Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1248
Peer-review started: October 13, 2023
First decision: January 5, 2024
Revised: January 19, 2024
Accepted: February 28, 2024
Article in press: February 28, 2024
Published online: April 15, 2024
Processing time: 180 Days and 9.1 Hours
The strategy for preventing colorectal cancer is screening by colonoscopy, which offers a direct way for detection and removal of adenomatous polyps (APs). American College of Gastroenterology guidelines recommend that people aged ≥ 45 years should undergo colonoscopy; however, how to deal with people aged ≤ 45 years is still unknown.
To compare the prevalence of APs and high-grade neoplasia between the left and right colon in patients ≤ 45 years.
A retrospective observational study was conducted at a single tertiary III hospital in China. This study included patients aged 18–45 years with undergoing initial colonoscopy dissection and pathological diagnosis AP or high-grade neoplasia between February 2014 and January 2021. The number of APs in the entire colon while screening and post-polypectomy surveillance in following 1–3 years were evaluated.
A total of 3053 cases were included. The prevalence of APs in the left and right colon was 55.0% and 41.6%, respectively (OR 1.7, 95%CI 1.6–2.4; P < 0.05). For APs with high-grade neoplasia, the prevalence was 2.7% and 0.9%, respectively (OR 3.0, 95%CI 2.0–4.6; P < 0.05). Therefore, the prevalence of APs and high-grade neoplasia in the left colon was significantly higher than in the right colon in patients aged ≤ 45 years. There were 327 patients who voluntarily participated in post-polypectomy surveillance in following 1–3 years, and APs were found in 216 cases (66.1%); 170 cases had 1–3 polyps (52.0%) and 46 cases had > 3 polyps (14.1%; OR 0.3, 95%CI 0.1–0.6; P < 0.05).
This study suggests that flexible sigmoidoscopy would be an optimal approach for initial screening in people aged ≤ 45 years and would be a more cost-effective and safe strategy.
Core Tip: This was a retrospective observational study to investigate the prevalence of adenomatous polyps (APs) and high-grade neoplasia and establish the significant difference between the left and right colon in patients aged ≤ 45 years. The prevalence of APs and high-grade neoplasia in the left colon was significantly higher than that in the right colon. This suggests that flexible sigmoidoscopy would be an optimal approach for the initial screening in people aged ≤ 45 years and would be a more cost-effective and safe strategy. Colonoscopy for post-polypectomy surveillance could be conducted at an appropriate interval of approximately 3 years.