Predicting proximal advanced neoplasms at screening sigmoidoscopy

Carlo Senore, Nereo Segnan, Luigina Bonelli, Stefania Sciallero, Marco Pennazio, Donato Angioli, Cristiano Crosta, Stefano Gasperoni, Giuseppe Malfitana

Research output: Contribution to journalArticlepeer-review


PURPOSE: This study was designed to assess the predictive value for advanced proximal neoplasms (cancer, adenoma ≥ 10 mm, or villous component >20 percent, or severe dysplasia) of the characteristics of distal polyps. METHODS: The study was conducted among patients, aged 55 to 64 years, referred for colonoscopy in the Italian trial of sigmoidoscopy screening for colorectal cancer. Patients reporting a history of colorectal cancer, adenomas, inflammatory bowel disease, recent colorectal endoscopy, or two first-degree relatives with colorectal cancer were excluded. We compared the prevalence of advanced proximal neoplasia in patients with "low-risk" (1-2 tubular adenomas, 20 percent, or severe dysplasia) polyps in the distal colon. RESULTS: Of 426 patients with polyps > 5 mm, 29 (6.9 percent) were detected with an advanced proximal neoplasm (including 4 colorectal cancers). The prevalence of proximal advanced neoplasia was 9.4 percent among patients with high-risk distal polyps and 2.5 percent among those with low-risk lesions (adjusted odds ratio, 3.19; 95 percent confidence interval, 1.06-9.59). Approximately 40 people with low-risk distal polyps 6 to 9 mm should undergo colonoscopy to detect one proximal advanced neoplasm; the corresponding number for patients with high-risk distal polyps is 10. CONCLUSIONS: The 2.5 percent prevalence of proximal advanced neoplasms among people with low-risk 6-mm to 9-mm distal polyps is similar to the prevalence observed among people without distal polyps. Restricting colonoscopy referral to patients with high-risk distal polyps might represent a cost-effective strategy in a screening context.

Original languageEnglish
Pages (from-to)1331-1340
Number of pages10
JournalDiseases of the Colon and Rectum
Issue number8
Publication statusPublished - Aug 2004


  • Colonic adenomas
  • Colorectal cancer
  • Proximal advanced neoplasia
  • Screening
  • Sigmoidoscopy

ASJC Scopus subject areas

  • Gastroenterology


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