CORRELATION OF POLYPOID LESIONS IN THE DISTAL COLORECTUM AND PROXIMALCOLON IN ASYMPTOMATIC SCREENING SUBJECTS

Objective: Knowledge of a possible correlation between distal polyps f ound at screening sigmoidoscopy and proximal colonic lesions is import ant for deciding whether to perform total colonoscopy or not. Patients : A prospective analysis of 2439 consecutive patients with colorectal polyps. Of these, 304 were asymptomatic subjects who underwent complet e colonoscopy for screening and were found to have adenomatous or hype rplastic polyps in the distal colorectum. Results: Ten (15%) out of 65 patients with distal hyperplastic polyps only and 86 (36%) out of 239 with distal adenomatous polyps were found to have adenomatous polyps in the proximal colon as well (P<0.001). The frequency of synchronous proximal adenomas in patients with small (less than or equal to 5 mm) or large distal adenomas (> 5 mm) was comparable (37% and 35%, respect ively). However, patients with small distal adenomas had significantly smaller proximal adenomas (P = 0.004) containing less villous compone nt (P = 0.017) than those with large distal adenomas. Neither the pati ent's age nor the presence of multiple distal adenomas increased the p revalence of proximal adenomas. Conclusion: Hyperplastic polyps found on rectosigmoidoscopy do not indicate a need for a complete colorectal examination, as 15% of patients with distal hyperplastic polyps will have proximal adenomatous polyps, a figure that is comparable with tha t of asymptomatic patients having no distal polyps, either hyperplasti c or adenomatous. When only small distal adenomas are found at screeni ng sigmoidoscopy in asymptomatic persons the decision to do a total co lonoscopy should be based on individual considerations, as in such cas es only small polyps are to be expected in the proximal colon.