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Abstract
Background/Aims
It has been reported that patients with gastric cancer may be at increased risk of synchronous or metachronous colorectal cancer. However, the incidence of colorectal adenoma in patients with gastric adenoma has not been discussed earlier. The aims of this study were to investigate the incidence of colorectal adenoma and to evaluate the necessity of colonoscopic surveillance in patients with gastric adenoma.
Methods
We performed colonoscopy in 221 patients with gastric adenoma between January 2002 and June 2008. As a control group, 387 consecutive patients without gastric adenoma on gastroscopy who underwent colonoscopy were included. We retrospectively examined the endoscopic and colonoscopic findings as well as the clinicopathologic features.
Results
Colorectal adenoma were diagnosed in 57.5% (127/221) of the gastric adenoma group and 38.0% (147/387) of the control group (p＜0.001). Univariate analysis demonstrated that gender, age, past history of diabetes, and past history of gastric adenoma were associated with the risk of colorectal adenoma. Multivariate analysis demonstrated that gender (male, aOR 2.31, 95% CI 1.61-3.31), age (≥50 years, aOR 2.47, 95% CI 1.53-4.01), past history of diabetes (aOR 2.35, 95% CI 1.32-4.20), and presence of gastric adenoma (aOR 1.63, 95% CI 1.13-2.36) appeared to be independent risk factors for colorectal adenoma.
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Table 1.
Baseline Characteristics of the Subjects with or without Gastric Adenoma
| Characteristics | Subjects with gastric adenoma (n=221) | Subjects without gastric adenoma (n=387) | p-value | p-value† |
|---|---|---|---|---|
| Sex | ||||
| Male | 164 (74.2%) | 201 (51.9%) | ＜0.001 | |
| Female | 57 (25.8%) | 186 (48.1%) | ||
| Age∗ | 64.4±8.9 | 58.3±11.8 | ＜0.001 | |
| Height (cm)∗ | 163.3±10.9 | 163.1±8.4 | 0.844 | 0.817 |
| Body weight (kg)∗ | 62.4±9.8 | 64.4±11.1 | 0.065 | 0.981 |
| BMI (kg/m2)∗ | 23.5±3.1 | 24.1±3.3 | 0.032 | 0.041 |
| Diabetes | 22/216 (10.2%) | 40/367 (10.9%) | 0.787 | 0.372 |
| Hypertension | 53/216 (24.5%) | 85/367 (23.2%) | 0.706 | 0.054 |
| Subjects with colon adenoma | 127/221 (57.5%) | 94/221 (42.5%) | ＜0.001 | 0.014 |
| Subjects with advanced colon adenoma‡ | 44/221 (19.9%) | 59/387 (15.2%) | 0.140 | 0.151 |
| Subjects with colon cancer | 18/221 (8.1%) | 20/387 (5.2%) | 0.145 | 0.406 |
Table 2.
Baseline Characteristics of the Subjects with or without Colorectal Neoplasm
| Characteristics | Subjects with colorectal neoplasm (n=274) | Subjects without colorectal neoplasm (n=334) | p-value |
|---|---|---|---|
| Sex | |||
| Male Female | 196 (71.5%) 78 (28.5%) | 169 (50.6%) 165 (49.4%) | ＜0.001 |
| Age∗ | 63.5±9.8 | 58.1±11.8 | ＜0.001 |
| Height (cm)∗ | 162.9±8.2 | 163.5±10.8 | 0.522 |
| Body weight (kg)∗ | 63.5±10.3 | 63.4±10.9 | 0.953 |
| BMI (kg/m2)∗ | 23.9±3.1 | 23.8±3.4 | 0.641 |
| Diabetes | 41/271 (15.1%) | 21/312 (6.7%) | 0.001 |
| Hypertension | 66/271 (24.4%) | 72/312 (23.1%) | 0.717 |
| Subjects with gastric adenoma | 127/274 (46.4%) | 94/334 (28.1%) | ＜0.001 |
Table 3.
Multivariate Analysis of Risk Factor for Colorectal Neoplasm
Table 4.
Characteristics of Colorectal Neoplasm in the Subjects with or without Gastric Adenoma
| Variables | Subjects with gastric adenoma (n=127) | Subjects without gastric adenoma (n=147) | p-value |
|---|---|---|---|
| Maximal size | 10.8±10.1 mm | 11.2±8.2 mm | 0.748 |
| Total number | 3.6±10.1 | 2.1±1.7 | 0.099 |
| Location (n=266) | 0.853 | ||
| Ascending colon | 26.0% (32/123) | 31.5% (45/143) | 0.328 |
| Transverse colon | 16.3% (20/123) | 12.6% (18/143) | 0.393 |
| Descending colon | 8.9% (11/123) | 8.4% (12/143) | 0.873 |
| Sigmoid colon | 30.9% (38/123) | 30.1% (43/143) | 0.884 |
| Rectum | 17.9% (22/123) | 17.5% (25/143) | 0.931 |
| Histology | |||
| Non-advanced adenoma Advanced adenoma∗ | 64.8% (81/125) 35.2% (44/125) | 58.2% (82/141) 41.8% (59/141) | 0.267 |
| Colon cancer | 14.4% (18/125) | 14.4% (20/141) | 0.892 |
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