CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(05): E497-E503
DOI: 10.1055/a-2062-9443
Original article

Hemorrhoids as a risk factor for colorectal adenomas on colonoscopy

1   Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
,
Toshihiro Nishizawa
1   Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
2   Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Japan
,
Shuntaro Yoshida
1   Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
3   Department of Internal medicine, Yoshida Clinic, Fukaya, Japan
,
Tatsuya Matsuno
1   Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
,
Kotaro Miyoshi
1   Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
4   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Eri Naito
1   Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
4   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Chihiro Shiomi
1   Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
4   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Takeshi Uozumi
1   Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
5   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
4   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Yutaka Saito
5   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
› Author Affiliations

Abstract

Background and study aims Colorectal premalignant polyps and hemorrhoids are important findings in colonoscopy; however, the association between them is unclear. Therefore, we investigated the association between the presence and severity of hemorrhoids and the detection of precancerous colorectal polyps on colonoscopy.

Patients and methods This retrospective, single-center, cross-sectional study enrolled patients who underwent colonoscopy at Toyoshima Endoscopy Clinic between May 2017 and October 2020. The association between hemorrhoids and other outcomes (patient age, sex, withdrawal time for colonoscopy, expert endoscopist, number of adenomas per colonoscopy, detection rates of adenoma, advanced neoplasia, clinically significant serrated polyp, and sessile serrated lesion) was assessed using a binomial logistic regression model.

Results A total of 12,408 patients were enrolled in this study. Hemorrhoids were identified in 1,863 patients. Univariable analysis showed that patients with hemorrhoids were older (61.0 vs. 52.5 years, P < 0.001), had a higher number of adenomas per colonoscopy (1.16 vs. 0.756, P < 0.001) than those without hemorrhoids. Multivariable analyses also demonstrated that hemorrhoids were associated with a higher number of adenomas per colonoscopy (odds ratio [OR]: 1.061; P = 0.002), regardless of patient age, sex, and expert endoscopist. Among patients with hemorrhoids, severe hemorrhoids with a mucosal elevation ≥ 10 mm were associated with a higher number of adenomas per colonoscopy than mild hemorrhoids (OR: 1.112, P = 0.044), regardless of patient age, sex, and expert endoscopist.

Conclusions Hemorrhoids, especially severe ones, are associated with a high number of adenomas. Complete colonoscopy should be performed in patients with hemorrhoids.



Publication History

Received: 14 August 2022

Accepted after revision: 23 March 2023

Article published online:
17 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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