The association between distal findings and proximal colorectal neoplasia: a systematic review and meta-analysis

Huang, J. L.W., Wang, Y.H., Jiang, J. Y., Yu, C.P., Wu, Y.L., Chen, P., Yuan, X.Q., Wang, H. H.X. and Wong, M. C.S. (2017) The association between distal findings and proximal colorectal neoplasia: a systematic review and meta-analysis. American Journal of Gastroenterology, 112(8), pp. 1234-1245. (doi: 10.1038/ajg.2017.130) (PMID:28555635)

Abstract

Objectives: Whether screening participants with distal hyperplastic polyps (HPs) detected by flexible sigmoidoscopy (FS) should be followed by subsequent colonoscopy is controversial. We evaluated the association between distal HPs and proximal neoplasia (PN)/advanced proximal neoplasia (APN) in asymptomatic, average-risk patients. Methods: We searched Ovid Medline, EMBASE, and the Cochrane Library from inception to 30 June 2016 and included all screening studies that examined the relationship between different distal findings and PN/APN. Data were independently extracted by two reviewers with disagreements resolved by a third reviewer. We pooled absolute risks and odds ratios (ORs) with a random effects meta-analysis. Seven subgroup analyses were performed according to study characteristics. Heterogeneity was characterized with theI2 statistics. Results: We analyzed 28 studies (104,961 subjects). When compared with normal distal findings, distal HP was not associated with PN (OR=1.16, 95% confidence interval (CI)=0.89–1.51,P=0.14,I2=40%) or APN (OR=1.09, 95% CI=0.87–1.36,P=0.39,I2=5%), while subjects with distal non-advanced or advanced adenoma had higher odds of PN/APN. Higher odds of PN/APN were observed for more severe distal lesions. Weaker association between distal and proximal findings was noticed in studies with higher quality, larger sample size, population-based design, and more stringent endoscopy quality-control measures. The Egger’s regression tests showed allP>0.05. Conclusions: Distal HP is not associated with PN/APN in asymptomatic screening population when compared with normal distal findings. Hence, the presence of distal HP alone detected by FS does not automatically indicate colonoscopy referral for all screening participants, as other risk factors of PN/APN should be considered.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wang, Professor Haoxiang
• Authors: Huang, J. L.W., Wang, Y.H., Jiang, J. Y., Yu, C.P., Wu, Y.L., Chen, P., Yuan, X.Q., Wang, H. H.X., and Wong, M. C.S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: American Journal of Gastroenterology
• Publisher: Lippincott, Williams & Wilkins
• ISSN: 0002-9270
• ISSN (Online): 1572-0241
• Published Online: 30 May 2017
• Copyright Holders: Copyright © The Authors 2017
• First Published: First published in American Journal of Gastroenterology 112(8):1234-1245
• Publisher Policy: Reproduced under a Creative Commons license