need total colonoscopy?
MedLine Citation:
PMID:  10462649     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The need for colonoscopy in the care of patients with rectosigmoid adenoma 5 mm or less in diameter is still debatable. METHODS: We estimated the prevalence of proximal adenomas among 3052 consecutive subjects undergoing total colonoscopy. Rectosigmoid adenoma was classified as diminutive (5 mm), small (6 to 10 mm), or large (>/=11 mm). Advanced proximal adenoma was 10 mm in diameter or larger, or with a villous component, severe dysplasia, or infiltrating adenocarcinoma. RESULTS: Proximal adenoma was found in 212 of 2483 patients (8.5%, 95% CI [7.5, 9.7]) without distal neoplastic polyps, 49 of 214 (22.9%, 95% CI [17.6, 29.2]) with diminutive, 44 of 174 (25.3%, 95% CI [19.1, 32.5] with small, and 70 of 181 (38.7%, 95% CI [31.6, 46.2]) with large distal adenoma. Advanced proximal adenoma was found in 49 (2.0%, 95% CI [1.5, 2.6]), 8 (3.7%, 95% CI [1.7, 7.5]), 17 (9.8%, 95% CI [6.0, 15.4]), and 29 patients (16.0%, 95% [11.2, 22.4]), respectively. In patients with distal adenoma risk for proximal lesions increased with increasing age, size, and number of distal adenomas (p = 0.01). Size of distal adenoma was the strongest predictor of the presence of proximal advanced adenoma (multivariate analyses). CONCLUSIONS: In a clinical setting, the decision to perform colonoscopy should take into account proximal lesions of clinical interest, life expectancy, costs, and risks associated with the procedure. When detection of advanced proximal adenoma is the goal, presence of distal diminutive adenoma alone might not be an indication for total colonoscopy.
Authors:
S Sciallero; L Bonelli; H Aste; T Casetti; E Bertinelli; S Bartolini; R Parri; G Castiglione; P Mantellini; M Costantini; C Naldoni; P Bruzzi
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  50     ISSN:  0016-5107     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-07     Completed Date:  1999-10-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  314-21     Citation Subset:  IM    
Affiliation:
Unit of Cinical Epidemiology and Trials, National Institute for Cancer Research, Genoa, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adenomatous Polyps / diagnosis,  epidemiology,  pathology*
Adolescent
Adult
Age Distribution
Aged
Cohort Studies
Colonoscopy / methods,  statistics & numerical data*
Colorectal Neoplasms / diagnosis,  epidemiology,  pathology*
Confidence Intervals
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Prevalence
Prospective Studies
Referral and Consultation / statistics & numerical data
Retrospective Studies
Risk Assessment
Severity of Illness Index
Sex Distribution
Sigmoid Neoplasms / diagnosis,  epidemiology,  pathology
Sigmoidoscopy / methods,  statistics & numerical data
Unnecessary Procedures

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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