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PubMed1998

Colonoscopic screening in first-degree relatives of patients with 'sporadic' colorectal cancer: a case-control study. The Association Nationale des Gastroentérologues des Hôpitaux and Registre Bourguignon des Cancers Digestifs (INSERM CRI 9505)

BACKGROUND & AIMS: A screening policy has not been well defined in first-degree relatives of patients with sporadic colorectal cancer. This study estimated the risk of colorectal adenoma in a cohort of individuals with only 1 affected first-degree relative. METHODS: A total of 476 first-degree relatives (age, 40-74 years) of 195 patients with sporadic colorectal cancer were offered a colonoscopy. Each examined relative was matched with 2 controls for age, sex, symptoms, and center. The prevalence of colorectal adenomas was compared using a multiple logistic regression analysis. RESULTS: In 185 relatives, odds ratios were 1.5 (95% confidence interval [CI], 1.0-2.4) for adenomas, 2.5 for large adenomas (95% CI, 1.1-5.4), 1.2 for small adenomas (95% CI, 0.7-1.9), and 2.6 (95% CI, 1.3-5.1) for high-risk adenomas (> or = 1 cm in size and/or with a villous component). The prevalence of high-risk adenomas in relatives was higher when the index patient was younger than 65 years, was male, and had distal rather than proximal cancer. CONCLUSIONS: Subjects with only 1 affected first-degree relative are at increased risk for developing large adenomas.

Adenoma↗
PubMed2004

A survey of colonoscopic polypectomy practices among clinical gastroenterologists.

BACKGROUND: Polypectomy techniques vary in clinical practice. The aim of this study was to determine patterns of polypectomy practices in a random sample of gastroenterologists. METHODS: A total of 300 gastroenterologists were selected randomly from the membership directory of a professional society. They were asked to complete a standardized survey by telephone, electronic mail, or facsimile. RESULTS: The offices of 285 physicians were contacted successfully. A total of 189 (63%) chose to participate. 152 (80%) of these physicians were in private practice, and 37 (20%) were in academic practice. The mean number of years in practice was 15.5 (range 1-46 years). Forceps techniques (cold or hot) dominated other polypectomy methods for polyps 1 to 3 mm in size ( p < 0.0001), whereas electrosurgical snare resection was dominate for polyps 7 to 9 mm in diameter ( p < 0.0001). No method of polypectomy was significantly more likely to be used for polyps 4 to 6 mm in size. The proportion of physicians who had used dye spraying was 8.5%; detachable snares, 20.1%; clips, 20.1%; and submucosal saline solution injection, 82%. Of those who had used submucosal saline solution injection, 29.7% had no rules for its use, and, in the remainder, there was marked variation regarding the criteria. For polyp stalks greater than 1 cm in diameter, 69% used no method to prevent bleeding. Of those who did use preventive techniques, 76% used epinephrine injection. The electrosurgical current used for polypectomy was pure coagulation in 46%, blend in 46%, and pure-cut in 3%; 4% varied the current. CONCLUSIONS: At present, polypectomy technique among clinical gastroenterologists is highly variable. Some newer ancillary techniques have had extremely limited use thus far.

Colonic Polyps↗
PubMed2005

A prospective study of the frequency and the topographical distribution of colon neoplasia in asymptomatic average-risk Chinese adults as determined by colonoscopic screening.

BACKGROUND: The goal of this study was to determine the frequency of colorectal neoplasia in an asymptomatic Taiwanese population and the topographic distribution of lesions relative to age and gender. METHODS: Colonoscopy was performed in 1846 consecutive asymptomatic adults undergoing a health evaluation in 2003. Neoplastic lesions were considered advanced if they exceeded 10 mm in size, had a villous component, or contained moderately or severely dysplastic tissue or invasive cancer. Lesions at and proximal to the splenic flexure were considered proximal in location; those distal to the splenic flexure were classified as distal in location. RESULTS: Of 1741 (94.3%) patients (1041 men, 700 women; mean 52.5 years) enrolled, 1708 (98.1%) underwent total colonoscopy. Of these patients, 263 (15.4%) had colorectal neoplasia; 51 (3.0%) had advanced lesions. A total of 331 lesions were detected; 125 (37.8%) were proximal in location. Two thirds of patients with proximal advanced lesions (66.7%, 10/15) had no distal lesion. The proportion of patients with proximal or proximal plus distal lesions increased with age ( p = 0.027). CONCLUSIONS: Colonoscopy is an effective primary screening modality for colorectal neoplasia in asymptomatic Chinese patients. Many lesions would be missed, especially in the elderly, if only sigmoidoscopy was used for initial screening.

Adult↗