The Incidence and Clinical Characteristics of Proximal Colonic Polyps When the Polyps Are Noted on Rectosigmoid Colon by Colonoscopy

Sae Kyung Joo; Ji Won Kim; Kook Lae Lee; Byeong Gwan Kim; Ji Bong Jeong; Jae Kyung Lee; Seong-Joon Koh; Young Hoon Kim

doi:10.4166/kjg.2013.62.1.42

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Joo, Kim, Lee, Kim, Jeong, Lee, Koh, and Kim: The Incidence and Clinical Characteristics of Proximal Colonic Polyps When the Polyps Are Noted on Rectosigmoid Colon by Colonoscopy

Original Article

Korean J Gastroenterol 2013;62(1):42-48.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.1.42

The Incidence and Clinical Characteristics of Proximal Colonic Polyps When the Polyps Are Noted on Rectosigmoid Colon by Colonoscopy

Sae Kyung Joo, Ji Won Kim, Kook Lae Lee, Byeong Gwan Kim, Ji Bong Jeong, Jae Kyung Lee, Seong-Joon Koh, Young Hoon Kim

Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea

Correspondence to: Ji Won Kim, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-849, Korea. Tel: +82-2-870-2221, Fax: +82-2-870-3863, E-mail: kjwjor@snu.ac.kr

Received 9 April 201325 May 2013 Accepted 27 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Colorectal cancer is the third most common type of cancer and second leading cause of cancer death overall. Recently, there has been an emphasis on primary screening for colorectal cancer with colonoscopy. In this study, we aimed to address clinical characteristics and incidence of colonic polyps according to location.

Methods

From January 2009 to December 2010, 6,417 total colonoscopic examinations were performed at Boramae Hospital in Seoul, Korea. We reviewed these patients retrospectively. The distal colon was defined as the rectosigmoid junction.

Results

Overall, 1,972 patients (31.3%) had one of more colorectal polyps. Total of 4,445 patients were excluded from this study because of combined advanced colorectal cancer, inflammatory bowel disease, or familial adenomatous polyposis. Patients who had only proximal polyps were 633 (32.1%), 530 patients (26.9%) had both proximal and distal polyps, and 809 patients (41.0%) had polyps only in the rectosigmoid region. The prevalence of the proximal polyps in patients with rectosigmoid polyps was found to be significantly related to the male gender and elderly patients. However, the prevalence of the proximal colonic polyps was not related to the size and number of rectosigmoid polyps. In 530 patients with both rectosigmoid and proximal colonic polyps, the characteristics of proximal colonic polyps as size and number were similar to those of rectosigmoid polyps. Advanced proximal adenomas without distal polyps were found in 25 (29.4%) patients whom were associated with size and pathology.

Conclusions

We recommend total colonoscopic examination in all patients regardless of the size and number, especially in elderly males.

Keywords: Colonic polyps, Colonoscopy, Adenoma

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Fig. 1.

Number of polyps. Total of 982 patients (49.8%) had a single polyp, 454 patients (23.0%) patients had two polyps and 536 (27.2%) patients had more than two polyps.

Fig. 2.

Location of polyps. Total of 994 polyps (22.7%) were found in the cecum and ascending colon, 1,086 polyps (24.9%) in the transverse colon, 638 polyps (14.6%) in the descending colon, and 1,650 polyps (37.8%) in the rectosigmoid colon. A-colon, ascending colon; T-colon, transverse.

Table 1.

Baseline Characteristics of Patients with Colorectal Polyps

Characteristic	Description
Patient (n)	1,972
Sex
Male	1,321 (67.0)
Female	651 (33.0)
Polyp (n)	4,368
1	982 (49.8)
2	454 (23.0)
≥3	536 (27.2)
Age (yr)	62.46±11.6
＜65	1,058 (53.7)
≥65	914 (46.3)
Size of polyp (mm)
1–4	2,474 (58.6)
5–9	1,302 (30.8)
10–14	290 (6.9)
15–19	57 (1.4)
Over 20	99 (2.3)

Values are presented n only, n (%), or mean±SD.

Table 2.

Proximal Colonic Polyps in Relation to the Characteristics of Patients

Characteristic	Patient		OR	95% CI	p-value
Characteristic	Total	With proximal polyp	OR	95% CI	p-value
Sex
Female	651	249 (38.2)
Male	1,321	384 (29.1)	1.25	1.09–1.55	0.04
Age (yr)
＜65	1,058	495 (46.8)
≥65	914	314 (34.4)	1.57	1.27–1.93	＜0.001
Size of polyp (mm)
1–4	2,474	584 (23.6)
5–9	1,302	281 (21.6)	3.62	2.85–4.60	＜0.001
Over 10	446	126 (28.3)	2.15	1.62–2.86	＜0.001
Number of polyp
1	982	434 (44.2)
2	454	122 (26.9)	1.33	1.00–1.78	0.05
≥3	536	77 (14.4)	0.88	0.62–1.25	0.46
Pathology
Non-adenoma		271 (17.1)
Adenoma		651 (25.5)	1.97	1.58–2.46	＜0.001
Villous		23 (13.8)	0.48	0.29–0.80	0.01
High grade		10 (25.6)	1.07	0.46–2.48	0.88
Adenocarcinoma		4 (16.0)	0.26	0.09–0.78	0.02

Values are presented n only or n (%).

Table 3.

Distal Colonic Polyps in Relation to the Characteristics of Patients

Characteristic	Patient		OR	95% CI	p-value
Characteristic	Total	With proximal polyp	OR	95% CI	p-value
Sex
Female	651	276 (34.1)
Male	1,321	533 (65.9)	7.99	0.64–0.99	0.04
Age (yr)
＜65	1,058	495 (61.2)
≥65	914	314 (38.8)	0.64	0.52–0.79	＜0.001
Size of polyp (mm)
1–4	2,474	709 (28.7)
5–9	1,302	357 (27.4)	0.75	0.56–1.00	0.05
Over 10	446	207 (46.4)	1.14	0.80–1.62	0.59
Number of polyp
1	982	548 (55.8)
2	454	181 (39.9)	0.82	0.59–1.15	0.16
≥3	536	80 (14.9)	0.70	0.48–1.03	0.07
Pathology
Non-adenoma		557 (35.1)
Adenoma		590 (23.1)	0.51	0.41–0.63	＜0.001
Villous		57 (34.1)	2.08	1.24–3.48	0.01
High grade		12 (30.8)	0.94	0.40–2.19	0.88
Adenocarcinoma		19 (76.0)	3.78	1.28–11.17	0.02

Values are presented n only or n (%).

Table 4.

Proximal and Distal Colonic Polyps in Relation to the Characteristics of Patients

Characteristic	Patient		OR	95% CI	p-value
Characteristic	Total	With proximal polyp^a	OR	95% CI	p-value
Sex
Female	651	126 (23.8)
Male	1,321	404 (76.2)	0.55	0.43–0.68	＜0.001
Age (yr)
＜65	1,058	246 (46.4)
≥65	914	284 (53.6)	1.49	1.22–1.82	＜0.001
Size of polyp (mm)
1–4	2,474	1,181 (47.7)
5–9	1,302	664 (50.9)	8.42	6.53–10.84	＜0.001
Over 10	446	269 (60.3)	5.11	3.71–7.03	＜0.001
Number of polyp
1	982	0 (0)
2	454	151 (33.3)	0.00	0.00–0.00	＜0.001
≥3	536	379 (70.7)	0.02	0.16–0.28	＜0.001
Pathology
Non-adenoma		759 (47.8)
Adenoma		1,309 (51.3)	4.03	3.04–5.32	＜0.001
Villous		87 (52.1)	2.61	1.85–3.69	＜0.001
High grade		17 (43.6)	2.01	1.05–3.86	0.04
Adenocarcinoma		2 (8.0)	2.29	1.24–4.25	0.01

Values are presented n only or n (%).

^a Proximal and distal colonic polyps.

Table 5.

Distal Findings in Advanced Proximal Polyps

Distal colon findings (n=216)	Advanced polyps (number of patients=85)
Pathology	Patient
No polyps (n=33)	25 (29.4)
Hyperplastic polyps (n=34)	18 (21.2)
Nonadvanced adenoma (n=139)	32 (37.6)
Advanced adenoma (n=10)	10 (11.8)
Size of polyp (mm)	Polyp
1–4	107 (49.5)
5–9	78 (36.1)
Over 10	31 (14.4)

Values are presented as n (%).

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