Year 2022 / Volume 114 / Number 12
Original
Findings in the distal and proximal colon in colonoscopy screening after positive FIT and related pre-procedure factors

719-724

DOI: 10.17235/reed.2022.8409/2021

M.ª Henar Núñez Rodríguez, Pilar Díez Redondo, Fausto Riu Pons, Marta Cimavilla, Andrea Loza, Manuel Perez-Miranda,

Abstract
Background: Colonoscopy is the gold standard method for the early diagnosis and prevention of colorectal cancer (CRC). Screening programs include immune determination of blood in feces. Regardless of the method used, proximal colon lesions appear to be detected less frequently. Objective: Analyze the characteristics of proximal and distal lesions and possible predisposing factors. Methods: A cross-sectional study was performed of 692 patients from the CRC screening program with FIT ≥ 100ngHb/ml (October 2017 - October 2018). The right colon was examined twice as patients were participating in a randomized clinical trial to re-evaluate the right colon by forward-viewing endoscope or proximal retroflexion. The adenoma detection rate (ADR), advanced neoplasia (AN) and CRC in the proximal and distal colon, the histological and morphological characteristics in each section were analyzed. Results: 52.9% of the patients were male, with a mean age of 59.5 years (SD: 7.6). 1490 polyps were found and the ADR was 57.7% (distal 42% and proximal 37%). Detection rates were 45.8% for AN, 40.9% for advanced adenomas, 5.2% for advanced SSL and CRC was diagnosed in 4.8% of patients. Males had more AN than females. The mean age of patients with AN was significantly higher. AN were associated with smoking and alcohol consumption (p=0.0001). Globally, FIT levels were higher in patients with AN (p=0.003). Sixty-six per cent of cancers were distally located and 61.3% of CRC were diagnosed in the early stages. Conclusions: In an average-risk asymptomatic population undergoing colonoscopy after positive FIT, AN were more common in the distal colon in males, older patients, smokers and those with alcohol intake.
Share Button
New comment
Comments
No comments for this article
References
1. Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut 2017;66:683-691
2. Brenner H, Hoffmeister M, Arndt V, et al. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst 2010;102:89-95
3. Soetikno RM, Kaltenbach T, Rouse RV, et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 2008;299:1027-1035
4. Provenzale D, Gupta S, Ahnen DJ, et al. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 1.2018. J Natl Compr Canc Netw 2018;16:939-949
5. Navarro M, Nicolas A, Ferrandez A, Lanas A. Colorectal cancer population screening programs worldwide in 2016: An update. World J Gastroenterol 2017;23:3632-3642
6. Gies A, Cuk K, Schrotz-King P, Brenner H. Direct Comparison of Diagnostic Performance of 9 Quantitative Fecal Immunochemical Tests for Colorectal Cancer Screening. Gastroenterology 2018;154:93-104
7. de Wijkerslooth TR, Stoop EM, Bossuyt PM, et al. Immunochemical fecal occult blood testing is equally sensitive for proximal and distal advanced neoplasia. Am J Gastroenterol 2012;107:1570-1578
8. Ribbing Wilen H, Blom J, Hoijer J, et al. Fecal immunochemical test in cancer screening - colonoscopy outcome in FIT positives and negatives. Scand J Gastroenterol 2019;54:303-310
9. Lee JK, Liles EG, Bent S, Levin TR, Corley DA. Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med 2014;160:171
10. Iovanescu D, Frandes M, Lungeanu D, et al. Diagnosis reliability of combined flexible sigmoidoscopy and fecal-immunochemical test in colorectal neoplasia screening. Onco Targets Ther 2016;9:6819-6828
11. Haug U, Kuntz KM, Knudsen AB, Hundt S, Brenner H. Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia. Br J Cancer 2011;104:1779-1785
12. Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012;143:844-857
13. Nunez Rodriguez MH, Diez Redondo P, Riu Pons F, et al. Proximal retroflexion versus second forward view of the right colon during screening colonoscopy: A multicentre randomized controlled trial. United European Gastroenterol J 2020:2050640620924210
14. American Joint Committee on Cancer (AJCC), TNM Staging System for Colorectal Cancer 8th Edition 2017
15. Mangas-Sanjuan C, Jover R, Cubiella J, et al. Endoscopic surveillance after colonic polyps and colorrectal cancer resection. 2018 update. Gastroenterol Hepatol 2019;42:188-201
16. Schramm C, Mbaya N, Franklin J, et al. Patient- and procedure-related factors affecting proximal and distal detection rates for polyps and adenomas: results from 1603 screening colonoscopies. Int J Colorectal Dis 2015;30:1715-1722
17. Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011;42:1-10
18. Erichsen R, Baron JA, Hamilton-Dutoit SJ, et al. Increased Risk of Colorectal Cancer Development Among Patients With Serrated Polyps. Gastroenterology 2016;150:895-902 e895
19. Morikawa T, Kato J, Yamaji Y, et al. A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology 2005;129:422-428
20. Dodou D, de Winter JC. The relationship between distal and proximal colonic neoplasia: a meta-analysis. J Gen Intern Med 2011;27:361-370
21. Kahi CJ, Vemulapalli KC, Snover DC, et al. Findings in the distal colorectum are not associated with proximal advanced serrated lesions. Clin Gastroenterol Hepatol 2015;13:345-351
22. Hamoudah T, Ma K, Esteban M, et al. Patients with small and diminutive proximal hyperplastic polyps have higher rates of synchronous advanced neoplasia compared with patients without serrated lesions. Gastrointest Endosc 2018;87:1518-1526
23. Quintero E, Castells A, Bujanda L, et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med 2012;366:697-706
24. Park DI, Ryu S, Kim YH, et al. Comparison of guaiac-based and quantitative immunochemical fecal occult blood testing in a population at average risk undergoing colorectal cancer screening. Am J Gastroenterol 2010;105:2017-2025
25. Auge JM, Pellise M, Escudero JM, et al. Risk stratification for advanced colorectal neoplasia according to fecal hemoglobin concentration in a colorectal cancer screening program. Gastroenterology 2014;147:628-636 e621
26. Cubiella J, Castro I, Hernandez V, et al. Diagnostic accuracy of fecal immunochemical test in average- and familial-risk colorectal cancer screening. United European Gastroenterol J 2014;2:522-529
27. Digby J, Fraser CG, Carey FA, et al. Faecal haemoglobin concentration is related to severity of colorectal neoplasia. J Clin Pathol 2013;66:415-419
28. Grazzini G, Visioli CB, Zorzi M, et al. Immunochemical faecal occult blood test: number of samples and positivity cutoff. What is the best strategy for colorectal cancer screening? Br J Cancer 2009;100:259-265
29. Sohn DK, Jeong SY, Choi HS, et al. Single immunochemical fecal occult blood test for detection of colorectal neoplasia. Cancer Res Treat 2005;37:20-23
30. Nakama H, Kamijo N, Abdul Fattah AS, Zhang B. Validity of immunological faecal occult blood screening for colorectal cancer: a follow up study. J Med Screen 1996;3:63-65
31. Kapidzic A, van der Meulen MP, Hol L, et al. Gender Differences in Fecal Immunochemical Test Performance for Early Detection of Colorectal Neoplasia. Clin Gastroenterol Hepatol 2015;13:1464-1471 e1464
32. Ciatto S, Martinelli F, Castiglione G, et al. Association of FOBT-assessed faecal Hb content with colonic lesions detected in the Florence screening programme. Br J Cancer 2007;96:218-221
33. Rodriguez-Alonso L, Rodriguez-Moranta F, Arajol C, et al. Proton pump inhibitors reduce the accuracy of faecal immunochemical test for detecting advanced colorectal neoplasia in symptomatic patients. PLoS One 2018;13:e0203359
Related articles
Citation tools
Núñez Rodríguez M, Díez Redondo P, Riu Pons F, Cimavilla M, Loza A, Perez-Miranda M, et all. Findings in the distal and proximal colon in colonoscopy screening after positive FIT and related pre-procedure factors. 8409/2021


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1730 visits.
This article has been downloaded 128 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 19/10/2021

Accepted: 05/03/2022

Online First: 14/03/2022

Published: 12/12/2022

Article revision time: 123 days

Article Online First time: 146 days

Article editing time: 419 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology