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Endoscopy may reduce risk for advanced adenomas, not sessile serrated polyps
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An inverse association was found between a history of endoscopy and advanced adenomas in the colon, but not sessile serrated polyps in a recent study.
Researchers conducted a case-control study to evaluate 213 patients with advanced adenoma and 172 with sessile serrated polyps (SSP), plus 1,704 controls, who underwent index colonoscopy between 1998 and 2007. Participants responded to a questionnaire on their endoscopy history, and a pathology review also was conducted on patients with polyps to confirm and potentially reclassify the diagnoses.
A history of endoscopy was observed in 36% of patients with advanced adenomas, 53% of those with SSPs and 57% of controls. Previous endoscopy of any type was inversely associated with the presence of advanced adenomas in general (OR=0.36; 95% CI, 0.26-0.50), as well as specifically in the rectum/distal colon (OR=0.38; 95% CI, 0.26-0.56) and proximal colon (OR=0.31; 95% CI, 0.19-0.52). This association remained significant after restricting analysis to patients who had undergone endoscopy more than 10 years ago (OR=0.41; 95% CI, 0.27-0.62). Evaluation for both sigmoidoscopy (OR=0.46; 95% CI, 0.32-0.67) and colonoscopy (OR=0.31; 95% CI, 0.18-0.54) also maintained this inverse association, which was stronger in patients who underwent both types (OR=0.24; 95% CI, 0.13-0.42).
There was no statistical significance between SSPs among patients having previous endoscopy (OR=0.80; 95% CI, 0.56-1.13), nor was the association significant for every evaluated method of endoscopy. Investigators also determined the difference between advanced adenomas and SSPs in association with any endoscopy (P=.001).
“Because SSPs are important precursors in the proximal colon, these results may help to explain why several colorectal cancer studies report poor effectiveness for endoscopy in preventing proximal colon cancer,” the researchers wrote. “There is now a growing awareness of the importance of SSPs, and future studies should assess whether this increased vigilance … results in better effectiveness of endoscopy for the prevention of SSPs, and more importantly, proximal colon cancer.”
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