Recently the incidence of colonic disease increases in Korea. Because a large proportion of polyps and cancer occur in the rectosigmoid colon, fecal occult blood test and sigmoidoscopy have been used widely in screening test. Adenomatous polyps
are
precursors of colorectal cancer. If adenomatous polyps are detected in sigmoidoscopy, total colonoscopy is recommended. Hyperplastic polyps of colorectum are a common endoscopic finding of uncertain significance. But, some studies suggest that
total
colonoscopy is indicated for patients wit hyperplastic polyp in distal colon, because the patients with hyperplastic polyp in distal colon, because the patients with rectosigmoidal hyperplastic polyps have high incidence of proximal colonic
adenomas or
cancers. To determine whether polyps found in the rectosigmoid area of the colon are associated with proximal colonic adenomas or cancers and to judge whether hyperplastic polyps are indicative of increased risk of developing adenomatous polyps,
the
4020 consecutive patients who underwent total colonoscopy were reviewed restrospectively. Of the 4020 patients, 76(1.9%) had adenomatous polyps, and 49(1.2%) had hyperplastic polyps, 42(2.0%) had inflammatory polyps, 86(2.1%) had cancer in
rectosigmold
colon. Of 76 patients with distal adenomatous polyps, 20(26.3%) had adenomatous polyp, and 5(6.6%) had colon cancer 8(10.5%) in proximal colon. Of the patients with rectosigmoidal hyperplastic or inflammatory polyps, no adenoma and cancer found
in
proximal colon. Of 3583 patients without any polypoid lesions in rectosigmoid colon, 50(1.4%) had adenomatous polyps, and 44(1.2%) had concer in proximal colon. These results showed that the patients with rectosigmoidal adenomatous polyps have
higher
incidence of proximal colonic adenomas or cancers than the patients with rectosigmoidal hyperplastic polyps or inflammatory polyps, or without any polypoid lesion(p<0.01).
Therefore distal hyperplastic or inflammatory polyps are not strong predictors of risk for proximal adenoma, but rectosigmoid adenomas are associated with proximal adenoma. We concluded colonoscopy should be performed in patients who are proved
to
have
distal adenomatous polyps.
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