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DOI: 10.1055/s-0029-1214757
© Georg Thieme Verlag KG Stuttgart · New York
Colonoscopic screening of an average-risk population for colorectal neoplasia
Publikationsverlauf
submitted 5 July 2008
accepted after revision 17 March 2009
Publikationsdatum:
16. Juni 2009 (online)
![](https://www.thieme-connect.de/media/endoscopy/200906/lookinside/thumbnails/10.1055-s-0029-1214757-1.jpg)
Background and study aims: The role of screening colonoscopy in an asymptomatic, average-risk population remains to be determined. Moreover, the value of screening colonoscopy in individuals older than 75 years and for right-sided lesions has recently been questioned. The aims were to assess: (i) the risk of colorectal neoplasia in a large consecutively screened asymptomatic average-risk population, aged 40 – 85 years; (ii) whether colonoscopy is better than sigmoidoscopy for primary screening; and (iii) the prevalence of right-sided lesions at different ages.
Patients and methods: This prospective study, analyzed data from 1563 consecutive, asymptomatic, average-risk individuals, aged 40 – 85 years, who underwent screening colonoscopy.
Results: Overall, neoplastic lesions were detected in 262 individuals (17 % of the study population), of whom 75 had advanced lesions (5 % of population) and nine had colorectal cancers (CRC) (0.6 % of population). The prevalence of all lesions increased with age, with the highest percentages in the > 75 age group (26.5 % with neoplastic and 6 % with advanced lesions). Higher age was also associated with relatively more right-sided lesions. In particular the prevalence of proximal neoplasia, without concurrent distal neoplasia, increased from 5 % in those < 50 years to 24 % in those > 75 years. Those with distal lesions had a higher overall risk for proximal lesions (odds ratio [OR] 3.2); nevertheless flexible sigmoidoscopy alone would have missed up to 40 % of all lesions and up to 3.5 % of advanced neoplastic lesions in this patient subgroup.
Conclusions: Screening colonoscopy in asymptomatic, average-risk individuals is mandatory, as noteworthy numbers of advanced colorectal neoplasias have been detected in all age groups, especially in those aged > 75. Most importantly, many of the detected lesions were proximal and would not be revealed by sigmoidoscopy alone.
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N. ArberMD
Department of Cancer Prevention
Tel Aviv Medical Center
6 Weizmann St.
Tel-Aviv 64239
Israel
Fax: 972-3-6950339
eMail: nadir@tasmc.health.gov.il