Original articleClinical endoscopyLikelihood of missed and recurrent adenomas in the proximal versus the distal colon
Section snippets
Study population
The rationale, design, and results of the PPT were published previously.18, 19, 20 In brief, the PPT was a 4-year multicenter, randomized, controlled trial to assess the effect of a low-fat, high-fiber, fruit and vegetable diet on the risk of colorectal adenoma recurrence. A total of 2079 participants who were at least 35 years old and had 1 or more histologically confirmed adenomatous polyps removed within 6 months from a complete colonoscopy were randomized. Exclusion criteria included
Baseline characteristics
Table 1 shows selected baseline characteristics of study participants by the location of the baseline adenoma. At baseline, 1030 participants (55.3%) had a distal-only adenoma, 503 (27%) had a proximal-only adenoma, and 331 (17.8%) had a synchronous proximal and distal adenoma. A total of 750 patients (37.8%) had an advanced adenoma at baseline: 440 participants (62.4%) had a distal-only advanced adenoma, 111 (15.7%) had a proximal-only advanced adenoma, and 154 (21.8%) had a synchronous
Discussion
We evaluated the association between adenoma location at baseline with the risk of adenoma recurrence and the location of the recurrent adenoma in an attempt to assess differences in susceptibility to adenoma recurrence by location. Our study suggests 3 potential mechanisms underlying a lower protective effect of colonoscopy in the proximal colon. First, we report that missed lesions are more common in the proximal colon. Second, recurrent adenomas and advanced adenomas are more likely to be in
References (34)
- et al.
Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial
Control Clin Trials
(2000) - et al.
Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial
Lancet
(2010) - et al.
Risk of developing proximal versus distal colorectal cancer after a negative colonoscopy: a population-based study
Clin Gastroenterol Hepatol
(2008) - et al.
The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer
Gastroenterology
(2010) - et al.
Effect of screening colonoscopy on colorectal cancer incidence and mortality
Clin Gastroenterol Hepatol
(2009) - et al.
Considerations regarding the present and future roles of colonoscopy in colorectal cancer prevention
Clin Gastroenterol Hepatol
(2008) - et al.
Colorectal cancers detected after colonoscopy frequently result from missed lesions
Clin Gastroenterol Hepatol
(2010) - et al.
Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society
Gastroenterology
(2006) - et al.
Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies
Gastroenterology
(1997) - et al.
Cap-fitted colonoscopy: a randomized, tandem colonoscopy study of adenoma miss rates
Gastrointest Endosc
(2010)
Adenoma characteristics as risk factors for recurrence of advanced adenomas
Gastroenterology
Association between body size and colorectal adenoma recurrence
Clin Gastroenterol Hepatol
Baseline findings of the Italian multicenter randomized controlled trial of “once-only sigmoidoscopy” - SCORE
J Natl Cancer Inst
The Norwegian Colorectal Cancer Prevention (NORCCAP) screening study: baseline findings and implementations for clinical work-up in age groups 50-64 years
Scand J Gastroenterol
Screening sigmoidoscopy and colorectal cancer mortality
J Natl Cancer Inst
A case-control study of screening sigmoidoscopy and mortality from colorectal cancer
N Engl J Med
Use of colonoscopy for colorectal cancer screening: evidence from the 2000 National Health Interview Survey
Cancer Epidemiol Biomarkers Prev
Cited by (57)
Blue-light imaging or narrow-band imaging for proximal colonic lesions: a prospective randomized tandem colonoscopy study
2023, Gastrointestinal EndoscopyInterventions to improve adenoma detection rates for colonoscopy
2022, Gastrointestinal EndoscopyNew-generation full-spectrum endoscopy versus standard forward-viewing colonoscopy: a multicenter, randomized, tandem colonoscopy trial (J-FUSE Study)
2018, Gastrointestinal EndoscopyCitation Excerpt :Another notable finding is that AMR-PP for lesions ≤5 mm in size and in the ascending colon were both significantly lower with FUSE than with SFVC. Many studies have shown that colonoscopy is less effective at preventing CRC in the proximal than the distal colon39-42 and that more lesions are missed in the proximal than distal colon.3,4,43,44 This discrepancy is attributable to the higher proportion of small and flat/depressed lesions in the proximal than the distal colon.45,46
Excellent Bowel Preparation Quality Is Not Superior to Good Bowel Preparation Quality for Improving Adenoma/Polyp Detection Rate
2024, Clinical Medicine Insights: OncologyInflammation in the proximal colon is a risk factor for the development of colorectal neoplasia in inflammatory bowel disease patients with primary sclerosing cholangitis
2023, Therapeutic Advances in Gastroenterology
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Dr. Laiyemo is supported by the National Cancer Institute's new faculty recruitment supplement to the Comprehensive Minority Institution/Cancer Center Partnership between Howard University Cancer Center and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins University (5U54CA091431-09 S1). Dr. Doubeni is supported by a mentored career development award (5K01CA127118-03) from the National Cancer Institute. This research was funded by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. The other authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr. Laiyemo at [email protected].