Is the distal hyperplastic polyp a marker for proximal neoplasia?
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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, eds. (1999) Textbook of Gastroenterology. Vol. 2. Lippincott, Philadelphia, pp. 1965-1965
- Shinya, H, Wolff, WI (1979) Morphology, anatomic distribution, and cancer potential of colonic polyps: an analysis of 7000 polyps endoscopically removed. Ann Surg 190: pp. 679-83 CrossRef
- Granqvist, S (1981) Distribution of large polyps in the large bowel in relation to age: a colonoscopic study. Scand J Gastroenterol 16: pp. 1025-31 CrossRef
- Lieberman, DA, Smith, FW (1991) Screening for colon malignancy with colonoscopy. Am J Gastroenterol 86: pp. 946-51
- DiSario, JA, Foutch, PG, Mai, HD, Pardy, K, Manne, RK (1991) Prevalence and malignant potential of colorectal polyps in asymptomatic, average-risk men. Am J Gastroenterol 86: pp. 941-5
- Johnson, DA, Gurney, MS, Volpe, RJ (1990) A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol 85: pp. 969-74
- Rex, D, Lehman, G, Hawes, R, Ulbright, T, Smith, J (1991) Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests. Gasterenterology 100: pp. 64-7
- Levin, TR, Palitz, A, Grossman, S (1999) Predicting advanced proximal colonic neoplasia with screening sigmoidoscopy. JAMA 281: pp. 1611-7 CrossRef
- Read, TE, Read, JD, Butterly, LF (1997) Importance of adenomas 5 mm or less in diameter that are detected by sigmoidoscopy. [see comments]. N Engl J Med 336: pp. 8-12 CrossRef
- Schoen, RE, Corle, D, Cranston, L (1998) Is colonoscopy needed for the nonadvanced adenoma found on sigmoidoscopy? The Polyp Prevention Trial [see comments]. Gastroenterology 115: pp. 533-41 CrossRef
- Wallace, MB, Kemp, JA, Trnka, YM, Donovan, JM, Farraye, FA (1998) Is colonoscopy indicated for small adenomas found by screening flexible sigmoidoscopy?. Ann Intern Med 129: pp. 273-8
- Zarchy, T, Ershoff, D (1994) Do characteristics of adenomas on flexible sigmoidoscopy predict advanced lesions on baseline colonoscopy?. Gastroenterology 106: pp. 1702-5
- Imperiale, TF, Wagner, DR, Lin, CY, Larkin, GN, Rogge, JD, Ransohoff, DF (2000) Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343: pp. 169-74 CrossRef
- Lieberman, DA, Weiss, DG, Bond, JH, Ahnen, DJ, Garewal, H, Chejfec, G (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 343: pp. 162-8 CrossRef
- Achkar, E, Winawer, SJ (1990) Controversies, dilemmas, and dialogues. A hyperplastic polyp is discovered on flexible sigmoidoscopy. Is a full colonoscopy indicated?. Am J Gastroenterol 85: pp. 367-70
- Fraser, GM, Niv, Y (1993) Hyperplastic polyp and colonic neoplasia. Is there an association?. J Clin Gastroenterol 16: pp. 278-80 CrossRef
- Waye, JD (1988) Hyperplastic colon polyps-are they markers?. Ann Intern Med 109: pp. 851-2
- Bond, JH (1993) 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 119: pp. 836-43
- Bond, JH (2000) Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 95: pp. 3053-63 CrossRef
- Colorectal cancer screen and surveillance. The role of colonoscopy in the management of patients with colonic polyps nepolasia. Guidelines for Clinical Application. Gastrointest Endosc 50: pp. 921-4 CrossRef
- Winawer, SJ, Fletcher, RH, Miller, L (1997) Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 112: pp. 594-642 CrossRef
- Byers, T, Levin, B, Rothenberger, D, Dodd, GD, Smith, RA (1997) 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 47: pp. 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 (1998) Large hyperplastic polyps predict colonic adenomas. Am J Gastroenterology 93: pp. 1685-1685
- 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 (1992) Significance of distal polyps detected with flexible sigmoidoscopy in asymptomatic patients. Arch Intern Med 152: pp. 1776-80 CrossRef
- Tsai, CJ, Lu, DK (1995) Small colorectal polyps: histopathology and clinical significance. Am J Gastroenterol 90: pp. 988-94
- Church, JM, Fazio, VW, Jones, IT (1988) Small colorectal polyps. Are they worth treating?. Dis Colon Rectum 31: pp. 50-3 CrossRef
- A multicenter study of colorectal adenomas: rationale, objectives, methods and characteristics of the study cohort. Tumori 81: pp. 157-63
- Rauf, A, Levendoglu, H (1988) Diminutive polyps detected by flexible sigmoidoscopy neccesitates full investigation. Gastrointest Endosc 34: pp. 199-199
- Zauber, A, Winawer, SJ, Diaz, B (1988) The National Polyp Study: the association of colonic hyperplastic polyps and adenomas. Am J Gastroenterol 83: pp. 1060-1060
- Ryan, ME, Norfleet, RG, Kirchner, JP (1989) The significance of diminutive colonic polyps found at flexible sigmoidoscopy. Gastrointest Endosc 35: pp. 85-9
- Black, J, Skolnick, MH, Burt, RW (1987) Lack of association between hyperplastic and adenomatous polyps of the colon. Gastroenterology 92: pp. 1319-1319
- Sciallero, S, Costantini, M, Bertinelli, E (1997) Distal hyperplastic polyps do not predict proximal adenomas: results from a multicentric study of colorectal adenomas. Gastrointest Endosc 46: pp. 124-30 CrossRef
- Kim, WH, Lee, SK, Chung, JH, Cho, YS, Yoo, HM, Kang, JK (2000) Significance of rectosigmoid polyp as a predictor of proximal colonic polyp. Yonsei Med J 41: pp. 98-106
- Pines, A, Bat, L, Rosenbaum, J, Levo, Y, Shemesh, E (1992) Are tiny polyps important when found on sigmoidoscopy in asymptomatic people?. J Clin Gastroenterol 15: pp. 113-6 CrossRef
- Provenzale, D, Martin, ZZ, Holland, KL, Sandler, RS (1988) Colon adenomas in patients with hyperplastic polyps. J Clin Gastroenterol 10: pp. 46-9 CrossRef
- DerSimonian, R, Laird, N (1986) Meta-analysis in clinical trials. Control Clin Trials 7: pp. 177-88 CrossRef
- SAS/STAT User’s Guide. Vol. 1. SAS Institute Inc., Cary, NC
- Goldstein, H (1995) Multilevel Statistical Levels. Edward Arnold, London
- Foutch, GP, DiSario, JA, Pardy, K (1991) The sentinal hyperplastic polyp: a marker for synchronous neoplasia in the proximal colon. Am J Gastroenterol 86: pp. 1482-5
- Brady, PG, Straker, RJ, McClave, SA, Nord, HJ, Pinkas, M, Robinson, BE (1993) Are hyperplastic rectosigmoid polyps associated with an increased risk of proximal colonic neoplasms?. Gastrointest Endosc 39: pp. 481-5 CrossRef
- Rex, DK, Smith, JJ, Ulbright, TM, Lehman, GA (1992) Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects. Gastroenterology 102: pp. 317-9
- Stoltenberg, PH, Kirtley, DW (1991) Are diminutive colorectal polyps clinically significant?. Gastrointest Endosc 34: pp. 172-172
- Nusko, G, Altendorf-Hofmann, A, Hermanek, P, Ell, C, Hahn, EG (1996) Correlation of polypoid lesions in the distal colorectum and proximal colon in asymptomatic screening subjects. Eur J Gastroenterol Hepatol 8: pp. 351-4 CrossRef
- Deal, SE, Woogen, SD, Stuckey, C, Zfass, AM (1991) Screening sigmoidoscopy for colonic neoplasms: hyperplastic polyps (HP) require further evaluation and 30 cm flexible sigmoidoscopy (FS) is inadequate. Gastrointest Endosc 37: pp. 262-262
- Blue, MG, Sivak, MV, Achkar, E, Matzen, R, Stahl, RR (1991) Hyperplastic polyps seen at sigmoidoscopy are markers for additional adenomas seen at colonoscopy. Gastroenterology 100: pp. 564-6
- Opelka, FG, Timmcke, AE, Gathright, JB, Ray, JE, Hicks, TC (1992) Diminutive colonic polyps: an indication for colonoscopy. Dis Colon Rectum 35: pp. 178-81 CrossRef
- Olsen, HW, Lawrence, WA (1998) Hyperplastic polyps at screening sigmoidoscopy are not an indication for colonoscopy. Gastrointest Endosc 47: pp. 312-312
- Provenzale, D, Garrett, JW, Condon, SE, Sandler, RS (1990) Risk for colon adenomas in patients with rectosigmoid hyperplastic polyps. Ann Intern Med 113: pp. 760-3
- Rokkas, T, Karameris, A, Mikou, G (1993) Small polyps found at sigmoidoscopy: are they significant?. Hepatogastroenterology 40: pp. 475-7
- Pennazio, M, Arrigoni, A, Risio, M, Spandre, M, Rossini, FP (1993) Small rectosigmoid polyps as markers of proximal neoplasms. Dis Colon Rectum 36: pp. 1121-5 CrossRef
- Ansher, AF, Lewis, JH, Fleischer, DE (1989) Hyperplastic colonic polyps as a marker for adenomatous colonic polyps. Am J Gastroenterol 84: pp. 113-7
- Ellis, NC, Boggs, WH, Slagle, GW (1993) Clinical significance of diminutive polyps of the rectum and sigmoid colon. Dis Colon Rectum 36: pp. 8-9 CrossRef
- Stryker, S, Wolff, B (1987) Natural history of untreated colonic polyps. Gastroenterology 93: pp. 1009-13
- Hofstad, B, Vatn, MH, Andersen, SN (1996) Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years. Gut 39: pp. 449-56
- Ransohoff, D, Sandler, R (2002) Screening for colorectal cancer. N Engl J Med 346: pp. 40-4 CrossRef
- Hawkins, NJ, Ward, RL (2001) Sporadic colorectal cancers with microsatellite instability and their possible origin in hyperplastic polyps and serrated adenomas. J Natl Cancer Inst 93: pp. 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 (1997) A case-control study of dietary intake and other lifestyle risk factors for hyperplastic polyps. Gastroenterology 113: pp. 423-9 CrossRef
- Jass, J, Iino, H, Ruszkiewicz, A (2000) Neoplastic progression occurs through mutator pathways in hyperplastic polyposis of the colorectum. Gut 47: pp. 43-9 CrossRef
- Jass, J (2001) Hyperplastic polyps of the colorectum—innocent or guilty?. Dis Colon Rectum 44: pp. 163-6 CrossRef
- Borzak, S, Ridker, P (1995) Discordance between meta-analyses and large-scale randomized controlled trials. Ann Intern Med 123: pp. 873-7
- Is the distal hyperplastic polyp a marker for proximal neoplasia?
Journal of General Internal Medicine
Volume 18, Issue 2 , pp 128-137
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- colorectal cancer
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- systematic review
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- 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.