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Detection of Proximal Adenomatous Polyps With Screening Sigmoidoscopy
A Systematic Review and Meta-analysis of Screening Colonoscopy
James D. Lewis, MD, MSCE;
Kimmie Ng, MD;
Kenneth E. Hung, MD, PhD;
Warren B. Bilker, PhD;
Jesse A. Berlin, ScD;
Colleen Brensinger, MS;
Anil K. Rustgi, MD
Arch Intern Med. 2003;163:413-420.
Background The relative effectiveness of flexible sigmoidoscopy compared with colonoscopy to screen for colorectal cancer depends on the magnitude of the association between findings in the proximal and distal colon and the false-negative rate of screening sigmoidoscopy for proximal neoplasia. To address this, we performed a systematic review and meta-analysis of screening colonoscopy studies.
Methods Published studies through July 31, 2000, of asymptomatic patients undergoing screening colonoscopy were identified from the MEDLINE database. We generated pooled estimates of the odds ratio for the association between findings in the distal and proximal colon and the prevalence of isolated proximal adenomatous neoplasia.
Results Using the sigmoid–descending colon junction to identify the beginning of the distal colon, the pooled odds ratio for the association between distal adenomatous polyps and any proximal neoplasia was 2.40 (95% confidence interval [CI], 1.42-4.05). Diminutive distal adenomatous polyps were also associated with proximal neoplasia (odds ratio, 2.36; 95% CI, 1.30-4.29). Distal hyperplastic polyps were not associated with proximal neoplasia (odds ratio, 1.44; 95% CI, 0.79-2.62). The prevalence of isolated advanced proximal neoplasia in the 3 studies was 2%, 3%, and 5%. Using the sigmoid–descending colon junction to identify the beginning of the distal colon yields a pooled estimate of isolated proximal neoplasia of 16.3% (95% CI, 13.6%-19.1%).
Conclusions Distal adenomatous polyps, including diminutive distal adenomatous polyps, are associated with an increased prevalence of synchronous proximal neoplasia. Two percent to 5% of patients undergoing screening colonoscopy may have isolated advanced proximal neoplasia. Even more patients may have isolated nonadvanced proximal neoplasia.
From the Division of Gastroenterology, Department of Medicine (Drs Lewis, Ng, Hung, and Rustgi), the Departments of Biostatistics and Epidemiology (Drs Lewis, Bilker, and Berlin and Ms Brensinger) and Genetics (Dr Rustgi), the Center for Clinical Epidemiology and Biostatistics (Drs Lewis, Bilker, and Berlin and Ms Brensinger), the Leonard Davis Institute of Health Economics (Dr Lewis), and the University of Pennsylvania Cancer Center (Drs Lewis and Rustgi), University of Pennsylvania School of Medicine, Philadelphia.
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