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Endoscopy 2006; 38(5): 449-455
DOI: 10.1055/s-2006-925227
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostic Yield of Advanced Colorectal Neoplasia at Colonoscopy, According to Indications: An Investigation from the Korean Association for the Study of Intestinal Diseases (KASID)

D.  I.  Park1 , Y.  H.  Kim2 , H.  S.  Kim3 , W.  H.  Kim3 , T.  I.  Kim3 , H.  J.  Kim4 , S.  K.  Yang5 , J.  S.  Byeon5 , M.  S.  Lee6 , I.  K.  Jung6 , M.  K.  Chung7 , S.  A.  Jung8 , Y.  T.  Jeen9 , J.  H.  Choi9 , H.  Choi10 , D.  S.  Han11 , J.  S.  Song12
  • 1Kangbuk Samsung Hospital, Sungkyun University School of Medicine, Seoul, South Korea
  • 2Samsung Medical Center, Sungkyun University School of Medicine, Seoul, South Korea
  • 3Yonsei University, Wonju & Seoul, South Korea
  • 4Kyunghee University, Seoul, South Korea
  • 5Ulsan University, Seoul, South Korea
  • 6Soonchunhyang University, Bucheon, South Korea
  • 7Youngnam University, Taegu, South Korea
  • 8Ewha Women’s University, Seoul, South Korea
  • 9Korea University, Ansan & Seoul, South Korea
  • 10Catholic University, Bucheon, South Korea
  • 11Hanyang University College of Medicine, Kuri, South Korea
  • 12Department of Preventive Medicine, Kwandong University College of Medicine, Kangneung, South Korea
Further Information

Publication History

Submitted 7 April 2005

Accepted after revision 4 August 2005

Publication Date:
09 May 2006 (online)

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Diagnostic Yield of Advanced Colorectal Neoplasia at Colonoscopy, According to Indications: An Investigation from the Korean Association for the Study of Intestinal Diseases (KASID)Endoscopy 2006; 38(08): 852-852
DOI: 10.1055/s-2006-944761

Background and Study Aims: The factors that more accurately predict the detection of colorectal cancers and adenomas at colonoscopy are different. We conducted a prospective multicenter study to evaluate which indications were most closely associated with advanced colorectal neoplasm (CRN), including colorectal cancer, in a group of patients undergoing colonoscopy.
Patients and Methods: The 17 468 patients were enrolled in this study between July 2003 and March 2004, from 11 tertiary medical centers in Korea. They were recruited according to 11 itemized colonoscopic indications. The term “advanced adenoma” refers here to tubular adenomas of diameter of 11 mm or more, or to tubulovillous, villous, or severely dysplastic adenomas, irrespective of their size. Cancer was defined as the invasion of malignant cells beyond the muscularis mucosa. Advanced CRN was defined as advanced adenoma or invasive cancer.
Results: Advanced CRN was found in 1227/17 307 patients (1176 advanced adenomas plus 51 carcinomas, 7.1 %). According to univariate and multivariate analysis, the factors associated with advanced CRN included age >60 years (odds ratio (OR) 2.1, 95 % confidence interval (CI) 1.8 - 2.4, P < 0.0001), male gender (OR 2.1, 95 %CI 1.7 - 2.7, P < 0.0001), referral for colonoscopy from primary care physician (OR 3.1, 95 %CI 2.5 - 3.7, P < 0.0001), and several other indications (OR 1.8, 95 %CI 1.5 - 2.3, P < 0.001). The yield of colonoscopy for advanced CRN was lower (2.2 %) than expected in patients with iron-deficiency anemia (OR 0.5, 95 %CI 0.2 - 0.9, P = 0.03).
Conclusions: Age, gender, and referral for colonoscopy from primary care physician constituted important independent predictors of advanced CRN in patients undergoing colonoscopy.

References

  • 1 Jemal A, Murray T, Samuels A. et al . Cancer statistics, 2003.  CA Cancer J Clin. 2003;  53 5-26
    CrossrefPubMedGoogle Scholar
  • 2 Ministry of Health and Welfare and National Cancer Center .Annual Report of the Korea Central Cancer Registry 2002. Seoul; Ministry of Health and Welfare
    Google Scholar
  • 3 Gilbertsen V A, Williams S E, Schuman L, McHugh R. Colonoscopy in the detection of carcinoma of the intestine.  Surg Gynecol Obstet. 1979;  149 877-878
    PubMedGoogle Scholar
  • 4 Lindsay D C, Freeman J G, Cobden I, Record C O. Should colonoscopy be the first investigation for colonic disease?.  Br Med J. 1988;  296 167-169
    PubMedGoogle Scholar
  • 5 Winawer S J, Zauber A G, Ho M N. et al . , and The National Polyp Study Workgroup. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.  N Engl J Med. 1993;  329 1977-1981
    CrossrefPubMedGoogle Scholar
  • 6 Selby J V, Friedman G D, Quesenberry C P jr, Weiss N S. Effect of fecal occult blood testing on mortality from colorectal cancer. A case-control study.  Ann Intern Med. 1993;  118 1-6
    CrossrefPubMedGoogle Scholar
  • 7 Newcomb P A, Norfleet R G, Storer B E. et al . Screening sigmoidoscopy and colorectal cancer mortality.  J Natl Cancer Inst. 1992;  84 1572-1575
    CrossrefPubMedGoogle Scholar
  • 8 Arminski T C, McLeaN D W. Incidence and distribution of adenomatous polyps of the colon and rectum based on 1,000 autopsy examinations.  Dis Colon Rectum. 1964;  19 249-261
    PubMedGoogle Scholar
  • 9 Vatn M H, Stalsberg H. The prevalence of polyps of the large intestine in Oslo: an autopsy study.  Cancer. 1982;  49 819-825
    CrossrefPubMedGoogle Scholar
  • 10 Rickert R R, Auerbach O, Garfinkel L. et al . Adenomatous lesions of the large bowel: an autopsy survey.  Cancer. 1979;  43 1847-1857
    PubMedGoogle Scholar
  • 11 Ransohoff D F, Lang C A. Small adenomas detected during fecal occult blood test screening for colorectal cancer. The impact of serendipity.  JAMA. 1990;  264 76-78
    CrossrefPubMedGoogle Scholar
  • 12 Evans J T. Management and survival of carcinoma of the colon: results of a national survey by the American College of Surgeons.  Ann Surg. 1978;  188 716-720
    PubMedGoogle Scholar
  • 13 Copeland E M, Miller L D, Jones R S. Prognostic factors in carcinoma of the colon and rectum.  Am J Surg. 1968;  116 875-881
    CrossrefPubMedGoogle Scholar
  • 14 Rex D K, Lehman G A, Ulbright T M. et al . Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history.  Am J Gastroenterol. 1993;  88 825-831
    PubMedGoogle Scholar
  • 15 Johnson D A, Gurney M S, Volpe R J. et al . A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk.  Am J Gastroenterol. 1990;  85 969-974
    PubMedGoogle Scholar
  • 16 Muto T, Bussey H J, Morson B C. The evolution of cancer of the colon and rectum.  Cancer. 1975;  36 2251-2270
    CrossrefPubMedGoogle Scholar
  • 17 Rosenstock E, Farmer R G, Petras R. et al . Surveillance for colonic carcinoma in ulcerative colitis.  Gastroenterology. 1985;  89 1342-1346
    PubMedGoogle Scholar
  • 18 Woolrich A J, DaSilva M D, Korelitz B I. Surveillance in the routine management of ulcerative colitis: the predictive value of low-grade dysplasia.  Gastroenterology. 1992;  103 431-438
    PubMedGoogle Scholar
  • 19 Bernstein C N, Shanahan F, Weinstein W M. Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis?.  Lancet. 1994;  343 71-74
    CrossrefPubMedGoogle Scholar
  • 20 Lynch D A, Lobo A J, Sobala G M. et al . Failure of colonoscopic surveillance in ulcerative colitis.  Gut. 1993;  34 1075-1080
    CrossrefPubMedGoogle Scholar
  • 21 Yang S K, Hong W S, Min Y I. et al . Incidence and prevalence of ulcerative colitis in the Songpa-Kangdong District, Seoul, Korea, 1986-1997.  J Gastroenterol Hepatol. 2000;  15 1037-1042
    CrossrefPubMedGoogle Scholar
  • 22 Rex D K. Colonoscopy: a review of its yield for cancers and adenomas by indication.  Am J Gastroenterol. 1995;  90 353-365
    PubMedGoogle Scholar
  • 23 Fijten G H, Starmans R, Muris J W. et al . Predictive value of signs and symptoms for colorectal cancer in patients with rectal bleeding in general practice.  Fam Pract. 1995;  12 279-286
    PubMedGoogle Scholar
  • 24 Speights V O, Johnson M W, Stoltenberg P H. et al . Colorectal cancer: current trends in initial clinical manifestations.  South Med J. 1991;  84 575-578
    PubMedGoogle Scholar
  • 25 Mant A, Bokey E L, Chapuis P H. et al . Rectal bleeding. Do other symptoms aid in diagnosis?.  Dis Colon Rectum. 1989;  32 191-196
    PubMedGoogle Scholar
  • 26 Segal W N, Greenberg P D, Rockey D C. et al . The outpatient evaluation of hematochezia.  Am J Gastroenterol. 1998;  93 179-182
    CrossrefPubMedGoogle Scholar
  • 27 Shinya H, Cwern M, Wolf G. Colonoscopic diagnosis and management of rectal bleeding.  Surg Clin N Am. 1982;  62 897-903
    PubMedGoogle Scholar
  • 28 Tedesco F J, Waye J D, Raskin J B. et al . Colonoscopic evaluation of rectal bleeding: a study of 304 patients.  Ann Intern Med. 1978;  89 907-909
    PubMedGoogle Scholar
  • 29 Forde K A, Waye J D. Controversies, dilemmas and dialogues. Is there a need to perform full colonoscopy in a middle-age person with episodic bright red blood per rectum and internal hemorrhoids?.  Am J Gastroenterol. 1989;  84 1227-1228
    PubMedGoogle Scholar
  • 30 Church J M. Analysis of the colonoscopic findings in patients with rectal bleeding according to the pattern of their presenting symptoms.  Dis Colon Rectum. 1991;  34 391-395
    PubMedGoogle Scholar
  • 31 Berkowitz I, Kaplan M. Indications for colonoscopy. An analysis based on indications and diagnostic yield.  S Afr Med J. 1993;  83 245-248
    PubMedGoogle Scholar
  • 32 Alemayehu G, Jarnerot G. Same-day upper and lower endoscopy in patients with occult bleeding, melena, hematochezia, and/or microcytic anemia. A retrospective study of 224 patients.  Scand J Gastroenterol. 1993;  28 667-672
    PubMedGoogle Scholar
  • 33 Brenna E, Skreden K, Waldum H L. et al . The benefit of colonoscopy.  Scand J Gastroenterol. 1990;  25 81-88
    PubMedGoogle Scholar
  • 34 Neugut A I, Garbowski G C, Waye J D. et al . Diagnostic yield of colorectal neoplasia with colonoscopy for abdominal pain, change in bowel habits, and rectal bleeding.  Am J Gastroenterol. 1993;  88 1179-1183
    PubMedGoogle Scholar
  • 35 Rex D K, Mark D, Clarke B. et al . Flexible sigmoidoscopy plus air-contrast barium enema versus colonoscopy for evaluation of symptomatic patients without evidence of bleeding.  Gastrointest Endosc. 1995;  42 132-138
    CrossrefPubMedGoogle Scholar
  • 36 Woolf C M. A genetic study of carcinoma of the large intestine.  Am J Hum Genet. 1958;  10 42-47
    PubMedGoogle Scholar
  • 37 Macklin M T. Inheritance of cancer of the stomach and large intestine in man.  J Natl Cancer Inst. 1960;  24 551-571
    PubMedGoogle Scholar
  • 38 Lovett E. Family studies in cancer of the colon and rectum.  Br J Surg. 1976;  63 13-18
    PubMedGoogle Scholar
  • 39 Sondergaard J O, Bulow S, Lynge E. Cancer incidence among parents of patients with colorectal cancer.  Int J Cancer. 1991;  47 202-206
    CrossrefPubMedGoogle Scholar
  • 40 St John D J, McDermott F T, Hopper J L. et al . Cancer risk in relatives of patients with common colorectal cancer.  Ann Intern Med. 1993;  118 785-790.
    CrossrefPubMedGoogle Scholar
  • 41 Fuchs C S, Giovannucci E L, Colditz G A. et al . A prospective study of family history and the risk of colorectal cancer.  N Engl J Med. 1994;  331 1669-1674
    CrossrefPubMedGoogle Scholar
  • 42 Levin B, Murphy G P. Revision in American Cancer Society recommendations for the early detection of colorectal cancer.  CA Cancer J Clin. 1992;  42 296-299
    PubMedGoogle Scholar
  • 43 Winawer S J, St John D J, Bond J H. et al . Prevention of colorectal cancer: guidelines based on new data. WHO Collaborating Center for the Prevention of Colorectal Cancer.  Bull World Health Organ. 1995;  73 7-10
    PubMedGoogle Scholar
  • 44 Winawer S J, Fletcher R H, Miller L. et al . Colorectal cancer screening: clinical guidelines and rationale.  Gastroenterology. 1997;  112 594-642
    CrossrefPubMedGoogle Scholar
  • 45 Hunt L M, Rooney P S, Hardcastle J D, Armitage N C. Endoscopic screening of relatives of patients with colorectal cancer.  Gut. 1998;  42 71-75
    CrossrefPubMedGoogle Scholar
  • 46 Grossman S, Milos M L. Colonoscopic screening of persons with suspected risk factors for colon cancer. I. Family history.  Gastroenterology. 1988;  94 395-400
    PubMedGoogle Scholar
  • 47 Ink O, Anciaux M L, Buffet C. et al . Colonic endoscopic screening and familial antecedent of sporadic rectocolonic cancer. Controlled prospective study.  Gastroenterol Clin Biol. 1989;  13 1060-1064
    PubMedGoogle Scholar
  • 48 McConnell J C, Nizin J S, Slade M S. Colonoscopy in patients with a primary family history of colon cancer.  Dis Colon Rectum. 1990;  33 105-107
    CrossrefPubMedGoogle Scholar
  • 49 Luchtefeld M A, Syverson D, Solfelt M. et al . Is colonoscopic screening appropriate in asymptomatic patients with family history of colon cancer?.  Dis Colon Rectum. 1991;  34 763-768
    CrossrefPubMedGoogle Scholar

Y.-H. Kim

Samsung Medical Center

50 Irwon-dong, Gangnam-ku · 135-230 Seoul · Korea ·

Fax: +82-2-34103849

Email: yhgi.kim@samsung.com