Journal of General Internal Medicine

, Volume 18, Issue 2, pp 128–137

Is the distal hyperplastic polyp a marker for proximal neoplasia?

A systematic review
  • Sachin Dave
  • Siu Hui
  • Kurt Kroenke
  • Thomas F. Imperiale


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.

Key words

colorectal cancer cancer screening sigmoidoscopy colorectal neoplasms systematic review 


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Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  • Sachin Dave
    • 1
  • Siu Hui
    • 1
  • Kurt Kroenke
    • 1
  • Thomas F. Imperiale
    • 1
    • 2
  1. 1.the Department of Medicine and The Regenstrief Institute, Inc.Indiana University School of MedicineIndianapolis
  2. 2.the Roudebush VA Medical CenterIndiana University School of MedicineIndianapolis

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