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World J Gastroenterol. Mar 7, 2009; 15(9): 1085-1092
Published online Mar 7, 2009. doi: 10.3748/wjg.15.1085
Colonoscopic yield of colorectal neoplasia in daily clinical practice
Jochim S Terhaar sive Droste, Mike E Craanen, Rene WM van der Hulst, Joep F Bartelsman, Dick P Bezemer, Kim R Cappendijk, Gerrit A Meijer, Linde M Morsink, Pleun Snel, Hans ARE Tuynman, Roy LJ van Wanrooy, Eric IC Wesdorp, Chris JJ Mulder
Jochim S Terhaar sive Droste, Mike E Craanen, Kim R Cappendijk, Linde M Morsink, Roy LJ van Wanrooy, Chris JJ Mulder, Department of Gastroenterology and Hepatology, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
Rene WM van der Hulst, Gastroenterology and Hepatology, Kennemer Gasthuis, 2000 AK, Haarlem, The Netherlands
Joep F Bartelsman, Gastroenterology and Hepatology, Academic Medical Centre, 1100 DD, Amsterdam, The Netherlands
Dick P Bezemer, Epidemiology and Biostatistics, VU University Medical Centre, 1007 MB, Amsterdam, The Netherlands
Gerrit A Meijer, Pathology, VU University Medical Centre, 1007 MB, Amsterdam, The Netherlands
Pleun Snel, Gastroenterology and Hepatology, Slotervaart Hospital, 1006 BK, Amsterdam, The Netherlands
Hans ARE Tuynman, Gastroenterology and Hepatology, Medical Centre Alkmaar, 1800 AM, Alkmaar, The Netherlands
Eric IC Wesdorp, Gastroenterology and Hepatology, Sint Lucas Andreas Hospital, 1061 AE, Amsterdam, The Netherlands
Author contributions: Mulder CJJ, Bartelsman JF, Snel P, Tuynman HARE and Wesdorp EIC performed research, devised the study concept and designed research; Craanen ME, van der Hulst RWM and Meijer GA performed critical revision of the article for intellectual content; Bezemer DP performed statistical analysis; Cappendijk KR, Morsink LM and van Wanrooy RLJ were responsible for data acquisition and Terhaar sive Droste JS wrote the paper.
Correspondence to: Jochim S Terhaar sive Droste, MD, Department of Gastroenterology and Hepatology, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. js.terhaar@vumc.nl
Telephone: +31-20-4440611
Fax: +31-20-4440554
Received: October 20, 2008
Revised: January 17, 2009
Accepted: January 24, 2009
Published online: March 7, 2009
Abstract

AIM: To assess the prevalence and location of advanced neoplasia in patients undergoing colonoscopy, and to compare the yield per indication.

METHODS: In a multicenter colonoscopy survey (n = 18 hospitals) in the Amsterdam area (Northern Holland), data of all colonoscopies performed during a three month period in 2005 were analyzed. The location and the histological features of all colonic neoplasia were recorded. The prevalence and the distribution of advanced colorectal neoplasia and differences in yield between indication clusters were evaluated. Advanced neoplasm was defined as adenoma > 10 mm in size, with > 25% villous features or with high-grade dysplasia or cancer.

RESULTS: A total of 4623 eligible patients underwent a total colonoscopy. The prevalence of advanced neoplasia was 13%, with 281 (6%) adenocarcinomas and 342 (7%) advanced adenomas. Sixty-seven percent and 33% of advanced neoplasia were located in the distal and proximal colon, respectively. Of all patients with right-sided advanced neoplasia (n = 228), 51% had a normal distal colon, whereas 27% had a synchronous distal adenoma. Ten percent of all colonoscopies were performed in asymptomatic patients, 7% of whom had advanced neoplasia. In the respective procedure indication clusters, the prevalence of right-sided advanced neoplasia ranged from 11%-57%.

CONCLUSION: One out of every 7-8 colonoscopies yielded an advanced colorectal neoplasm. Colonoscopy is warranted for the evaluation of both symptomatic and asymptomatic patients.

Keywords: Colorectal cancer; Screening; Advanced neoplasia; Colonoscopy; Adenoma