Z Gastroenterol 2018; 56(05): e29
DOI: 10.1055/s-0038-1654603
VORTRÄGE
Georg Thieme Verlag KG Stuttgart · New York

Patients with atrial fibrillation have a significantly increased prevalence of advanced premalignant adenomas and colorectal cancer in screening colonoscopy

D Niederseer
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Med, Oberndorf, Austria
2   Department of Cardiology, University Hospital Zurich, Zürich, Switzerland
,
S Hammerl
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Med, Oberndorf, Austria
,
PC Kahr
2   Department of Cardiology, University Hospital Zurich, Zürich, Switzerland
,
U Huber-Schönauer
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Med, Oberndorf, Austria
,
G Strebinger
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Med, Oberndorf, Austria
,
CM Schmied
2   Department of Cardiology, University Hospital Zurich, Zürich, Switzerland
,
L Haegeli
3   Department of Cardiology, Cantonal Hospital Aarau, Aarau, Switzerland
,
E Aigner
4   Department of Internal Medicine I, Paracelsus Medical University Salzburg, Salzburg, Austria
,
C Datz
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Med, Oberndorf, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
09 May 2018 (online)

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Background:

Colorectal cancer (CRC) is a common and lethal cancer. Screening colonoscopy has demonstrated to reduce the incidence and mortality rate of CRC by removal of premalignant adenomas. Recently, evidence has emerged that patients with coronary artery disease are at increased risk for developing CRC by shared risk factors. The purpose of this study was to investigate whether there is also an association between CRC and atrial fibrillation (AF) in the setting of routine colonoscopic screening, as AF is a clinical surrogate marker of cardiac disease.

Methods:

We investigated 1'949 asymptomatic patients (average age 60.9 ± 8.5 years, range 46 – 79 years, 49% female) undergoing screening colonoscopy within the SAKKOPI registry. Screening results of patients with known AF were compared to non-AF patients. Propensity Score Matching was used to create age- and gender-matched couples of AF and non-AF patients. Haldane-Anscombe correction was used for calculation of odds ratios in small frequency samples.

Results:

Of 46 patients (2.4%) with AF, tubular (n = 16, 34.8%) and advanced adenomas (n = 2, 4.3%) were identified at a rate not different from non-AF patients (25.6% and 4.1%, respectively). However, we observed a higher prevalence of colorectal carcinoma in AF (8.7% vs. 0.5%, p < 0.001). Since demographic variables were significantly different between AF and non-AF patients, propensity score matching was performed to create comparable groups. Differences between AF and non-AF patients persisted: the odds ratio was 2.6 (95% CI: 1.1 – 6.2) for having any type of abnormal colonoscopy and 9.9 (95% CI: 1.2 – 79.6) for CRC.

Conclusion:

Patients with AF had a significantly higher burden of advanced premalignant adenomas and CRC in a cohort of patients undergoing routine screening colonoscopy. Although data from larger cohorts will be required in the future, our data suggests that cardiologists should especially consider CRC screening in AF patients.