Whether screening participants with distal hyperplastic polyps detected by flexible sigmoidoscopy should be followed by subsequent colonoscopy is controversial.
Dr Martin Wong and colleagues from China evaluated the association between distal hyperplastic polyps, and proximal neoplasia/advanced proximal neoplasia in asymptomatic, average-risk patients.
The team searched Ovid Medline, EMBASE, and the Cochrane Library from inception 2016 and included all screening studies that examined the relationship between different distal findings and proximal neoplasia/advanced proximal neoplasia.
Data were independently extracted by 2 reviewers with disagreements resolved by a third reviewer.
|The researchers analyzed 28 studies|
|American Journal of Gastroenterology|
The researchers pooled absolute risks and odds ratios with a random effects meta-analysis.
The team performed 7 subgroup analyses according to study characteristics.
The researchers analyzed 28 studies.
When compared with normal distal findings, distal hyperplastic polyps was not associated with proximal neoplasia/advanced proximal neoplasia, while subjects with distal non-advanced or advanced adenoma had higher odds of proximal neoplasia/advanced proximal neoplasia.
The researchers observed higher odds of proximal neoplasia/advanced proximal neoplasia 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.
Dr Wong's team concludes, "Distal hyperplastic polyps is not associated with proximal neoplasia/advanced proximal neoplasia in asymptomatic screening population when compared with normal distal findings."
"Hence, the presence of distal hyperplastic polyps alone detected by flexible sigmoidoscopy does not automatically indicate colonoscopy referral for all screening participants, as other risk factors of proximal neoplasia/advanced proximal neoplasia should be considered."