Likelihood of Missed and Recurrent Adenomas in the Proximal Versus the Distal Colon

Overview

Journal Gastrointest Endosc

Specialties Gastroenterology
Pharmacology
Radiology

Date 2011 May 10

PMID 21549375

Citations 33

Authors

Adeyinka O Laiyemo

Chyke Doubeni

Andrew K Sanderson 2nd

Paul F Pinsky

Dilhana S Badurdeen

V Paul Doria-Rose

Pamela M Marcus

Robert E Schoen

Elaine Lanza

Arthur Schatzkin

Amanda J Cross

Affiliations

Soon will be listed here.

Abstract

Background: Colonoscopy may be less efficacious in reducing colorectal cancer mortality in the proximal compared with the distal colon. A greater likelihood for missed and recurrent adenomas in the proximal colon may contribute to this phenomenon.

Objective: To examine whether a proximal adenoma is associated with the risk and location of missed and recurrent adenomas.

Design: Prospective.

Setting: Polyp Prevention Trial.

Participants: A total of 1864 patients with an adenoma at baseline underwent a follow-up colonoscopy 4 years later (adenoma recurrence). Of these, 1731 underwent a clearing colonoscopy 1 year after the baseline examination (missed adenoma).

Main Outcome Measurements: Association of baseline adenoma location with the risk and location of adenomas found at colonoscopy performed 1 year and 4 years later.

Results: At the year 1 colonoscopy, 598 patients (34.6%) had an adenoma (missed adenoma). Compared with those with a distal-only adenoma at baseline, patients with a proximal-only adenoma at baseline were more likely to have any missed adenomas (relative risk [RR] 1.28; 95% CI, 1.09-1.49) and a proximal-only missed adenoma (RR 2.05; 95% CI, 1.49-2.80). At the year 4 colonoscopy, 733 patients (39.3%) had adenoma recurrence. Patients with a baseline proximal-only adenoma were more likely to have any adenoma recurrence (RR 1.14; 95% CI, 1.00-1.31) and a proximal-only adenoma recurrence (RR 1.52; 95% CI, 1.15-2.02). Sensitivity analyses involving missed adenomas did not materially affect the risk or location of recurrent adenomas at year 4 colonoscopy.

Limitation: Lesions may still be missed on repeated colonoscopies.

Conclusions: Missed and recurrent adenomas are more likely to be in the proximal colon.

Citing Articles

Relationship Between Adenoma Detection Rate and Respective Withdrawal Time in Different Colon Segments: A Retrospective, Single-Center Study.

Chen X, Xu B, Wei B, Ji L, Yang C, Zhan Q JGH Open. 2025; 9(1):e70095.

PMID: 39781025 PMC: 11708806. DOI: 10.1002/jgh3.70095.

Dysbiosis promotes recurrence of adenomatous polyps in the distal colorectum.

Yin L, Qi P, Hu Y, Fu X, He R, Wang M World J Gastrointest Oncol. 2024; 16(8):3600-3623.

PMID: 39171160 PMC: 11334022. DOI: 10.4251/wjgo.v16.i8.3600.

Excellent Bowel Preparation Quality Is Not Superior to Good Bowel Preparation Quality for Improving Adenoma/Polyp Detection Rate.

Li Y, Meng F, Cao R, Gao C, Su D, Wang K Clin Med Insights Oncol. 2024; 18:11795549241229190.

PMID: 38332773 PMC: 10851725. DOI: 10.1177/11795549241229190.

Texture and color enhancement imaging (TXI) plus endocuff vision versus TXI alone for colorectal adenoma detection: a randomized controlled trial.

Pattarajierapan S, Tipmanee P, Supasiri T, Wisedopas N, Khomvilai S Surg Endosc. 2023; 37(11):8340-8348.

PMID: 37697119 DOI: 10.1007/s00464-023-10396-0.

Inflammation in the proximal colon is a risk factor for the development of colorectal neoplasia in inflammatory bowel disease patients with primary sclerosing cholangitis.

Jamil O, Shaw D, Deng Z, Dinardi N, Fillman N, Khanna S Therap Adv Gastroenterol. 2023; 16:17562848231184985.

PMID: 37692199 PMC: 10486214. DOI: 10.1177/17562848231184985.

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