Incidence and characterization of colorectal adenomas in the area of influence of a specialized institution
DOI:
https://doi.org/10.22516/25007440.838Keywords:
Colonoscopy, Colorectal adenomas, Colorectal cancerAbstract
Aim: To locate and characterize colorectal adenomas endoscopically and histologically in a cohort of patients undergoing colonoscopy in Medellín, Colombia.
Materials and methods: Descriptive cross-sectional study. We included patients older than 18 years who underwent colonoscopy between February and July 2020 at a specialized center in Medellín, Colombia. We determined the incidence of adenomas, their location in different segments of the colon, their endoscopic and histological characteristics, and cases of colorectal cancer (CRC) and high-grade dysplasia (HGD).
Results: 992 colonoscopies were performed, finding colorectal polyps in 266 patients, of which 208 had adenomas. We resected 461 polyps, of which 336 were adenomas (72 %). The histological type with the highest representation was tubular (78 %). The location of adenomas was 37 % in the right colon, 25 % in the transverse colon, and 38 % in the left colon. CRC cases were nine per 1,000 patients, including advanced carcinoma and carcinoma in situ (HGD).
Conclusions: Given the incidence of adenomas in the right and transverse colon, rectosigmoidoscopy is discouraged as a screening study for CRC. Tubular adenomas, sessile in appearance and tiny, predominated in the population studied. We recommend screening in the population over 40 years of age and the search for precursor lesions as strategies to reduce morbidity and mortality rates due to CRC.
Downloads
References
Roncucci L, Mariani F. Prevention of colorectal cancer: How many tools do we have in our basket? Eur J Intern Med. 2015;26(10):752-6. https://www.doi.org/10.1016/j.ejim.2015.08.019
Zhou L, Zhang H, Sun S, Huang M, Liu J, Xu D, Song M, Sun C, Li H, Zheng D, Fan Y, Liao Y, Wang P, Wu J. Clinical, endoscopic and pathological characteristics of colorectal polyps in elderly patients: Single-center experience. Mol Clin Oncol. 2017;7(1):81-87. https://www.doi.org/10.3892/mco.2017.1284
Matsuda T, Kawano H, Hisabe T, Ikematsu H, Kobayashi N, Mizuno K, et al. Current status and future perspectives of endoscopic diagnosis and treatment of diminutive colorectal polyps. Dig Endosc. 2014;26 Suppl 2:104-8. https://www.doi.org/10.1111/den.12281
Shaukat A, Kaltenbach T, Dominitz JA, Robertson DJ, Anderson JC, Cruise M, et al. Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2020;159(5):1916-1934.e2. https://www.doi.org/10.1053/j.gastro.2020.08.050
Arévalo F, Aragón V, Alva J, Perez Narrea M, Cerrillo G, Montes P, et al. Pólipos colorectales: actualización en el diagnóstico. Rev Gastroenterol Perú. 2012;32(2):123-33.
Declaración de Helsinki de la AMM - Principios éticos para las investigaciones médicas en seres humanos [Internet]. Universidad de Navarra; 2013 [consultado el 12 de mayo de 2021]. Disponible en: http://www.redsamid.net/archivos/201606/2013-declaracion-helsinki-brasil.pdf?1
Resolución número 8430 de 1993, por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud [Internet]. Ministerio de Salud de Colombia; 1993 [consultado el el 12 de mayo de 2021]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF
Gil Parada FL, Torres Amaya M, Riveros Santoya SV, Castaño Llano R, Ibáñez H, Huertas Quintero MM, et al. Guía de práctica clínica para la tamización de cáncer colorrectal. Rev Colomb Gastroenterol. 2015;30(2).
Winawer SJ, Zauber AG. The advanced adenoma as the primary target of screening. Gastrointest Endosc Clin N Am. 2002;12(1):1-9, v. https://www.doi.org/10.1016/s1052-5157(03)00053-9
Gschwantler M, Kriwanek S, Langner E, Göritzer B, Schrutka-Kölbl C, Brownstone E, et al. High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics. Eur J Gastroenterol Hepatol. 2002;14(2):183-8. https://www.doi.org/10.1097/00042737-200202000-00013
Toll AD, Fabius D, Hyslop T, Pequignot E, DiMarino AJ, Infantolino A, et al. Prognostic significance of high-grade dysplasia in colorectal adenomas. Colorectal Dis. 2011;13(4):370-3. https://www.doi.org/10.1111/j.1463-1318.2010.02385.x
Paggi S, Radaelli F, Repici A, Hassan C. Advances in the removal of diminutive colorectal polyps. Expert Rev Gastroenterol Hepatol. 2015;9(2):237-44. https://www.doi.org/10.1586/17474124.2014.950955
Nagorni A, Bjelakovic G, Petrovic B. Narrow band imaging versus conventional white light colonoscopy for the detection of colorectal polyps. Cochrane Database Syst Rev. 2012;1:CD008361. https://www.doi.org/10.1002/14651858.CD008361.pub2
Adelstein BA, Macaskill P, Chan SF, Katelaris PH, Irwig L. Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review. BMC Gastroenterol. 2011;11:65. https://www.doi.org/10.1186/1471-230X-11-65
Chu Y, Zhang J, Wang P, Li T, Jiang S, Zhao Q, et al. Will purposely seeking detect more colorectal polyps than routine performing during colonoscopy? Medicine (Baltimore). 2020;99(42):e22738. https://www.doi.org/10.1097/MD.0000000000022738
Klare P, Ascher S, Hapfelmeier A, Wolf P, Beitz A, Schmid RM, von Delius S. Patient age and duration of colonoscopy are predictors for adenoma detection in both proximal and distal colon. World J Gastroenterol. 2015;21(2):525-32. https://www.doi.org/10.3748/wjg.v21.i2.525
Hemmasi G, Sohrabi M, Zamani F, Ajdarkosh H, Rakhshani N, Khoonsari M, et al. Prevalence of colorectal adenoma in an average-risk population aged 40-50 versus 50-60 years. Eur J Cancer Prev. 2015;24(5):386-90. https://www.doi.org/10.1097/CEJ.0000000000000097
Søreide K, Nedrebø BS, Reite A, Thorsen K, Kørner H. Endoscopy, morphology, morphometry and molecular markers: predicting cancer risk in colorectal adenoma. Expert Rev Mol Diagn. 2009;9(2):125-37. https://www.doi.org/10.1586/14737159.9.2.125
Angarita FA, Feinberg AE, Feinberg SM, Riddell RH, McCart JA. Management of complex polyps of the colon and rectum. Int J Colorectal Dis. 2018;33(2):115-129. https://www.doi.org/10.1007/s00384-017-2950-1
Schoefl R, Ziachehabi A, Wewalka F. Small colorectal polyps. Dig Dis. 2015;33(1):38-41. https://www.doi.org/10.1159/000366034
Tanaka S, Saitoh Y, Matsuda T, Igarashi M, Matsumoto T, Iwao Y, et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol. 2015;50(3):252-60. https://www.doi.org/10.1007/s00535-014-1021-4
Speake D, Biyani D, Frizelle FA, Watson AJ. Flat adenomas. ANZ J Surg. 2007;77(1-2):4-8. https://www.doi.org/10.1111/j.1445-2197.2006.03847.x
Pommergaard HC, Burcharth J, Rosenberg J, Raskov H. The association between location, age and advanced colorectal adenoma characteristics: a propensity-matched analysis. Scand J Gastroenterol. 2017;52(1):1-4. https://www.doi.org/10.1080/00365521.2016.1218929
Lindberg LJ, Ladelund S, Bernstein I, Therkildsen C, Nilbert M. Risk of Synchronous and Metachronous Colorectal Cancer: Population-Based Estimates in Denmark with Focus on Non-Hereditary Cases Diagnosed After Age 50. Scand J Surg. 2019;108(2):152-158. https://www.doi.org/10.1177/1457496918798212
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Revista colombiana de Gastroenterología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
Los autores/as ceden sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación en esta revista.
Los contenidos están protegidos bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
| Article metrics | |
|---|---|
| Abstract views | undefined |
| Galley vies | undefined |
| PDF Views | undefined |
| HTML views | undefined |
| Other views | undefined |
