Is the distal hyperplastic polyp a marker for proximal neoplasia?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
CONTEXT: The current literature is unclear about the association between distal hyperplastic polyps and synchronous neoplasia (adenomatous polyps and cancer) in the proximal colon.
OBJECTIVE: To estimate the prevalence of proximal neoplasia associated with distal hyperplastic polyps.
DATA SOURCES: Database searches (medline and embase from 1966 to 2001) and manual search of the bibliographies of included and excluded studies, case reports, editorials, review articles, and textbooks of Gastroenterology.
STUDY SELECTION: Studies describing the prevalence of proximal neoplasia in persons with distal hyperplastic polyps.
DATA EXTRACTION: Demographics, clinical variables, study design, and prevalence of proximal neoplasia associated with various distal colorectal findings.
DATA SYNTHESIS: Of 18 included studies, 12 involved asymptomatic individuals in which the pooled absolute risk of any proximal neoplasia associated with distal hyperplastic polyps was 25% (95% confidence interval [95% CI], 21% to 29%). In 4 studies where colonoscopy was performed irrespective of distal findings, the absolute risk was 21% (95% CI, 14% to 28%). The relative risk of finding any proximal neoplasia in persons with distal hyperplastic polyps was 1.3 (95% CI, 0.9 to 1.8) compared to those with no distal polyps. Among 6 studies of patients with symptoms or risk factors for neoplasia, the absolute risk of proximal neoplasia was 35% (95% CI, 32% to 39%) in persons with distal hyperplastic polyps. In 2 studies of screening colonoscopy, advanced proximal neoplasia (cancer, or a polyp with villous histology or severe dysplasia, or a tubular adenoma ≥1 cm) was present in 4% to 5% of persons with distal hyperplastic polyps, which was 1.5 to 2.6 times greater than in those with no distal polyps.
CONCLUSIONS: In asymptomatic persons, a distal hyperplastic polyp is associated with a 21% to 25% risk for any proximal neoplasia and a 4% to 5% risk of advanced proximal neoplasia, and may justify examination of the proximal colon. Further study is needed to determine the risk of advanced proximal neoplasia associated with size and number of distal hyperplastic polyps.
- Macrae F, Young G. Neoplastic and nonneoplastic polyps of the colon and rectum. In: Yamada. ed. Textbook of Gastroenterology. Vol. 2. Philadelphia: Lippincott; 1999:1965.
- Shinya H, Wolff WI. Morphology, anatomic distribution, and cancer potential of colonic polyps: an analysis of 7000 polyps endoscopically removed. Ann Surg. 1979;190:679–83. CrossRef
- Granqvist S. Distribution of large polyps in the large bowel in relation to age: a colonoscopic study. Scand J Gastroenterol. 1981;16:1025–31. CrossRef
- Lieberman DA, Smith FW. Screening for colon malignancy with colonoscopy. Am J Gastroenterol. 1991;86:946–51.
- DiSario JA, Foutch PG, Mai HD, Pardy K, Manne RK. Prevalence and malignant potential of colorectal polyps in asymptomatic, average-risk men. Am J Gastroenterol. 1991;86:941–5.
- Johnson DA, Gurney MS, Volpe RJ, et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol. 1990;85:969–74.
- Rex D, Lehman G, Hawes R, Ulbright T, Smith J. Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests. Gasterenterology. 1991;100:64–7.
- Levin TR, Palitz A, Grossman S, et al. Predicting advanced proximal colonic neoplasia with screening sigmoidoscopy. JAMA. 1999;281:1611–7. CrossRef
- Read TE, Read JD, Butterly LF. Importance of adenomas 5 mm or less in diameter that are detected by sigmoidoscopy. [see comments]. N Engl J Med. 1997;336:8–12. CrossRef
- Schoen RE, Corle D, Cranston L, et al. Is colonoscopy needed for the nonadvanced adenoma found on sigmoidoscopy? The Polyp Prevention Trial [see comments]. Gastroenterology. 1998;115:533–41. CrossRef
- Wallace MB, Kemp JA, Trnka YM, Donovan JM, Farraye FA. Is colonoscopy indicated for small adenomas found by screening flexible sigmoidoscopy? Ann Intern Med. 1998;129:273–8.
- Zarchy T, Ershoff D. Do characteristics of adenomas on flexible sigmoidoscopy predict advanced lesions on baseline colonoscopy? Gastroenterology. 1994;106:1702–5.
- Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169–74. CrossRef
- Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000;343:162–8. CrossRef
- Achkar E, Winawer SJ. Controversies, dilemmas, and dialogues. A hyperplastic polyp is discovered on flexible sigmoidoscopy. Is a full colonoscopy indicated? Am J Gastroenterol. 1990;85:367–70.
- Fraser GM, Niv Y. Hyperplastic polyp and colonic neoplasia. Is there an association? J Clin Gastroenterol. 1993;16:278–80. CrossRef
- Waye JD. Hyperplastic colon polyps-are they markers? Ann Intern Med. 1988;109:851–2.
- Bond JH. Polyp guidelines: diagnosis, treatment, and surveillance for patients with nonfamilial colorectal polyps. The Practice Parameters Committee of the American College of Gastroenterology. Ann Intern Med. 1993;119:836–43.
- Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 2000;95:3053–63. CrossRef
- ASGE. Colorectal cancer screen and surveillance. The role of colonoscopy in the management of patients with colonic polyps nepolasia. Guidelines for Clinical Application. Gastrointest Endosc. 1999;50:921–4. CrossRef
- Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. 1997;112:594–642. CrossRef
- Byers T, Levin B, Rothenberger D, Dodd GD, Smith RA. American Cancer Society guidelines for screening and surveillance for early detection of colorectal polyps and cancer: update 1997. American Cancer Society Detection and Treatment Advisory Group on Colorectal Cancer. CA Cancer J Clin. 1997;47:154–60. CrossRef
- Anonymous. Guide to Clinical Preventive Services. Washington, D.C.: Department of Health and Human Services; 1995:89–103.
- Butterly L, Fiarman GS, Bockler M. Large hyperplastic polyps predict colonic adenomas. Am J Gastroenterology. 1998;93:1685.
- Postelnik A, Woodger A, Kapparis A, Frommer D. Hyperplastic polyps of the colon indicate increased liability for colon neoplasms. Gastroenterology. 1988;94:A357.
- Winawer SJ, Diaz B, Zauber A, Gottlieb LS, O’Brien M, Sternberg SS, and the NPS Workgroup. The National Polyp Study: colorectal adenomas and hyperplastic polyps. Gasterenterology 1988;94:A499.
- Baba ER, Fujii T, Nakamura K. et al. Is hyperplastic rectal polyp (HRP) useful as marker for colorectal cancer in low risk patients? Gastroenterology. 1998;114:A561.
- Matter SE, Campbell DR. Significance of distal polyps detected with flexible sigmoidoscopy in asymptomatic patients. Arch Intern Med. 1992;152:1776–80. CrossRef
- Tsai CJ, Lu DK. Small colorectal polyps: histopathology and clinical significance. Am J Gastroenterol. 1995;90:988–94.
- Church JM, Fazio VW, Jones IT. Small colorectal polyps. Are they worth treating? Dis Colon Rectum. 1988;31:50–3. CrossRef
- The Multicentric Study of Colorectal Adenomas (SMAC) Workgroup. A multicenter study of colorectal adenomas: rationale, objectives, methods and characteristics of the study cohort. Tumori. 1995;81:157–63.
- Rauf A, Levendoglu H. Diminutive polyps detected by flexible sigmoidoscopy neccesitates full investigation. Gastrointest Endosc. 1988;34:199.
- Zauber A, Winawer SJ, Diaz B, et al., and the NPS Workgroup. The National Polyp Study: the association of colonic hyperplastic polyps and adenomas. Am J Gastroenterol. 1988;83:1060.
- Ryan ME, Norfleet RG, Kirchner JP, et al. The significance of diminutive colonic polyps found at flexible sigmoidoscopy. Gastrointest Endosc. 1989;35:85–9.
- Black J, Skolnick MH, Burt RW. Lack of association between hyperplastic and adenomatous polyps of the colon. Gastroenterology. 1987;92:1319.
- Sciallero S, Costantini M, Bertinelli E, et al. Distal hyperplastic polyps do not predict proximal adenomas: results from a multicentric study of colorectal adenomas. Gastrointest Endosc. 1997;46:124–30. CrossRef
- Kim WH, Lee SK, Chung JH, Cho YS, Yoo HM, Kang JK. Significance of rectosigmoid polyp as a predictor of proximal colonic polyp. Yonsei Med J. 2000;41:98–106.
- Pines A, Bat L, Rosenbaum J, Levo Y, Shemesh E. Are tiny polyps important when found on sigmoidoscopy in asymptomatic people? J Clin Gastroenterol. 1992;15:113–6. CrossRef
- Provenzale D, Martin ZZ, Holland KL, Sandler RS. Colon adenomas in patients with hyperplastic polyps. J Clin Gastroenterol. 1988;10:46–9. CrossRef
- DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88. CrossRef
- SAS Institute. SAS/STAT User’s Guide. Vol. 1. Cary, NC: SAS Institute Inc.; 1988.
- Goldstein H. Multilevel Statistical Levels. London: Edward Arnold; 1995.
- Foutch GP, DiSario JA, Pardy K. The sentinal hyperplastic polyp: a marker for synchronous neoplasia in the proximal colon. Am J Gastroenterol. 1991;86:1482–5.
- Brady PG, Straker RJ, McClave SA, Nord HJ, Pinkas M, Robinson BE. Are hyperplastic rectosigmoid polyps associated with an increased risk of proximal colonic neoplasms? Gastrointest Endosc. 1993;39:481–5. CrossRef
- Rex DK, Smith JJ, Ulbright TM, Lehman GA. Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects. Gastroenterology. 1992;102:317–9.
- Stoltenberg PH, Kirtley DW. Are diminutive colorectal polyps clinically significant? Gastrointest Endosc. 1991;34:172.
- Nusko G, Altendorf-Hofmann A, Hermanek P, Ell C, Hahn EG. Correlation of polypoid lesions in the distal colorectum and proximal colon in asymptomatic screening subjects. Eur J Gastroenterol Hepatol. 1996;8:351–4. CrossRef
- Deal SE, Woogen SD, Stuckey C, Zfass AM. Screening sigmoidoscopy for colonic neoplasms: hyperplastic polyps (HP) require further evaluation and 30 cm flexible sigmoidoscopy (FS) is inadequate. Gastrointest Endosc. 1991;37:262.
- Blue MG, Sivak MV Jr. Achkar E, Matzen R, Stahl RR. Hyperplastic polyps seen at sigmoidoscopy are markers for additional adenomas seen at colonoscopy. [see comments] Gastroenterology. 1991;100:564–6.
- Opelka FG, Timmcke AE, Gathright JB Jr., Ray JE, Hicks TC. Diminutive colonic polyps: an indication for colonoscopy. Dis Colon Rectum. 1992;35:178–81. CrossRef
- Olsen HW, Lawrence WA. Hyperplastic polyps at screening sigmoidoscopy are not an indication for colonoscopy. Gastrointest Endosc. 1998;47:312.
- Provenzale D, Garrett JW, Condon SE, Sandler RS. Risk for colon adenomas in patients with rectosigmoid hyperplastic polyps. Ann Intern Med. 1990;113:760–3.
- Rokkas T, Karameris A, Mikou G. Small polyps found at sigmoidoscopy: are they significant? Hepatogastroenterology. 1993;40:475–7.
- Pennazio M, Arrigoni A, Risio M, Spandre M, Rossini FP. Small rectosigmoid polyps as markers of proximal neoplasms. Dis Colon Rectum. 1993;36:1121–5. CrossRef
- Ansher AF, Lewis JH, Fleischer DE, et al. Hyperplastic colonic polyps as a marker for adenomatous colonic polyps. Am J Gastroenterol. 1989;84:113–7.
- Ellis NC, Boggs WH, Slagle GW. Clinical significance of diminutive polyps of the rectum and sigmoid colon. Dis Colon Rectum. 1993;36:8–9. CrossRef
- Stryker S, Wolff B. Natural history of untreated colonic polyps. Gastroenterology. 1987;93:1009–13.
- Hofstad B, Vatn MH, Andersen SN, et al. Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years. Gut. 1996;39:449–56.
- Ransohoff D, Sandler R. Screening for colorectal cancer. N Engl J Med. 2002;346:40–4. CrossRef
- Hawkins NJ, Ward RL. Sporadic colorectal cancers with microsatellite instability and their possible origin in hyperplastic polyps and serrated adenomas. J Natl Cancer Inst. 2001;93:1307–13. CrossRef
- Khvatyuk O, Zaubert AG, Winawer SJ. Association of hyperplastic polyps and advanced adenomas: are there high-risk hyperplastic polyps? Am J Gastroenterol. 2001;96:S154.
- Martinez M, McPherson R, Levin B, Glober G. A case-control study of dietary intake and other lifestyle risk factors for hyperplastic polyps. Gastroenterology. 1997;113:423–9. CrossRef
- Jass J, Iino H, Ruszkiewicz A, et al. Neoplastic progression occurs through mutator pathways in hyperplastic polyposis of the colorectum. Gut. 2000;47:43–9. CrossRef
- Jass J. Hyperplastic polyps of the colorectum—innocent or guilty? Dis Colon Rectum. 2001;44:163–6. CrossRef
- Borzak S, Ridker P. Discordance between meta-analyses and large-scale randomized controlled trials. Ann Intern Med. 1995;123:873–7.
- Is the distal hyperplastic polyp a marker for proximal neoplasia?
Journal of General Internal Medicine
Volume 18, Issue 2 , pp 128-137
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- colorectal cancer
- cancer screening
- colorectal neoplasms
- systematic review
- Industry Sectors
- Author Affiliations
- 1. the Department of Medicine and The Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, Ind.
- 2. the Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, Ind.