CHARACTERISTICS OF RECTOSIGMOID ADENOMAS AS PREDICTORS OF SYNCHRONOUSADVANCED PROXIMAL COLON NEOPLASMS

Background/Aim: Colonoscopy is recommended to every patient with adeno ma in rectosigmoid to disclose synchronous proximal neoplasms. The aim of this study was to determine whether characteristics of rectosigmoi d adenomas are associated with proximal advanced neoplasms. Patients/M ethods: One hundred consecutive symptomatic patients who underwent tot al colonoscopy and had rectosigmoid adenomas were included in the stud y. Patients with iron-deficiency anemia were excluded. All polyps were removed endoscopically. An adenoma was considered advanced if it had a diameter >1 cm and/or villous and/or severe dysplasia histology were present. Results: Advanced rectosigmoid adenomas were found in 55 of the 100 patients. Proximal neoplasms were found in 26 (26%) patients. In particular, nonadvanced adenomas were found in 15 (15%), advanced a denomas in eight (8%), and cancer in three (3%) patients. The presence of proximal neoplasms was related to neither sex, age, or presenting symptoms nor to any of the characteristics of rectosigmoid adenomas. O n the contrary, the presence of advanced proximal neoplasms (advanced adenoma or cancer) was significantly correlated with the presence of a dvanced rectosigmoid adenomas, which were detected in 11 (20%) of the 55 patients with advanced and in none of the 45 patients with nonadvan ced, rectosigmoid adenomas (odds ratio: 23.5, p = 0.001). Logistic reg ression analysis revealed that the presence of advanced rectosigmoid a denoma was the main predictor of advanced proximal neoplasms (beta: 1. 34, p < 10(-6)). Conclusions: Among patients with rectosigmoid adenoma s, 1) proximal advanced neoplasms appear to exist only in those with a dvanced adenomas and 2) baseline colonoscopy does not seem necessary i n those without advanced adenomas.