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Risk for Colon Adenomas in Patients with Rectosigmoid Hyperplastic Polyps

Dawn Provenzale, MD; John W. Garrett, MD; Sean E. Condon, MS; and Robert S. Sandler, MD, MPH
[+] Article, Author, and Disclosure Information

Grant Support: By grants RO1 CA 44684 and P30 DK 3497 from the National Institutes of Health.

Requests for Reprints: Robert S. Sandler, MD, MPH, CB# 7080, 423 Burnett-Womack Building, University of North Carolina, Chapel Hill, NC 27599-7080.

Current Author Addresses: Dr. Provenzale: Division of Clinical Decision Making, Box 302, New England Medical Center, 750 Washington Street, Boston, MA 02111.

Mr. Condon: Department of Biostatistics, CB# 7400, University of North Carolina, Chapel Hill, NC 27599-7400.

Dr. Garrett: Asheville Gastroenterology Associates, 30 Choctaw Street, Asheville, NC 28801.

Dr. Sandler: CB# 7080, University of North Carolina, Chapel Hill, NC 27599-7080.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;113(10):760-763. doi:10.7326/0003-4819-113-10-760
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Objective: To determine whether hyperplastic polyps found in the rectosigmoid area of the colon are associated with proximal adenomas, and to judge whether patients with distal hyperplastic polyps found during sigmoidoscopy might benefit from full colonoscopy.

Design: Data on patients having colonoscopy collected prospectively according to a set protocol. The size and location of all polyps were noted, and all polyps were biopsied.

Setting: Two university hospitals.

Patients: One thousand eight hundred and thirty-six consecutive patients referred for colonoscopy between 31 December 1987 and 31 August 1989.

Results: Of the 970 patients who met eligibility requirements, 274 (28.3%) had adenomas and 108 (11.1%) had hyperplastic polyps. The proportion of patients with distal hyperplastic polyps and proximal adenomas (31.9%) was similar to the proportion of those without distal hyperplastic polyps (23.0%) (crude odds ratio, 1.57; 95% CI, 0.77 to 3.06). After adjusting for age and sex, the results were unchanged (adjusted odds ratio, 1.53; CI, 0.82 to 2.88). Patients with distal adenomas, on the other hand, were three times more likely to have proximal adenomas than those without distal adenomas (adjusted odds ratio, 3.42; CI, 1.99 to 5.88).

Conclusions: Distal hyperplastic polyps are not strong predictors of risk for proximal adenomas. Based on the magnitude of the risk difference, we do not believe that finding a hyperplastic polyp during sigmoidoscopy justifies doing a full colonoscopy to search for proximal adenomas. Because rectosigmoid adenomas are associated with proximal adenomas, however, small polyps seen during sigmoidoscopy should be biopsied to determine their type. Colonoscopy should be reserved for patients who are proved to have adenomas.





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