Hyperplastic polyps and nonadvanced adenomas, but not advanced polypoid lesions, are detected more frequently in the presence of colonic diverticula during screening colonoscopies

Zusammenfassung

Hintergrund Die bisher veröffentlichte Studienlage zur Assoziation von Kolondivertikeln und kolorektalen Polypen einschließlich des kolorektalen Karzinoms (KRK) ist konträr. Ziel der Studie war es, die Assoziation für sämtliche relevanten histologischen Polypensubtypen, d. h. hyperplastische Polypen (HP), sessil und traditionell serratierte Adenome (SSA und TSA), klinisch relevante serratierte Polypen (krSP), tubuläre Adenome und fortgeschrittene Adenome in einer ausschließlichen Vorsorgekoloskopie-Kohorte zu untersuchen.

Material und Methoden Wir führten eine retrospektive Analyse von Personen ≥ 50 Jahre und einem durchschnittlichen Risiko für ein KRK, die eine Vorsorgekoloskopie zwischen dem 01.01.2012 und dem 14.12.2016 in einer Universitätsklinik und 6 gastroenterologischen Schwerpunktpraxen erhalten haben, durch. Ausschlusskriterien waren Erkrankungen mit einem erhöhten KRK-Risiko (z. B. chronisch-entzündliche Darmerkrankungen, KRK in der Vorgeschichte, hereditäre Karzinomsyndrome), eine vorherige Koloskopie und eine unvollständige Untersuchung.

Ergebnisse 4196 Koloskopien wurden eingeschlossen (mittleres Alter 63,4 Jahre, Standardabweichung ± 7,6 Jahre, 48,6 %). Bei Vorliegen von Divertikeln zeigten sich nach Adjustierung für Alter und Geschlecht erhöhte Odds-Ratios (OR) für den Nachweis von HP im gesamten (OR 1,340, 95 %-Konfidenzintervall 1,133 – 1,584, p = 0,001) und im distalen Kolon (OR 1,459, 95 %-KI 1,208 – 1,763, p < 0,001) sowie von tubulären Adenomen im distalen Kolon (OR 1,355, 95 %-KI 1,144 – 1,604, p < 0,001). Die mittlere Polypenanzahl pro Untersuchung mit dem Nachweis von mindestens einem Polypensubtypen unterschied sich nicht zwischen beiden Gruppen.

Schlussfolgerung Die Untersucher sollten beim Vorliegen einer Divertikulose wachsam für den Nachweis von vor allem distal gelegenen Adenomen sein.

Abstract

Background Studies investigating the association between colonic diverticula and colorectal polyps and colorectal cancer (CRC) have reported conflicting results. We aimed to evaluate this association for all relevant different histological polyp subtypes (i. e., hyperplastic polyps [HPs], sessile and traditionally serrated adenomas, clinically relevant serrated polyps, nonadvanced and advanced adenomas) in an exclusive colonoscopy screening cohort.

Material and methods We conducted a retrospective analysis of individuals ≥ 50 years of age with an average risk for CRC who underwent a screening colonoscopy between January 1, 2012, and December 14, 2016, at a tertiary academic hospital and 6 community-based private practices. Exclusion criteria were conditions with increased risk for CRC (e. g., inflammatory bowel disease, history of CRC, hereditary cancer syndromes), previous colonoscopy at the same institution, and incomplete procedures.

Results A total of 4196 colonoscopies were included (mean age: 63.4, standard deviation: ± 7.6 years, 48.6 % men). In the presence of colonic diverticula, significantly increased odds ratios (OR) were found for the detection of HPs overall (OR: 1.340, 95 % confidence interval [CI]: 1.133 – 1.584, p = 0.001) and in the distal colon (OR: 1.459, 95 % CI: 1.208 – 1.763, p < 0.001), as well as for nonadvanced adenomas (OR: 1.355, 95 % CI: 1.144 – 1.604, p < 0.001) in the distal colon after adjusting for age and gender. The mean numbers of different histological polyp subtypes detected per procedure with at least one of the histological polyp subtype did not differ between both groups.

Conclusions Endoscopists should be vigilant for the detection of adenomatous polyps in the distal colon when diverticula are present during colonoscopy.

Key words

diverticulosis - colorectal adenoma - colorectal carcinoma - screening

Schlüsselwörter

Divertikulose - kolorektales Adenom - kolorektales Karzinom - Screening

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