nach oben

Digestive Diseases and Sciences

Erschienen in:

01.01.2009 | Original Paper

A Risk Profile for Advanced Proximal Neoplasms on Diagnostic Colonoscopy

verfasst von: Thomas M. Zarchy, Frank Tsai, Emily Ramicone, Linda S. Chan

Erschienen in: Digestive Diseases and Sciences | Ausgabe 1/2009

Einloggen, um Zugang zu erhalten

Abstract

The capacity for colonoscopy is limited and a method to prioritize patients for diagnostic colonoscopy is needed in health care centers. A retrospective cross-sectional cohort study was carried out in county and community endoscopy centers, which included 1,065 county and 279 community patients aged ≥40 years undergoing diagnostic colonoscopy. We constructed a risk profile for proximal advanced neoplasms on diagnostic colonoscopy at the county center based on the size of the regression coefficients for independent risk factors from logistic regression. An advanced neoplasm was defined as one of size ≥1 cm or containing villous histology, high-grade dysplasia, or cancer. In our county colonoscopy population (n = 929 after exclusions), the stepwise logistic regression analysis identified age ≥60 years (adjusted odds ratio [AOR]: 2.60; 95% confidence interval [CI]:1.14, 6.14), iron deficiency anemia (AOR: 4.74; 95% CI: 2.07, 11.34), and an advanced neoplasm in the recto-sigmoid (AOR: 6.01; 95% CI: 2.02, 16.00) as the statistically significant predictors of an advanced proximal neoplasm. In the county population, the prevalence rates of an advanced proximal neoplasm and proximal high-grade dysplasia/cancer in the low-risk group were 0.71% (95% CI: 0.15, 2.05) and 0.24% (95% CI: 0.01, 1.31), respectively. Avoiding colonoscopy in this group would increase the capacity for colonoscopy by 46% in the higher risk groups. In a disparate community population (n = 237 after exclusions), this scoring system had a goodness-of-fit test showing high concordance (P = 0.51). This clinical profile stratified the risk for an advanced neoplasm proximal to the sigmoid in patients undergoing diagnostic colonoscopy. It identified a large subset of low-risk patients.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96PubMedCrossRef

Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58:130–160PubMedCrossRef

Lieberman DA, Holub J, Eisen G, Kraemer D, Morris CD (2005) Utilization of colonoscopy in the United States: results from a national consortium. Gastrointest Endosc 62:875–883. doi:10.1016/j.gie.2005.06.037 PubMedCrossRef

Seeff LC, Manninen DL, Dong FB, Chattopadhyay SK, Nadel MR, Tangka FKL, Molinari NA (2004) Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States? Gastroenterology 127:1661–1669. doi:10.1053/j.gastro.2004.09.052 PubMedCrossRef

El-Serag HB, Petersen L, Hampel H, Richardson P, Cooper G (2006) The use of screening colonoscopy for patients cared for by the Department of Veterans Affairs. Arch Intern Med 166:2202–2208. doi:10.1001/archinte.166.20.2202 PubMedCrossRef

Levin TR (2004) Colonoscopy capacity: can we build it? Will they come? Gastroenterology 127:1841–1844. doi:10.1053/j.gastro.2004.10.014 PubMedCrossRef

Van Rosendaal GM, Sutherland LR, Verhoef MJ, Bailey RJ, Blustein PK, Lalor EA, Thomson AB, Meddings JB (2000) Defining the role of fiberoptic sigmoidoscopy in the investigation of patients presenting with bright red rectal bleeding. Am J Gastroenterol 95:1184–1187PubMedCrossRef

Lewis JD, Brown A, Localio AR, Schwartz JS (2002) Initial evaluation of rectal bleeding in young persons: a cost-effectiveness analysis. Ann Intern Med 136:99–110PubMed

De Bosset V, Gonvers JJ, Vader JP, Dubois RW, Burnand B, Froehlich F (1999) Appropriateness of colonoscopy: lower abdominal pain or constipation. Endoscopy 31(8):637–640. doi:10.1055/s-1999-69 PubMedCrossRef

10.

Rockey DC, Cello JP (1993) Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med 329:1691–1695. doi:10.1056/NEJM199312023292303 PubMedCrossRef

11.

Mysliwiec PA, Brown ML, Klabunde CN, Ransohoff DF (2004) Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy. Ann Intern Med 141:264–271PubMed

12.

Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF (2003) Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer. Ann Intern Med 139:959–965PubMed

13.

Atkin WS, Morson BC, Cuzick J (1992) Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 326:658–662PubMed

14.

Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL (1987) Natural history of untreated colonic polyps. Gastroenterology 93:1009–1013PubMed

15.

Ladabaum W, Song K (2005) Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand. Gastroenterology 129:1151–1162. doi:10.1053/j.gastro.2005.07.059 PubMedCrossRef

16.

Meissner HI, Breen N, Klabunde CN, Vernon SW (2006) Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiol Biomarkers Prev 15:389–394. doi:10.1158/1055-9965.EPI-05-0678 PubMedCrossRef

17.

Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS (1992) A case–control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 326:653–657PubMed

18.

Thiis-Evensen E, Hoff GS, Sauer J, Langmark F, et al (1999) Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scand J Gastroenterol 34:414–420. doi:10.1080/003655299750026443 PubMedCrossRef

19.

Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, Ederer F (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 328:1365–1371. doi:10.1056/NEJM199305133281901 PubMedCrossRef

20.

Kronborg O, Fenger C, Olsen J, Jørgensen OD, Søndergaard O (1996) Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 348:1467–1471. doi:10.1016/S0140-6736(96)03430-7 PubMedCrossRef

21.

Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, James PD, Mangham CM (1996) Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 348:1472–1477. doi:10.1016/S0140-6736(96)03386-7 PubMedCrossRef

22.

Schoenfeld PS, Cash B, Kita J, Piorkowski M, Cruess D, Ransohoff D (1999) Effectiveness and patient satisfaction with screening flexible sigmoidoscopy performed by registered nurses. Gastrointest Endosc 49:158–162. doi:10.1016/S0016-5107(99)70480-3 PubMedCrossRef

23.

Anderson ML, Pasha TM, Leighton JA (2000) Endoscopic perforation of the colon: lessons from a 10-year study. Am J Gastroenterol 95:3418–3422. doi:10.1111/j.1572-0241.2000.03356.x PubMedCrossRef

24.

Farraye FA, Horton K, Hersey H, Trnka Y, Heeren T, Provenzale D (2004) Screening flexible sigmoidoscopy using an upper endoscope is better tolerated by women. Am J Gastroenterol 99(6):1074–1080. doi:10.1111/j.1572-0241.2004.30215.x PubMedCrossRef

25.

Kuganeswaran E, Clarkston WK, Cuddy PG, Quiason SG, Pandya PK, Dierenfeldt WT, Jonnalagadda SS, Smith OJ, Chen ST (1999) A double-blind placebo controlled trial of oral midazolam as premedication before flexible sigmoidoscopy. Am J Gastroenterol 94(11):3215–3219. doi:10.1111/j.1572-0241.1999.01521.x PubMedCrossRef

26.

Pinsky PF, Schoen RE, Weissfeld JL, Kramer B, Hayes RB, Yokochi L; PLCO Project Team (2005) Variability in flexible sigmoidoscopy performance among examiners in a screening trial. Clin Gastroenterol Hepatol 3:792–797. doi:10.1016/S1542-3565(05)00286-7 PubMedCrossRef

27.

Atkin WS, Edwards R, Wardle J, Northover JM, Sutton S, Hart AR, Williams CB, Cuzick J (2001) Design of a multicentre randomised trial to evaluate flexible sigmoidoscopy in colorectal cancer screening. J Med Screen 8:137–144. doi:10.1136/jms.8.3.137 PubMedCrossRef

28.

Thompson WG, Meola T, Lipkin M Jr, Freedman ML (1988) Red cell distribution width, mean corpuscular volume, and transferrin saturation in the diagnosis of iron deficiency. Arch Intern Med 148(10):2128–2130. doi:10.1001/archinte.148.10.2128 PubMedCrossRef

29.

Zarchy TM, Chan LS, Ramicone E (2003) Which clinical factors predict threatening lesions proximal to the sigmoid on colonoscopy? Gastroenterology 124(4):A422. doi:10.1016/S0016-5085(03)82135-2 CrossRef

30.

Zarchy TM, Ershoff D (1994) Do characteristics of adenomas on flexible sigmoidoscopy predict advanced lesions on baseline colonoscopy? Gastroenterology 106:1501–1504PubMed

31.

Read TE, Read JD, Butterly LF (1997) Importance of adenomas 5 mm or less in diameter that are detected by sigmoidoscopy. N Engl J Med 336:8–12. doi:10.1056/NEJM199701023360102 PubMedCrossRef

32.

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 129:273–278PubMed

33.

Collins JF, Lieberman DA, Durbin TE, Weiss DG; Veterans Affairs Cooperative Study #380 Group (2005) Accuracy of screening for fecal occult blood on a single stool sample obtained by digital rectal examination: a comparison with recommended sampling practice. Ann Intern Med 142:81–85PubMed

34.

Schoenfeld P, Cash B, Flood A, Dobhan R, Eastone J, Coyle W, Kikendall JW, Kim HM, Weiss DG, Emory T, Schatzkin A, Lieberman D; CONCeRN Study Investigators (2005) Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 352:2061–2068. doi:10.1056/NEJMoa042990 PubMedCrossRef

35.

Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J, Nowacki MP, Butruk E (2006) Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 355:1863–1872. doi:10.1056/NEJMoa054967 PubMedCrossRef

36.

Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Speizer FE, Willett WC (1994) A prospective study of family history and the risk of colorectal cancer. N Engl J Med 331:1669–1674. doi:10.1056/NEJM199412223312501 PubMedCrossRef

37.

St John DJ, McDermott FT, Hopper JL, Debney EA, Johnson WR, Hughes ES (1993) Cancer risk in relatives of patients with common colorectal cancer. Ann Intern Med 118:785–790PubMed

38.

Eisen GM, Weinberg DS (2005) Narrative review: screening for colorectal cancer in patients with a first-degree relative with colonic neoplasia. Ann Intern Med 143:190–198PubMed

39.

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 343:162–168. doi:10.1056/NEJM200007203430301 PubMedCrossRef

40.

Segnan N, Senore NC, Andreoni B, Azzoni A, Bisanti L, Cardelli A, Castiglione G, Crosta C, Ederle A, Fantin A, Ferrari A, Fracchia M, Ferrero F, Gasperoni S, Recchia S, Risio M, Rubeca T, Saracco G, Zappa M; SCORE3 Working Group-Italy (2007) SCORE3 Working Group, Italy. Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology 132:2304–2312. doi:10.1053/j.gastro.2007.03.030 PubMedCrossRef

Titel: A Risk Profile for Advanced Proximal Neoplasms on Diagnostic Colonoscopy
verfasst von: Thomas M. Zarchy
Frank Tsai
Emily Ramicone
Linda S. Chan
Publikationsdatum: 01.01.2009
Verlag: Springer US
Erschienen in: Digestive Diseases and Sciences / Ausgabe 1/2009
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-008-0328-5

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Reizdarmsyndrom: Diäten wirksamer als Medikamente

29.04.2024 Reizdarmsyndrom Nachrichten

Bei Reizdarmsyndrom scheinen Diäten, wie etwa die FODMAP-arme oder die kohlenhydratreduzierte Ernährung, effektiver als eine medikamentöse Therapie zu sein. Das hat eine Studie aus Schweden ergeben, die die drei Therapieoptionen im direkten Vergleich analysierte.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2009

The D2/D3 Agonist PD128907 (R-(+)-trans-3,4a,10b-Tetrahydro-4-Propyl-2H,5H-[1]Benzopyrano[4,3-b]-1,4-Oxazin-9-ol) Inhibits Stimulated Pyloric Relaxation and Spontaneous Gastric Emptying

Effect of Music on Patients Undergoing Colonoscopy: A Meta-Analysis of Randomized Controlled Trials

Stanford Multidisciplinary Seminars in Digestive Diseases and Sciences

Choledochal Cyst Complications Presenting as Duodenal Obstruction in an 82-Year-Old Patient with Gallbladder Agenesis

It Is Possible to Classify Non-erosive Reflux Disease (NERD) Patients into Endoscopically Normal Groups and Minimal Change Groups by Subjective Symptoms and Responsiveness to Rabeprazole—A Report from a Study with Japanese Patients