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Endoscopy 2001; 33(7): 574-579
DOI: 10.1055/s-2001-15379
Original Article

© Georg Thieme Verlag Stuttgart · New York

Right-Sided Shift Found in Metachronous Colorectal Adenomas

G. Nusko1 , U. Mansmann2 , G. Wiest1 , W. Brueckl1 , T. Kirchner3 , E. G. Hahn1
  • 1 Dept. of Medicine 1, University of Erlangen, Erlangen, Germany
  • 2 Institute of Medical Statistics, Free University of Berlin, Berlin, Germany
  • 3 Dept. of Pathology, University of Erlangen, Erlangen, Germany
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Publication History

Publication Date:
31 December 2001 (online)

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Background and Study Aims: Patients who have had a colorectal adenoma are likely to develop a metachronous adenoma, and therefore need to be kept under surveillance. The question is whether metachronous adenomas will be found at the same anatomical site as the preceding adenomas, thus prompting us to focus surveillance examinations on this region, using flexible sigmoidoscopy or total colonoscopy.

Patients and Methods: Between 1978 and 1996 a long-term follow up of 1091 patients was prospectively documented at the Erlangen Registry of Colorectal Polyps. The anatomical sites - distal (rectosigmoid) and proximal colon - of two subsequent generations of metachronous adenomas were analysed using logistic regression analysis.

Results: In 556 (51 %) patients metachronous adenomas were found during follow up. In 211 (37.9 %) of these patients a right-sided shift in the first generation of metachronous adenomas in comparison with initial lesions (P < 0.0001) was found. Some 305 patients underwent further follow up, and 51 (27.1 %) out of 188 patients with metachronous lesions demonstrated a right-sided shift in their second generation (vs. first generation) of metachronous adenomas. Proximally located first generation metachronous adenomas would be missed by flexible sigmoidoscopy in 50.8 % of patients with only distal adenomas at baseline colonoscopy, and in 58.7 % of patients with second-generation lesions. Multivariate analysis revealed that multiplicity (odds ratio 2.64, 95 % Cl 1.49 - 4.66) and size of initial adenomas (> 5 mm) (odds ratio 3.60, 95 % Cl 1.96 - 6.66) were significantly associated with a right-sided shift in metachronous adenomas, while female gender was associated with a significantly lower tendency to manifest a right-sided shift (odds ratio of 0.64. 95 % Cl 0.43 - 0.94).

Conclusions: Metachronous adenomas are found significantly more often in the right colon than would be expected assuming clustering at the same anatomical site as the preceding lesions. Total colonoscopy is thus needed for surveillance, regardless of the initial adenoma site.

References

  • 1 Muto T, Bussey H JR, Morson B C. The evolution of cancer of the colon and rectum.  Cancer. 1975;  36 2251-2270
    CrossrefPubMedGoogle Scholar
  • 2 Morson B C. Evolution of cancer of the colon and rectum.  Cancer. 1974;  34 845-849
    PubMedGoogle Scholar
  • 3 Winawer S J, Zauber A G, Ho M N, et al. Prevention of colorectal cancer by colonoscopic polypectomy.  N Engl J Med. 1993;  392 1977-1981
    PubMedGoogle Scholar
  • 4 Jorgensen O D, Kronborg O, Fenger C. The Funen Adenoma Follow up Study. Incidence and death from colorectal carcinoma in the adenoma surveillance program.  Scand J Gastroenterol. 1993;  28 869-874
    CrossrefPubMedGoogle Scholar
  • 5 Müller A D, Sonnenberg A. Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case-control study of 32 702 veterans.  Ann Int Med. 1995;  123 904-910
    PubMedGoogle Scholar
  • 6 Hoff G, Sauar J, Vatn M H, et al. Polypectomy of adenomas in the prevention of colorectal cancer: 10 years follow-up of the Telemark polyp study I.  Scand J Gastroenterol. 1996;  31 1006-1010
    PubMedGoogle Scholar
  • 7 Matek W, Guggenmoos-Holzmann I, Demling L. Follow-up of patients with colorectal adenomas.  Endoscopy. 1985;  17 175-181
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Brenna E, Skreden K, Waldum H L. The benefit of colonoscopy.  Scand J Gastroenterol. 1990;  25 81-88
    PubMedGoogle Scholar
  • 9 Nava H, Carlsson G, Petrelli N J, et al. Follow-up colonoscopy in patients with colorectal adenomatous polyps.  Dis Colon Rectum. 1987;  30 465-468
    CrossrefPubMedGoogle Scholar
  • 10 Neugut A I, Johnsen C M, Forde K A, et al. Recurrence rates for colorectal polyps.  Cancer. 1985;  55 1586-1589
    PubMedGoogle Scholar
  • 11 Waye J D, Braunfeld S. Surveillance intervals after colonoscopic polypectomy.  Endoscopy. 1982;  14 79-81
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Woolfson I K, Eckholdt G J, Wetzel C R. Usefulness of performing colonoscopy one year after endoscopic polypectomy.  Dis Colon Rectum. 1990;  33 389-393
    CrossrefPubMedGoogle Scholar
  • 13 Winawer S J, Zauber A G, O'Brien M J, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps.  N Engl J Med. 1993;  328 901-906
    CrossrefPubMedGoogle Scholar
  • 14 Jorgensen O D, Kronborg O, Fenger C. A randomized surveillance study of patients with pedunculated and small sessile tubular and tubulovillous adenomas. The Funen Adenoma Follow-up Study.  Scand J Gastroenterol. 1995;  30 686-692
    CrossrefPubMedGoogle Scholar
  • 15 Zauber A G, Winawer S J. Initial management and follow-up surveillance of patients with colorectal adenomas.  Gastroenterol Clin N Am. 1997;  26 85-101
    PubMedGoogle Scholar
  • 16 Zauber A G, Winawer S J, Bond J H, et al. Can surveillance intervals be lengthened following colonoscopic polypectomy?.  Gastroenterology. 1997;  112 A50
    PubMedGoogle Scholar
  • 17 Bond J H. Polyp guidelines: diagnosis, treatment, and surveillance for paients with nonfamilial colorectal polyps.  Ann Int Med. 1993;  119 836-843
    PubMedGoogle Scholar
  • 18 Reinus J F. Guidelines for clinical practice. Management of colorectal polyps.  Dig Dis Sci. 1994;  39 2282-2284
    PubMedGoogle Scholar
  • 19 Cappell M S, Forde K A. Spatial clustering of multiple hyperplastic, adenomatous, and malignant colonic polyps in individual patients.  Dis Colon Rectum. 1989;  32 641-652
    PubMedGoogle Scholar
  • 20 Olsen H W, Lawrence W A, Snook C W, et al. Review of recurrent polyps and cancer in 500 patients with initial colonoscopy for polyps.  Dis Colon Rectum. 1988;  31 222-227
    PubMedGoogle Scholar
  • 21 Jass J R, Sobin L H. Histological typing of intestinal tumours. WHO international classification of tumours. Berlin; Springer, 1989 2nd ed
    Google Scholar
  • 22 Moertel C G, Bargen J A, Dockerty M B. Multiple carcinomas of the large intestine. A review of the literature and a study of 261 cases.  Gastroenterology. 1958;  34 85-98
    PubMedGoogle Scholar
  • 23 Ghahremani G G, Dowlatshahi K. Colorectal carcinomas: diagnostic implications of their changing frequency and anatomic distribution.  World J Surg. 1989;  13 321-325
    CrossrefPubMedGoogle Scholar
  • 24 Delattre O, Law D J, Remvikos Y, et al. Multiple genetic alterations in distal and proximal colorectal cancer.  Lancet. 1989;  353-355
    CrossrefPubMedGoogle Scholar
  • 25 Eide T J. The age-, sex-, and site-specific occurrence of adenomas and carcinomas of the large intestine within a defined population.  Scand J Gastroenterol. 1986;  21 1083-1088
    PubMedGoogle Scholar
  • 26 Granqvist S. Distribution of polyps in the large bowel in relation to age: colonoscopic study.  Scand J Gastroenterol. 1981;  16 1025-1031
    PubMedGoogle Scholar
  • 27 Ponz de Leon M, Sacchetti C, Sassatelli R, et al. Evidence for the existence of different types of large bowel tumor: suggestions from the clinical data of a population-based registry.  J Surg Oncol. 1990;  44 35-43
    PubMedGoogle Scholar
  • 28 Ikeda Y, Mori M, Yoshizumi T, et al. Cancer and adenomatous polyp distribution in the colorectum.  Am J Gastroenterol. 1999;  94 191-193
    CrossrefPubMedGoogle Scholar
  • 29 Matek W, Hermanek P, Demling L. Is the adenoma-carcinoma sequence contradicted by the differing location of colorectal adenomas and carcinomas?.  Endoscopy. 1986;  18 17-19
    PubMedGoogle Scholar
  • 30 Jass J R, Young P J, Robinson E M. Predictors of presence, multiplicity, size and dysplasia of colorectal adenomas. A necropsy study in New Zealand.  Gut. 1992;  33 1508-1514
    PubMedGoogle Scholar
  • 31 Wegener M, Borsch G, Schmidt G. Colorectal adenomas: distribution, incidence of malignant transformation, and rate of recurrence.  Dis Colon Rectum. 1986;  29 383-387
    CrossrefPubMedGoogle Scholar
  • 32 O'Brien M J, Winawer S J, Zauber A G, et al. The national polyp study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas.  Gastroenterology. 1990;  98 371-379
    PubMedGoogle Scholar
  • 33 Eckardt V F, Fuchs M, Kanzler G, et al. Follow-up of patients with colonic polyps containing severe atypia and invasive carcinoma. Compliance, recurrence, and survival.  Cancer. 1988;  61 2552-2557
    PubMedGoogle Scholar
  • 34 Murakami R, Tsukuma H, Kanamori S, et al. Natural history of colorectal polyps and the effect of polypectomy on the occurrence of subsequent cancer.  lnt J Cancer. 1990;  46 159-164
    CrossrefPubMedGoogle Scholar
  • 35 Fric P, Zavoral M, Dvorakova H, et al. An adapted program of colorectal cancer screening - 7 years' experience and cost- benefit analysis.  Hepato-Gastroenterol. 1994;  41 413-316
    PubMedGoogle Scholar
  • 36 Neugut A I, Jacobson J S, Ahsan H, et al. Incidence and recurrence rates of colorectal adenomas: a prospective study.  Gastroenterology. 1995;  108 402-408
    CrossrefPubMedGoogle Scholar
  • 37 Rex D K, Cutler C S, Lemmel G T, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.  Gastroenterology. 1997;  112 24-28
    CrossrefPubMedGoogle Scholar
  • 38 Anwar S, White J, Hall C, et al. Sporatic colorectal polyps: management options and guidelines.  Scand J Gastroenterol. 1999;  34 4-11
    CrossrefPubMedGoogle Scholar
  • 39 Winawer S J, St John D J, Bond J H, et al. Prevention of colorectal cancer: guidelines based on new data.  Bull World Health Organiz. 1995;  73 7-10
    PubMedGoogle Scholar

G. Nusko, M.D., Ph.D.

Dept. of Medicine 1
University of Erlangen

Krankenhausstrasse 12
91054 Erlangen
Germany


Fax: Fax:+ 49-9131-8536909

Email: E-mail:gerhard.nusko@med1.imed.uni-erlangen.de