A MULTICENTER, MULTIYEAR, CASE-CONTROLLED STUDY OF THE RISK OF COLONIC POLYPS IN PATIENTS WITH GASTRIC POLYPS - ARE GASTRIC ADENOMAS A NEW INDICATION FOR SURVEILLANCE COLONOSCOPY
Ms. Cappell et Tc. Fiest, A MULTICENTER, MULTIYEAR, CASE-CONTROLLED STUDY OF THE RISK OF COLONIC POLYPS IN PATIENTS WITH GASTRIC POLYPS - ARE GASTRIC ADENOMAS A NEW INDICATION FOR SURVEILLANCE COLONOSCOPY, Journal of clinical gastroenterology, 21(3), 1995, pp. 198-202
A multicenter, multiyear, case-controlled colonoscopic study of 41 pat
ients with gastric polyps undergoing colonoscopy analyzed whether pati
ents with gastric polyps, particularly adenomas, run an increased risk
of having colonic polyps. The primary controls were 109 patients unde
rgoing colonoscopy matched for age and colonoscopy indications. A seco
ndary control group was 69 of these 109 patients who, in addition to m
atching for age and colonoscopy indications with study patients, had n
o gastric polyps demonstrated by upper gastrointestinal examination. P
atients with nonmalignant mucosal gastric polyps had a significantly g
reater incidence than primary controls of colonic polyps [odds ratio (
OR) = 3.19, OR confidence interval = 1.46 - 6.99, p < 0.004, chi(2)],
colonic neoplasms (OR = 3.58, OR confidence interval = 1.56 - 8.23, p
< 0.006, chi(2)), and colonic cancer (OR = 4.5, OR confidence interval
= 1.05 - 19.4, p < 0.04, Fisher's exact test). Moreover, patients wit
h gastric adenomas had a significantly greater incidence than did prim
ary controls of colonic polyps (OR = 7.6, OR confidence interval = 1.2
9 - 44.7, p < 0.02, Fisher's exact test). The association between gast
ric and colonic polyps did not arise as an artifact of the significant
ly higher frequency of females in the study group because this associa
tion remained after patient stratification by sex. The higher risk of
colonic polyps in study patients did not arise as an artifact of unapp
reciated gastric polyps in the primary controls because study patients
also had a significantly higher risk of colonic polyps than the secon
dary controls (OR = 3.21, OR confidence interval = 1.35 - 7.63, p < 0.
01, chi(2)). Our retrospective case-controlled study suggests that gas
tric adenomas may be a new, significant risk factor for colonic polyps
. A strong association would require that patients with gastric adenom
as undergo surveillance colonoscopy to diagnose and remove colonic pol
yps. However, before we apply this finding to clinical practice, the a
pparent association should be confirmed by another, preferably prospec
tive, study.