When is colonoscopy necessary? - Distal-proximal adenoma relationships in the polyp prevention trial (PPT)

R. E. Schoen, J. Weissfeld, R. Burt, Michael P Lance, F. Iber, D. Corle, L. Cranston, M. Hassen, K. Lewin, H. Appleman, A. Schatzkin

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

The need for colonoscopy in individuals with low risk distal adenomas found on sigmoidosocopy is a controversial and important screening issue. AIM: To examine the prevalence of advanced (adv) proximal adenomas in patients (pts) with non-advanced distal adenomas in a large cohort with central pathologic review. METHODS: The PPT is a multi-center randomized study (N=2079) of dietary intervention on adenoma recurrence. Using the index colonoscopy prior to randomization, pts with distal adenomas (distal to splenic flexure or ≤50 cm) and no prior history of adenoma or previous colonsocopy were included (N=1123). Relationships between distal and adv proximal adenomas were examined. RESULTS: Mean age 60, 38% female, 10% minority. 45.6% of the distal polyps (512/1123) were adv, i.e., had a villous component, HG Dysplasia (HGD), or were ≥1cm. 18.7% (48/257) of the proximal adenomas were adv. 4.3% of all patients had an adv proximal adenoma (48/1123). Villous Histology: 2.9% of pts with distal villous compared to 1.4% of pts w/o distal villous had a proximal villous lesion (OR 2.1, p=NS). HGD: 3.5% of pts with distal HGD compared to 0.8% of pts w/o distal HGD had proximal HGD (OR 4.8, p=.03). ≥1cm: 4.2% of pts with distal ≥1cm compared to 3.0% of pts w/o distal ≥1cm had a proximal ≥1cm lesion (OR 1.4, p=NS). Overall, 5.7% of pts (29/512) with a distal adv lesion compared to 3.1% of pts (19/611) w/o a distal adv lesion had a proximal adv lesion (OR 1.9, 95%CI 1.0, 3.5, p=.05). Altering the definition of a distal/proximal lesion did not change the results. CONCLUSIONS: 1) Pts with an adv distal adenoma are about twice as likely to have an adv proximal adenoma. 2) 3.1% of pts w/o an adv distal adenoma had an adv proximal adenoma. Not performing a colonoscopy in patients with a distal non-adv adenoma in this cohort would have missed 40% (19/48) of the proximal adv adenomas. 3) These results support performing a colonoscopy in pts with a non-adv distal adenoma found on flexible sigmoidoscopy.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997
Externally publishedYes

Fingerprint

Colonoscopy
Polyps
Adenoma
Sigmoidoscopy
Transverse Colon
Random Allocation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Schoen, R. E., Weissfeld, J., Burt, R., Lance, M. P., Iber, F., Corle, D., ... Schatzkin, A. (1997). When is colonoscopy necessary? - Distal-proximal adenoma relationships in the polyp prevention trial (PPT). Gastrointestinal Endoscopy, 45(4).

When is colonoscopy necessary? - Distal-proximal adenoma relationships in the polyp prevention trial (PPT). / Schoen, R. E.; Weissfeld, J.; Burt, R.; Lance, Michael P; Iber, F.; Corle, D.; Cranston, L.; Hassen, M.; Lewin, K.; Appleman, H.; Schatzkin, A.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 1997.

Research output: Contribution to journalArticle

Schoen, RE, Weissfeld, J, Burt, R, Lance, MP, Iber, F, Corle, D, Cranston, L, Hassen, M, Lewin, K, Appleman, H & Schatzkin, A 1997, 'When is colonoscopy necessary? - Distal-proximal adenoma relationships in the polyp prevention trial (PPT)', Gastrointestinal Endoscopy, vol. 45, no. 4.
Schoen, R. E. ; Weissfeld, J. ; Burt, R. ; Lance, Michael P ; Iber, F. ; Corle, D. ; Cranston, L. ; Hassen, M. ; Lewin, K. ; Appleman, H. ; Schatzkin, A. / When is colonoscopy necessary? - Distal-proximal adenoma relationships in the polyp prevention trial (PPT). In: Gastrointestinal Endoscopy. 1997 ; Vol. 45, No. 4.
@article{334356bedf7f4ec99c47332c6f60aa4e,
title = "When is colonoscopy necessary? - Distal-proximal adenoma relationships in the polyp prevention trial (PPT)",
abstract = "The need for colonoscopy in individuals with low risk distal adenomas found on sigmoidosocopy is a controversial and important screening issue. AIM: To examine the prevalence of advanced (adv) proximal adenomas in patients (pts) with non-advanced distal adenomas in a large cohort with central pathologic review. METHODS: The PPT is a multi-center randomized study (N=2079) of dietary intervention on adenoma recurrence. Using the index colonoscopy prior to randomization, pts with distal adenomas (distal to splenic flexure or ≤50 cm) and no prior history of adenoma or previous colonsocopy were included (N=1123). Relationships between distal and adv proximal adenomas were examined. RESULTS: Mean age 60, 38{\%} female, 10{\%} minority. 45.6{\%} of the distal polyps (512/1123) were adv, i.e., had a villous component, HG Dysplasia (HGD), or were ≥1cm. 18.7{\%} (48/257) of the proximal adenomas were adv. 4.3{\%} of all patients had an adv proximal adenoma (48/1123). Villous Histology: 2.9{\%} of pts with distal villous compared to 1.4{\%} of pts w/o distal villous had a proximal villous lesion (OR 2.1, p=NS). HGD: 3.5{\%} of pts with distal HGD compared to 0.8{\%} of pts w/o distal HGD had proximal HGD (OR 4.8, p=.03). ≥1cm: 4.2{\%} of pts with distal ≥1cm compared to 3.0{\%} of pts w/o distal ≥1cm had a proximal ≥1cm lesion (OR 1.4, p=NS). Overall, 5.7{\%} of pts (29/512) with a distal adv lesion compared to 3.1{\%} of pts (19/611) w/o a distal adv lesion had a proximal adv lesion (OR 1.9, 95{\%}CI 1.0, 3.5, p=.05). Altering the definition of a distal/proximal lesion did not change the results. CONCLUSIONS: 1) Pts with an adv distal adenoma are about twice as likely to have an adv proximal adenoma. 2) 3.1{\%} of pts w/o an adv distal adenoma had an adv proximal adenoma. Not performing a colonoscopy in patients with a distal non-adv adenoma in this cohort would have missed 40{\%} (19/48) of the proximal adv adenomas. 3) These results support performing a colonoscopy in pts with a non-adv distal adenoma found on flexible sigmoidoscopy.",
author = "Schoen, {R. E.} and J. Weissfeld and R. Burt and Lance, {Michael P} and F. Iber and D. Corle and L. Cranston and M. Hassen and K. Lewin and H. Appleman and A. Schatzkin",
year = "1997",
language = "English (US)",
volume = "45",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - When is colonoscopy necessary? - Distal-proximal adenoma relationships in the polyp prevention trial (PPT)

AU - Schoen, R. E.

AU - Weissfeld, J.

AU - Burt, R.

AU - Lance, Michael P

AU - Iber, F.

AU - Corle, D.

AU - Cranston, L.

AU - Hassen, M.

AU - Lewin, K.

AU - Appleman, H.

AU - Schatzkin, A.

PY - 1997

Y1 - 1997

N2 - The need for colonoscopy in individuals with low risk distal adenomas found on sigmoidosocopy is a controversial and important screening issue. AIM: To examine the prevalence of advanced (adv) proximal adenomas in patients (pts) with non-advanced distal adenomas in a large cohort with central pathologic review. METHODS: The PPT is a multi-center randomized study (N=2079) of dietary intervention on adenoma recurrence. Using the index colonoscopy prior to randomization, pts with distal adenomas (distal to splenic flexure or ≤50 cm) and no prior history of adenoma or previous colonsocopy were included (N=1123). Relationships between distal and adv proximal adenomas were examined. RESULTS: Mean age 60, 38% female, 10% minority. 45.6% of the distal polyps (512/1123) were adv, i.e., had a villous component, HG Dysplasia (HGD), or were ≥1cm. 18.7% (48/257) of the proximal adenomas were adv. 4.3% of all patients had an adv proximal adenoma (48/1123). Villous Histology: 2.9% of pts with distal villous compared to 1.4% of pts w/o distal villous had a proximal villous lesion (OR 2.1, p=NS). HGD: 3.5% of pts with distal HGD compared to 0.8% of pts w/o distal HGD had proximal HGD (OR 4.8, p=.03). ≥1cm: 4.2% of pts with distal ≥1cm compared to 3.0% of pts w/o distal ≥1cm had a proximal ≥1cm lesion (OR 1.4, p=NS). Overall, 5.7% of pts (29/512) with a distal adv lesion compared to 3.1% of pts (19/611) w/o a distal adv lesion had a proximal adv lesion (OR 1.9, 95%CI 1.0, 3.5, p=.05). Altering the definition of a distal/proximal lesion did not change the results. CONCLUSIONS: 1) Pts with an adv distal adenoma are about twice as likely to have an adv proximal adenoma. 2) 3.1% of pts w/o an adv distal adenoma had an adv proximal adenoma. Not performing a colonoscopy in patients with a distal non-adv adenoma in this cohort would have missed 40% (19/48) of the proximal adv adenomas. 3) These results support performing a colonoscopy in pts with a non-adv distal adenoma found on flexible sigmoidoscopy.

AB - The need for colonoscopy in individuals with low risk distal adenomas found on sigmoidosocopy is a controversial and important screening issue. AIM: To examine the prevalence of advanced (adv) proximal adenomas in patients (pts) with non-advanced distal adenomas in a large cohort with central pathologic review. METHODS: The PPT is a multi-center randomized study (N=2079) of dietary intervention on adenoma recurrence. Using the index colonoscopy prior to randomization, pts with distal adenomas (distal to splenic flexure or ≤50 cm) and no prior history of adenoma or previous colonsocopy were included (N=1123). Relationships between distal and adv proximal adenomas were examined. RESULTS: Mean age 60, 38% female, 10% minority. 45.6% of the distal polyps (512/1123) were adv, i.e., had a villous component, HG Dysplasia (HGD), or were ≥1cm. 18.7% (48/257) of the proximal adenomas were adv. 4.3% of all patients had an adv proximal adenoma (48/1123). Villous Histology: 2.9% of pts with distal villous compared to 1.4% of pts w/o distal villous had a proximal villous lesion (OR 2.1, p=NS). HGD: 3.5% of pts with distal HGD compared to 0.8% of pts w/o distal HGD had proximal HGD (OR 4.8, p=.03). ≥1cm: 4.2% of pts with distal ≥1cm compared to 3.0% of pts w/o distal ≥1cm had a proximal ≥1cm lesion (OR 1.4, p=NS). Overall, 5.7% of pts (29/512) with a distal adv lesion compared to 3.1% of pts (19/611) w/o a distal adv lesion had a proximal adv lesion (OR 1.9, 95%CI 1.0, 3.5, p=.05). Altering the definition of a distal/proximal lesion did not change the results. CONCLUSIONS: 1) Pts with an adv distal adenoma are about twice as likely to have an adv proximal adenoma. 2) 3.1% of pts w/o an adv distal adenoma had an adv proximal adenoma. Not performing a colonoscopy in patients with a distal non-adv adenoma in this cohort would have missed 40% (19/48) of the proximal adv adenomas. 3) These results support performing a colonoscopy in pts with a non-adv distal adenoma found on flexible sigmoidoscopy.

UR - http://www.scopus.com/inward/record.url?scp=25344439118&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=25344439118&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:25344439118

VL - 45

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 4

ER -