The Association between Distal Findings and Proximal Colorectal Neoplasia: A Systematic Review and Meta-Analysis
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AbstractObjectives: Whether screening participants with distal hyperplastic polyps (HPs) detected by Flexible Sigmoidoscopy (FS) should be followed by subsequent colonoscopy is controversial. We evaluated the association between distal HPs and proximal neoplasia (PN)/advanced proximal neoplasia (APN) in asymptomatic, average-risk patients.

Methods: We searched Ovid Medline, EMBASE and the Cochrane Library from inception to 31 July 2016, and included all screening studies that examined the relationship between different distal findings and PN/APN. Data were independently extracted by two reviewers with disagreements resolved by a third reviewer. We pooled absolute risks and odds ratios with a random effects meta-analysis. Four subgroup analyses were performed according to study characteristics. Heterogeneity was characterized with the I2 statistics.

Results: We analyzed 28 studies (104,961 subjects). When compared with normal distal findings, distal HP was not associated with PN (OR=1.16, 95% CI=0.89-1.51, p=0.14, I2=40%) or APN (OR=1.09, 95% CI=0.87-1.36, p=0.39, I2=5%), whilst subjects with distal non-advanced or advanced adenoma had higher odds of PN/APN. Higher odds of PN/APN were observed for more severe distal lesions. Weaker association between distal and proximal findings was noticed in studies with higher quality, larger sample size, population-based design and more stringent endoscopy quality control measures. The Egger’s regression tests showed all p> 0.05.

Conclusions: Distal HP is not associated with PN/APN in asymptomatic screening population when compared to normal distal findings. Hence, the presence of distal HP alone detected by FS does not automatically indicate colonoscopy referral for all screening participants, as other risk factors of PN/APN should be considered.
All Author(s) ListJason LW Huang, YH Wang, Johnny Y Jiang, CP Yu , YL Wu , P Chen , XQ Yuan , Harry HX Wang, Martin CS Wong
Journal nameAmerican Journal of Gastroenterology
Volume Number112
Issue Number8
PublisherSpringer Nature
Place of PublicationBethesda, MD, USA
Pages1234 - 1245
LanguagesEnglish-United States
Keywordscolorectal cancer screening, distal finding, proximal neoplasia, meta-analysis

Last updated on 2021-12-09 at 00:05