The Detection of Proximal Colon Polyps and Its Importance in Screening Colonoscopy

Abstract

Abstract Background: Colon polyps are precursors of colorectal cancer (CRC), therefore their endoscopic detection is very important. A shift of in the localization of colorectal polyps toward the proximal colon has been recently observed in Western countries. Aim: The aim of this paper was to establish the most important clinical and endoscopic aspects of right colon polyps and to correlate them with their histopathological types, with an emphasis on sessile serrated adenomas/polyps (SSA/Ps). Material and method: We perfomed a retrospective study on a series of consecutive patients who underwent colonoscopy in the Gastroenterology and Endoscopy Unit of the County Emergency Clinical Hospital of Tîrgu Mureș between January 1, 2010 – December 31, 2014, comparing the results with those of patients who underwent colonoscopy between January 1, 2005 – December 31, 2009. In all cases with abnormal aspects at endoscopy, multiple biopsies were taken for histopathological examination. Only cases where the diagnosis of colon polyp was confirmed by the Histopathology Department were included in the study. Results: In the 2010–2014 period there were 871 patients diagnosed with colon polyps (1,038 polyps), with a mean age of 62.28 years. The most frequent histopathological form was tubular adenoma in 55.97% of cases (n = 581). SSA/Ps were found in 66 patients (75 polyps). Considering all polyps, the most frequent localization was in the sigmoid colon in 32.36% of cases (n = 336), but for SSA/Ps the most common localization was the ascending colon in 24% of cases (n = 18), followed by the sigmoid colon in 21.33% of cases (n = 16). Compared with patients investigated between 2005 and 2009, we found an increasing localization in the right colon, from 10.43% (n = 67) in 2005–2009 to 15.41% (n = 160) in 2010–2014. SSA/Ps were found in the right colon in 5.97% of cases (n = 4) in the first period compared with 11.25% of cases (n = 18) in the second period. Conclusions: In the last years we found an increasing localization of colon polyps in the right colon. These findings underscore the importance of high quality colonoscopy to maximize protection against colorectal cancer.