Colon Polyps and Cancer

The role of endoscopy, in particular colonoscopy, clearly is paramount in the screening, diagnosis, and prevention of colorectal cancer. In preparation for writing this ”state-of-the-art” review on colon polyps and cancer, a PubMed literature search linking the topic with endoscopy yielded an enormous number of papers published in peer-reviewed journals just in the past 12 months. I have selected a few of these to highlight that I believe are most germane to current issues of risk stratification, screening and surveillance, prevention, and the premalignant potential of different types of adenomas detected by endoscopy. Several of these papers address the advantages and limitations of direct colonoscopy screening for colorectal neoplasia, and discuss the emerging role of virtual colonoscopy screening.

References

• 1 Harewood G C, Lieberman D A. Colonoscopy practice patterns since introduction of Medicare coverage for average-risk screening.  Clin Gastroenterol Hepatol. 2004;  2 72-77
• 2 Mysliwiec P A, Brown M L, Dlabunde C N, Ransohoff D F. Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy.  Ann Intern Med. 2004;  141 264-271
• 3 Rex O 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
• 4 Hixson L J, Fennerty M B, Sampliner R E. et al . Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps.  Gastrointest Endosc. 1991;  37 125-127
• 5 Pickhardt P J, Nugent P A, Mysliwiec P A. et al . Location of adenomas missed by optical colonoscopy.  Ann Intern Med. 2004;  141 352-359
• 6 Rex D K, Rahmani E Y, Haseman J H. et al . Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice.  Gastroenterology. 1997;  112 17-23
• 7 Bressler B, Paszat L F, Vinden C. et al . Colonoscopic miss rates for right-sided colon cancer: a population-based analysis.  Gastroenterology. 2004;  127 452-456
• 8 Leaper M, Johnston M J, Barclay M. et al . Reasons for failure to diagnose colorectal carcinoma at colonoscopy.  Endoscopy. 2004;  36 499-503
• 9 Bretthauer M, Skovlund E, Grotmol T. Inter-endoscopist variation in polyp and neoplasia pick-up rates in flexible sigmoidoscopy screening for colorectal cancer.  Scand J Gastroenterol. 2003;  38 1268-1274
• 10 Sanchez W, Harewood G C, Petersen B T. Evaluation of polyp detection in relation to procedure time of screening or surveillance colonoscopy.  Am J Gastroenterol. 2004;  99 1941-1945
• 11 Ball J E, Osbourne J, Jowett . et al . Quality improvement programme to achieve acceptable colonoscopy completion rates: prospective before and after study.  Br Med J. 2004;  329 665-667
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• 15 Pineau B C, Paskett E D, Chen G J. et al . Virtual colonoscopy using oral contrast compared with colonoscopy for the detection of patients with colorectal polyps.  Gastroenterology. 2003;  125 304-310
• 16 Johnson C D, Harmen W S, Wilson L A. et al . Prospective blinded evaluation of computed tomographic colonography for screen-detection of colorectal polyps.  Gastroenterology. 2003;  125 311-319
• 17 Cotton P B, Durkalski V, Pineau B C. et al . Computed tomographic colonography (virtual colonoscopy).  JAMA. 2004;  291 1713-1719
• 18 Pickhardt P J, Choi J R, Hwang I. et al . Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults.  N Engl J Med. 2003;  349 2191-2200
• 19 Nelson D B, McQuaid K R, Bond J H. et al . Procedural success and complications of large-scale screening colonoscopy.  Gastrointest Endosc. 2002;  55 307-314
• 20 Lieberman D A, Weiss D G, VA C ooperative. One-time screening for colorectal cancer with combined fecal occult blood testing and examination of the distal colon.  N Engl J Med. 2001;  345 555-560
• 21 Lieberman D A, Weiss D G, Bond J H. et al . Use of colonoscopy to screen asymptomatic adults for colorectal cancer.  N Engl J Med. 2000;  343 162-168
• 22 Lieberman D A, Prindiville S, Weiss D G. et al . Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals.  JAMA. 2003;  290 2959-2967
• 23 Sandler R S, Halabi S, Baron J A. et al . A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer.  N Engl J Med. 2003;  348 883-890
• 24 Baron J A, Cole B F, Sandler R S. et al . A randomized trial of aspirin to prevent colorectal adenomas.  N Engl J Med. 2003;  348 891-899
• 25 Burt R W, Leppert M F, Slattery M L. et al . Genetic testing and phenotype in a large kindred with attenuated familial adenomatous polyposis.  Gastroenterology. 2004;  127 444-451
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• 27 Lynch K L, Ahnen D J, Byers T. et al . First-degree relatives of patients with advanced colorectal adenomas have increased prevalence of colorectal cancer.  Clin Gastroenterol Hepatol. 2003;  1 96-102
• 28 Muto T, Kamiya J, Sawada T. et al . Small flat adenoma of the large bowel with special reference to its clinicopathologic features.  Dis Colon Rectum. 1985;  28 847-851
• 29 O’Brien M J, Winawer S J, Zauber A G. et al . Flat adenomas in the National Polyp Study: is there increased risk for high-grade dysplasia initially or during surveillance?.  Clin Gastroenterol Hepatol. 2004;  2 905-911
• 30 Diebold M D, Samalin E, Merle C. et al . Colonic flat neoplasia: frequency and concordance between endoscopic appearance and histological diagnosis in a French prospective series.  Am J Gastroenterol. 2004;  99 1795-1800
• 31 Pinsky P F, Schoen R E, Weissfeld J L. et al . Predictors of advanced proximal neoplasia in persons with abnormal screening flexible sigmoidoscopy.  Clin Gastroenterol Hepatol. 2003;  1 103-110