DISTAL HYPERPLASTIC POLYPS DO NOT PREDICT PROXIMAL ADENOMAS - RESULTSFROM A MULTICENTRIC STUDY OF COLORECTAL ADENOMAS

Background: The association between distal hyperplastic polyps and pro ximal adenomas is still a matter of debate. We investigated this assoc iation while taking into account patient characteristics. Methods: Aft er exclusion of patients with inflammatory bowel diseases, familial ad enomatous polyposis, or any cancer, 3088 eligible consecutive subjects aged 18 to 69 years underwent total colonoscopy in four gastroenterol ogy units. The odds ratios (OR) of having proximal adenomas according to patient characteristics (age, sex, medical center, year of endoscop y, reasons for referral, and distal findings) were estimated in univar iate and multivariate analyses. Results: Patients with distal polyps o f any type showed an adjusted OR of 2.5 (95% Cl [1.9, 3.1] p < .001) o f having proximal adenomas as compared with those without distal polyp s. When distal adenomas and distal hyperplastic polyps were included i n the multivariate model as independent factors, the presence of adeno mas significantly increased the risk of proximal adenomas (OR = 2.8: 9 5% Cl [2.2, 3.6] p < .001), whereas the presence of hyperplastic polyp s did not (OR = 1.1: 95% Cl [0.8, 1.5] p = .64). No association with n umber, size, or location of distal hyperplastic polyps was seen. Concl usions: Our data show that the presence of hyperplastic polyps should not be the sole indication for total colonoscopy because they are not associated with proximal adenomas when adjusting for patient character istics and presence of distal adenomas.