Intestinal Polypoid Adenomas Follow-up

  • Author: Alan BR Thomson, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 5, 2012
 

Further Inpatient Care

  • Flexible sigmoidoscopy and colonoscopy generally are outpatient procedures. Inpatient care rarely is required for the diagnosis and treatment of adenomas.
Next

Further Outpatient Care

  • The interval between colonoscopy depends on the size, number, and histological type of polyp, as well as the patient's family history. Polyp recurrence rates are 20% at 5 years and 50% at 15 years, with even higher recurrence rates for multiple index polyps. Polyps may be missed at the index colonoscopy, and the presence of a polyp when colonoscopy is repeated at 1 year is about 33%.
  • In general, a 3-year interval for surveillance colonoscopy, for the patient previously found to have an adenomatous polyp, is safe and cost-effective for most patients after removal of adenomas. Specific clinical scenarios dictate alterations from this general guideline.
  • Postpolypectomy surveillance guidelines suggest the following:
    • Repeat colonoscopy every 3 years for high-risk persons, those with a polyp with a villous component or with high-grade dysplasia, or if there is a first-degree relative with colon cancer.
    • Large (>2 cm) sessile polyps or multiple (3 or more) adenomas, found on initial colonoscopy, warrant repeat colonoscopy 3-6 months after initial diagnosis to ensure complete removal of all adenomatous tissue.
    • If either the endoscopist or the pathologist is unsure that the polyp has been completely removed, a repeat colonoscopy in 3-6 months is recommended.
    • A suboptimal examination at colonoscopy or multiple (>4) adenomas indicates need for follow-up colonoscopy in 1 year or sooner.
    • If the 3-year follow-up examination reveals no recurrent adenomas, repeat colonoscopy is recommended every 5 years.
    • Follow-up of single tubular adenomas less than 1 cm is debated and patient-specific, depending primarily on comorbidities and age.
    • Repeat colonoscopy every 10 years for the low-risk person.
Previous
Next

Deterrence/Prevention

  • Observational epidemiologic studies have implicated several dietary factors as potentially modulating the prevalence of adenomas. A recent summary by the American College of Gastroenterology makes the following recommendations: a low-fat (25-30% of total calories) high-fiber (20-30 g/d) diet with 5 servings per day of fruits and vegetables, maintenance of normal body weight, no excessive use of alcohol, abstinence from tobacco, and calcium supplementation.
  • Antioxidant supplements do not have a significant beneficial effect on primary or secondary prevention of adenoma.
  • The only intervention proven to decrease the incidence of recurrent sporadic adenomas is calcium carbonate (3 g/d).
  • Growing evidence suggests a protective role for coxibs, NSAIDs, and ASA against the development of colorectal cancer. For example, the Prevention of Colorectal Sporadic Adenomatous Polyps Trial studied celecoxib at a dose of 400 mg per day versus placebo. The cumulative rate of adenomas detected through year 3 was 33.6% in the celecoxib group versus 49.3% in the placebo group (relative risk [RR], 0.64; 95% confidence interval, 0.56-0.75; P < 0.001). In addition, a significant effect in reversing adenoma growth has been illustrated with the use of sulindac and celecoxib in patients with FAP.
  • The use of chemoprotection for primary or secondary polyp formation is not yet fully endorsed.
  • Smoking tobacco (ie, cigarettes smoked per day, smoking duration, pack/y, recent use) increases the risk (odds ratio [OR] = 6.2 [95% confidence interval, 4.7-5.3]) for both hyperplastic polyps and adenomatous polyps.
Previous
Next

Complications

  • The primary complication associated with adenomas is the potential development of colorectal cancer. Less than 5% of all adenomas progress to cancer. The risk of progression to cancer rises with increasing size, villous component, and degree of dysplasia.
  • Complications of colonoscopy include perforation and bleeding. A diagnostic colonoscopy carries a complication risk of about 0.1%; polypectomy substantially increases the risk of complications to up to 0.2% for perforation and 1% for bleeding.
Previous
Next

Prognosis

  • Almost all cases of colorectal cancer arise from an adenoma; excision of adenomas reduces the incidence of colorectal cancer. Adherence to guidelines for surveillance of adenomas is expected to substantially reduce the risk of developing colon cancer.
Previous
Next

Patient Education

  • A sustained public awareness campaign emphasizing the importance of early detection of adenomas in the prevention of colorectal cancer has been supported by all major gastroenterology associations.
  • Dietary recommendations, such as those outlined in the Diet section, have been promoted by the National Cancer Institute, the American Cancer Society, and many other organizations.
Previous
 
Contributor Information and Disclosures
Author

Alan BR Thomson, MD  Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Dennis J Ahnen, MD  Staff Physician, Denver VA Medical Center and Professor of Medicine, University of Colorado Denver School of Medicine

Dennis J Ahnen, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Gastroenterological Association, Crohns and Colitis Foundation of America, and Gastroenterology Research Group

Disclosure: EXACT Sciences travel expenses Review panel membership

Specialty Editor Board

Rajeev Vasudeva, MD, FACG  Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Columbia Medical Society, South Carolina Gastroenterology Association, and South Carolina Medical Association

Disclosure: Pricara Honoraria Speaking and teaching; UCB Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, John Riopelle, DO, to the development and writing of this article.

References

  1. da Fonte AC, Chojniak R, Ferreira FD, Pinto PN, Neto PJ, Bitencourt AG. Inclusion of computed tomographic colonography on pre-operative CT for patients with colorectal cancer. Eur J Radiol. Nov 17 2011;[Medline].

  2. Sutherland T, Coyle E, Lee WK, Lui B. Diagnosing colorectal polyps and masses - the use of CT colonography. Aust Fam Physician. Mar 2011;40(3):117-20. [Medline].

  3. Wilkins T, LeClair B, Smolkin M, et al. Screening colonoscopies by primary care physicians: a meta-analysis. Ann Fam Med. Jan-Feb 2009;7(1):56-62. [Medline]. [Full Text].

  4. Dellon ES, Lippmann QK, Sandler RS, Shaheen NJ. Gastrointestinal endoscopy nurse experience and polyp detection during screening colonoscopy. Clin Gastroenterol Hepatol. Dec 2008;6(12):1342-7. [Medline].

  5. Dominitz JA. Colonoscopic surveillance after polypectomy: predicting risk of advanced adenoma recurrence. Gastroenterology. Dec 2008;135(6):2147-9. [Medline].

  6. Sanchez del Rio A, Campo R, Llach J, et al. Variation among endoscopy units in the achievement of the standards of colonoscopic performance indicators. Hepatogastroenterology. Sep-Oct 2008;55(86-87):1594-9. [Medline].

  7. Atkin W, Rogers P, Cardwell C, Cook C, Cuzick J, Wardle J, et al. Wide variation in adenoma detection rates at screening flexible sigmoidoscopy. Gastroenterology. May 2004;126(5):1247-56. [Medline].

  8. Stengel JZ, Jones DP. Single-dose lubiprostone along with split-dose PEG solution without dietary restrictions for bowel cleansing prior to colonoscopy: a randomized, double-blind, placebo-controlled trial. Am J Gastroenterol. Sep 2008;103(9):2224-30. [Medline].

  9. Matsumoto T, Iwao Y, Igarashi M, et al. Endoscopic and chromoendoscopic atlas featuring dysplastic lesions in surveillance colonoscopy for patients with long-standing ulcerative colitis. Inflamm Bowel Dis. Feb 2008;14(2):259-64. [Medline]. [Full Text].

  10. Kaltenbach T, Friedland S, Soetikno R. A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates. Gut. Oct 2008;57(10):1406-12. [Medline].

  11. Gupta AK, Pretlow TP, Schoen RE. Aberrant crypt foci: what we know and what we need to know. Clin Gastroenterol Hepatol. May 2007;5(5):526-33. [Medline].

  12. Khare S, Chaudhary K, Bissonnette M, Carroll R. Aberrant crypt foci in colon cancer epidemiology. Methods Mol Biol. 2009;472:373-86. [Medline].

  13. Kiesslich R, Goetz M, Vieth M, Galle PR, Neurath MF. Technology insight: confocal laser endoscopy for in vivo diagnosis of colorectal cancer. Nat Clin Pract Oncol. Aug 2007;4(8):480-90. [Medline].

  14. Nguyen NQ, Leong RW. Current application of confocal endomicroscopy in gastrointestinal disorders. J Gastroenterol Hepatol. Oct 2008;23(10):1483-91. [Medline].

  15. Matsuda T, Saito Y, Fu KI, et al. Does autofluorescence imaging videoendoscopy system improve the colonoscopic polyp detection rate?--a pilot study. Am J Gastroenterol. Aug 2008;103(8):1926-32. [Medline].

  16. McCallum AL, Jenkins JT, Gillen D, Molloy RG. Evaluation of autofluorescence colonoscopy for the detection and diagnosis of colonic polyps. Gastrointest Endosc. Aug 2008;68(2):283-90. [Medline].

  17. Jensch S, de Vries AH, Peringa J, et al. CT colonography with limited bowel preparation: performance characteristics in an increased-risk population. Radiology. Apr 2008;247(1):122-32. [Medline]. [Full Text].

  18. Imperiale TF, Glowinski EA, Lin-Cooper C, et al. Five-year risk of colorectal neoplasia after negative screening colonoscopy. N Engl J Med. Sep 18 2008;359(12):1218-24. [Medline].

  19. Shin A, Shrubsole MJ, Rice JM, et al. Meat intake, heterocyclic amine exposure, and metabolizing enzyme polymorphisms in relation to colorectal polyp risk. Cancer Epidemiol Biomarkers Prev. Feb 2008;17(2):320-9. [Medline]. [Full Text].

  20. Groff RJ, Nash R, Ahnen DJ. Significance of serrated polyps of the colon. Curr Gastroenterol Rep. Oct 2008;10(5):490-8. [Medline].

  21. DuPont AW, Arguedas MR, Wilcox CM. Aspirin chemoprevention in patients with increased risk for colorectal cancer: a cost-effectiveness analysis. Aliment Pharmacol Ther. Aug 1 2007;26(3):431-41. [Medline].

  22. Adler A, Aschenbeck J, Yenerim T, et al. Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial. Gastroenterology. Feb 2009;136(2):410-6.e1; quiz 715. [Medline].

  23. Alberts DS, Martinez ME, Roe DJ, et al. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians' Network. N Engl J Med. Apr 20 2000;342(16):1156-62. [Medline].

  24. [Best Evidence] Arber N, Eagle CJ, Spicak J, Racz I, Dite P, Hajer J, et al. Celecoxib for the prevention of colorectal adenomatous polyps. N Engl J Med. Aug 31 2006;355(9):885-95. [Medline].

  25. Atkin WS, Edwards R, Wardle J. UK flexible sigmoidoscopy screening trial: Compliance, yield, and adverse effects. Gastroenterology. 2000;188:A187.

  26. Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. Dec 14 2006;355(24):2588-9. [Medline].

  27. Barclay RL, Vicari JJ, Greenlaw RL. Effect of a time-dependent colonoscopic withdrawal protocol on adenoma detection during screening colonoscopy. Clin Gastroenterol Hepatol. Oct 2008;6(10):1091-8. [Medline].

  28. Baron JA, Beach M, Mandel JS, van Stolk RU, Haile RW, Sandler RS, et al. Calcium supplements for the prevention of colorectal adenomas. Calcium Polyp Prevention Study Group. N Engl J Med. Jan 14 1999;340(2):101-7. [Medline].

  29. Bechtler M, Eickhoff A, Riemann JF. [Interval colon cancer and possible causes] [German]. Dtsch Med Wochenschr. Nov 2008;133(47):2458-62. [Medline].

  30. Bersentes K, Fennerty MB, Sampliner RE, Garewal HS. Lack of spontaneous regression of tubular adenomas in two years of follow-up. Am J Gastroenterol. Jul 1997;92(7):1117-20. [Medline].

  31. Bisgaard ML, Ripa R, Knudsen AL, Bulow S. Familial adenomatous polyposis patients without an identified APC germline mutation have a severe phenotype. Gut. Feb 2004;53(2):266-70. [Medline].

  32. [Best Evidence] Bjelakovic G, Nagorni A, Nikolova D, Simonetti RG, Bjelakovic M, Gluud C. Meta-analysis: antioxidant supplements for primary and secondary prevention of colorectal adenoma. Aliment Pharmacol Ther. Jul 15 2006;24(2):281-91. [Medline].

  33. Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. Nov 2000;95(11):3053-63. [Medline].

  34. Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L. Rates of New or Missed Colorectal Cancers After Colonoscopy and Their Risk Factors: a Population-Based Analysis. Gastroenterology. Jan 2007;132(1):96-102. [Medline].

  35. Brown SR, Baraza W, Hurlstone P. Chromoscopy versus conventional endoscopy for the detection of polyps in the colon and rectum. Cochrane Database Syst Rev. Oct 17 2007;CD006439. [Medline].

  36. Burt R, Neklason DW. Genetic testing for inherited colon cancer. Gastroenterology. May 2005;128(6):1696-716. [Medline].

  37. Butterly LF, Chase MP, Pohl H, Fiarman GS. Prevalence of clinically important histology in small adenomas. Clin Gastroenterol Hepatol. 2006Mar;4(3):343-8. [Medline].

  38. Cai W, Zalis ME, Nappi J, Harris GJ, Yoshida H. Structure-analysis method for electronic cleansing in cathartic and noncathartic CT colonography. Med Phys. Jul 2008;35(7):3259-77. [Medline].

  39. Chan AO, Lam KF, Tong T, Siu DC, Jim MH, Hui WM, et al. Coexistence between colorectal cancer/adenoma and coronary artery disease: results from 1382 patients. Aliment Pharmacol Ther. Apr 2006;24(3):535-539. [Medline].

  40. Chan AT, Tranah GJ, Giovannucci EL, Hunter DJ, Fuchs CS. A prospective study of genetic polymorphisms in the cytochrome P-450 2C9 enzyme and the risk for distal colorectal adenoma. Clin Gastroenterol Hepatol. Aug 2004;2(8):704-12. [Medline].

  41. Chang HK, Yu E, Kim J, Bae YK, Jang KT, Jung ES, et al. Adenocarcinoma of the small intestine: a multi-institutional study of 197 surgically resected cases. Hum Pathol. Aug 2010;41(8):1087-96. [Medline].

  42. Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol. 2007;102:1-6. [Medline].

  43. Chen SC, Rex DK. Variable detection of nonadenomatous polyps by individual endoscopists at colonoscopy and correlation with adenoma detection. J Clin Gastroenterol. Jul 2008;42(6):704-7. [Medline].

  44. Chen X, Halberg RB, Burch RP, Dove WF. Intestinal adenomagenesis involves core molecular signatures of the epithelial-mesenchymal transition. J Mol Histol. Jun 2008;39(3):283-94. [Medline].

  45. Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M. Italian Multicentre Study Group. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. Jun 2001;48(6):812-5. [Medline].

  46. Cornett D, Barancin C, Roeder B, et al. Findings on optical colonoscopy after positive CT colonography exam. Am J Gastroenterol. Aug 2008;103(8):2068-74. [Medline].

  47. Cotton PB, Durkalski VL, Pineau BC, Palesch YY, Mauldin PD, Hoffman B, et al. Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA. Apr 14 2004;291(14):1713-9. [Medline].

  48. De Jong AE, Morreau H, Van Puijenbroek M, Eilers PH, Wijnen J, Nagengast FM, et al. The role of mismatch repair gene defects in the development of adenomas in patients with HNPCC. Gastroenterology. Jan 2004;126(1):42-8. [Medline].

  49. East JE, Suzuki N, Bassett P, et al. Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity. Endoscopy. Oct 2008;40(10):811-7. [Medline].

  50. Farris AB, Misdraji J, Srivastava A, et al. Sessile serrated adenoma: challenging discrimination from other serrated colonic polyps. Am J Surg Pathol. Jan 2008;32(1):30-5. [Medline].

  51. Fatima H, Rex DK, Rothstein R, et al. Cecal insertion and withdrawal times with wide-angle versus standard colonoscopes: a randomized controlled trial. Clin Gastroenterol Hepatol. Jan 2008;6(1):109-14. [Medline].

  52. Forrester K, Almoguera C, Han K, Grizzle WE, Perucho M. Detection of high incidence of K-ras oncogenes during human colon tumorigenesis. Nature. May 28-Jun 3 1987;327(6120):298-303. [Medline].

  53. Fraser CG, Mathew CM, McKay K, Carey FA, Steele RJ. Automated immunochemical quantitation of haemoglobin in faeces collected on cards for screening for colorectal cancer. Gut. Sep 2008;57(9):1256-60. [Medline].

  54. Friedman S, Rubin PH, Bodian C, Harpaz N, Present DH. Screening and surveillance colonoscopy in chronic Crohn's colitis: results of a surveillance program spanning 25 years. Clin Gastroenterol Hepatol. Sep 2008;6(9):993-8; quiz 953-4. [Medline].

  55. Giardiello FM, Hamilton SR, Krush AJ, Piantadosi S, Hylind LM, Celano P, et al. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis. N Engl J Med. May 6 1993;328(18):1313-6. [Medline].

  56. Giardiello FM, Offerhaus GJ, DuBois RN. The role of nonsteroidal anti-inflammatory drugs in colorectal cancer prevention. Eur J Cancer. Jul-Aug 1995;31A(7-8):1071-6. [Medline].

  57. Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Willett WC. Aspirin use and the risk for colorectal cancer and adenoma in male health professionals. Ann Intern Med. Aug 15 1994;121(4):241-6. [Medline].

  58. Gottlieb LS, Winawer SJ, Sternberg S. National Polyp Study (NPS): The diminutive colonic polyp. Gastrointestinal Endoscopy. 1984;30:143.

  59. Graser A, Stieber P, Nagel D, et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut. Feb 2009;58(2):241-8. [Medline].

  60. Grazzini G, Visioli CB, Zorzi M, et al. Immunochemical faecal occult blood test: number of samples and positivity cutoff. What is the best strategy for colorectal cancer screening?. Br J Cancer. Jan 27 2009;100(2):259-65. [Medline].

  61. Gupta AK, Melton LJ, Petersen GM, Timmons LJ, Vege SS, Harmsen WS, et al. Changing trends in the incidence, stage, survival, and screen-detection of colorectal cancer: a population-based study. Clin Gastroenterol Hepatol. Feb 2005;3(2):150-8. [Medline].

  62. Gupta S. Colorectal polyps: the scope and management of the problem. Am J Med Sci. Nov 2008;336(5):407-17. [Medline].

  63. Hirata T, Kawakami Y, Kinjo N, et al. Association between colonic polyps and diverticular disease. World J Gastroenterol. Apr 21 2008;14(15):2411-3. [Medline].

  64. Hol L, van Leerdam ME. Colon tumors and colonoscopy. Endoscopy. Oct 2008;40(10):843-8. [Medline].

  65. Holt PR. New insights into calcium, dairy and colon cancer. World J Gastroenterol. Jul 28 2008;14(28):4429-33. [Medline].

  66. Hundt S, Haug U, Brenner H. Comparative evaluation of immunochemical fecal occult blood tests for colorectal adenoma detection. Ann Intern Med. Feb 3 2009;150(3):162-9. [Medline].

  67. Hurlstone DP, Cross SS, Slater R, Sanders DS, Brown S. Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy. Gut. Mar 2004;53(3):376-80. [Medline].

  68. Iafrate F, Hassan C, Zullo A, et al. CT colonography with reduced bowel preparation after incomplete colonoscopy in the elderly. Eur Radiol. Jul 2008;18(7):1385-95. [Medline].

  69. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. Jul 20 2000;343(3):169-74. [Medline].

  70. Itzkowitz SH, Jandorf L, Brand R, Rabeneck L, Schroy PC 3rd, Sontag S, et al. Improved fecal DNA test for colorectal cancer screening. Clin Gastroenterol Hepatol. Jan 2007;5(1):111-7. [Medline].

  71. Itzkowitz SH, Kim YS. Colonic Polyps and Polyposis Syndromes. In: Feldman M, Scharschmidt BF, Sleisenger MH. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 6th ed. Philadelphia, Pa: WB Saunders; 1998:1865-1905.

  72. Jass JR. Hyperplastic polyps and colorectal cancer: is there a link?. Clin Gastroenterol Hepatol. Jan 2004;2(1):1-8. [Medline].

  73. Jaszewski R, Misra S, Tobi M, et al. Folic acid supplementation inhibits recurrence of colorectal adenomas: a randomized chemoprevention trial. World J Gastroenterol. Jul 28 2008;14(28):4492-8. [Medline].

  74. Ji BT, Weissfeld JL, Chow WH, Huang WY, Schoen RE, Hayes RB. Tobacco smoking and colorectal hyperplastic and adenomatous polyps. Cancer Epidemiol Biomarkers Prev. May 2006;15(5):897-901. [Medline].

  75. Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. Sep 18 2008;359(12):1207-17. [Medline].

  76. Johnson CD, Harmsen WS, Wilson LA, Maccarty RL, Welch TJ, Ilstrup DM, et al. Prospective blinded evaluation of computed tomographic colonography for screen detection of colorectal polyps. Gastroenterology. Aug 2003;125(2):311-9. [Medline].

  77. Johnson JC, Schmidt CR, Shrubsole MJ, Billheimer DD, Joshi PR, Morrow JD, et al. Urine PGE-M: a metabolite of prostaglandin E2 as a potential biomarker of advanced colorectal neoplasia. Clin Gastroenterol Hepatol. Nov; 2006;4(11):1358-65. [Medline].

  78. Juchems MS, Ernst A, Johnson P, et al. Electronic colon-cleansing for CT colonography: diagnostic performance. Abdom Imaging. May-Jun 2009;34(3):359-64. [Medline].

  79. Kim DH, Pickhardt PJ, Taylor AJ, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med. Oct 4 2007;357(14):1403-12. [Medline].

  80. Kim JH, Kim WH, Kim TI, et al. Incomplete colonoscopy in patients with occlusive colorectal cancer: usefulness of CT colonography according to tumor location. Yonsei Med J. Dec 31 2007;48(6):934-41. [Medline]. [Full Text].

  81. Kim Y, Kim Y, Lee S. An association between colonic adenoma and abdominal obesity: a cross-sectional study. BMC Gastroenterol. Jan 15 2009;9:4. [Medline]. [Full Text].

  82. Konda A, Duffy MC. Surveillance of patients at increased risk of colon cancer: inflammatory bowel disease and other conditions. Gastroenterol Clin North Am. Mar 2008;37(1):191-213, viii. [Medline].

  83. Konukoglu E, Acar B, Paik DS, et al. Polyp enhancing level set evolution of colon wall: method and pilot study. IEEE Trans Med Imaging. Dec 2007;26(12):1649-56. [Medline].

  84. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, practice parameters committee. Am J Gastroenterol. Apr 2004;99:1371-85. [Medline].

  85. Ladenheim J, Garcia G, Titzer D, Herzenberg H, Lavori P, Edson R, et al. Effect of sulindac on sporadic colonic polyps. Gastroenterology. Apr 1995;108(4):1083-7. [Medline].

  86. Laiyemo AO, Murphy G, Albert PS, et al. Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years. Ann Intern Med. Mar 18 2008;148(6):419-26. [Medline]. [Full Text].

  87. Lasson A, Kilander A, Stotzer PO. Diagnostic yield of colonoscopy based on symptoms. Scand J Gastroenterol. Mar 2008;43(3):356-62. [Medline].

  88. Lee GE, Park HS, Yun KE, et al. Association between BMI and metabolic syndrome and adenomatous colonic polyps in Korean men. Obesity (Silver Spring). Jun 2008;16(6):1434-9. [Medline].

  89. Lee SH, Chung IK, Kim SJ, et al. An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve. Gastrointest Endosc. Apr 2008;67(4):683-9. [Medline].

  90. Lee SS, Park SH, Choi EK, et al. Colorectal polyps on portal phase contrast-enhanced CT colonography: lesion attenuation and distinction from tagged feces. AJR Am J Roentgenol. Jul 2007;189(1):35-40. [Medline]. [Full Text].

  91. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. May 2008;134(5):1570-95. [Medline].

  92. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. May-Jun 2008;58(3):130-60. [Medline]. [Full Text].

  93. Levine JS, Ahnen DJ. Clinical practice. Adenomatous polyps of the colon. N Engl J Med. Dec 14 2006;355(24):2551-7. [Medline].

  94. Liang JJ, Alrawi S, Tan D. Nomenclature, molecular genetics and clinical significance of the precursor lesions in the serrated polyp pathway of colorectal carcinoma. Int J Clin Exp Pathol. Jan 1 2008;1(4):317-24. [Medline]. [Full Text].

  95. Lieberman D, Moravec M, Holub J, Michaels L, Eisen G. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology. Oct 2008;135(4):1100-5. [Medline]. [Full Text].

  96. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. Jul 20 2000;343(3):162-8. [Medline].

  97. Logan RF, Little J, Hawtin PG, Hardcastle JD. Effect of aspirin and non-steroidal anti-inflammatory drugs on colorectal adenomas: case-control study of subjects participating in the Nottingham faecal occult blood screening programme. BMJ. Jul 31 1993;307(6899):285-9. [Medline].

  98. Loitsch SM, Shastri Y, Stein J. Stool test for colorectal cancer screening--it's time to move!. Clin Lab. 2008;54(11-12):473-84. [Medline].

  99. MacLennan R, Macrae F, Bain C, Battistutta D, Chapuis P, Gratten H, et al. Randomized trial of intake of fat, fiber, and beta carotene to prevent colorectal adenomas. The Australian Polyp Prevention Project. J Natl Cancer Inst. Dec 6 1995;87(23):1760-6. [Medline].

  100. Macrae FA, Young GP. Neoplastic and Nonneoplastic Polyps of the colon and rectum. In: Yamada T. Textbook of Gastroenterology. 3rd ed. Philadelphia, Pa: JP Lippincott; 1999:1965-1994.

  101. Mahmood U, Wallace MB. Molecular Imaging in Gastrointestinal Disease. Gastroenterology. 2007;132(1):11-14. [Medline].

  102. Marion JF, Waye JD, Present DH, et al. Chromoendoscopy-targeted biopsies are superior to standard colonoscopic surveillance for detecting dysplasia in inflammatory bowel disease patients: a prospective endoscopic trial. Am J Gastroenterol. Sep 2008;103(9):2342-9. [Medline].

  103. Matsushita M, Danbara N, Omiya M, et al. Is closure of large mucosal defects after endoscopic mucosal resection and endoscopic submucosal dissection truly needed?. Endoscopy. Aug 2008;40(8):706; author reply 707. [Medline].

  104. Meining A, Saur D, Bajbouj M, et al. In vivo histopathology for detection of gastrointestinal neoplasia with a portable, confocal miniprobe: an examiner blinded analysis. Clin Gastroenterol Hepatol. Nov 2007;5(11):1261-7. [Medline].

  105. Morin PJ, Vogelstein B, Kinzler KW. Apoptosis and APC in colorectal tumorigenesis. Proc Natl Acad Sci U S A. Jul 23 1996;93(15):7950-4. [Medline].

  106. Morini S, Hassan C, Zullo A, et al. Detection of colonic polyps according to insertion/withdrawal phases of colonoscopy. Int J Colorectal Dis. May 2009;24(5):527-30. [Medline].

  107. Morini S, Zullo A, Hassan C, Tomao S, Campo SM. Diverticulosis and colorectal cancer: between lights and shadows. J Clin Gastroenterol. Aug 2008;42(7):763-70. [Medline].

  108. Murray MA, Zimmerman MJ, Ee HC. Sporadic duodenal adenoma is associated with colorectal neoplasia. Gut. Feb 2004;53(2):261-5. [Medline].

  109. Nappi J, Yoshida H. Adaptive correction of the pseudo-enhancement of CT attenuation for fecal-tagging CT colonography. Med Image Anal. Aug 2008;12(4):413-26. [Medline]. [Full Text].

  110. Nathanson JW, Zisman TL, Julian C, McCaffrey S, Rubin DT. Identification of patients at increased risk for colorectal cancer in an open access endoscopy center. J Clin Gastroenterol. Oct 2008;42(9):1025-31. [Medline].

  111. Neurath MF, Kiesslich R. Is chromoendoscopy the new standard for cancer surveillance in patients with ulcerative colitis?. Nat Clin Pract Gastroenterol Hepatol. Mar 2009;6(3):134-5. [Medline].

  112. Nusko G, Hahn EG, Mansmann U. Risk of advanced metachronous colorectal adenoma during long-term follow-up. Int J Colorectal Dis. Nov 2008;23(11):1065-71. [Medline].

  113. O'Brien MJ, Winawer SJ, Zauber AG, et al. Flat adenomas in the National Polyp Study: is there increased risk for high-grade dysplasia initially or during surveillance?. Clin Gastroenterol Hepatol. Oct 2004;2(10):905-11. [Medline].

  114. O'Brien MJ, Winawer SJ, Zauber AG, Gottlieb LS, Sternberg SS, Diaz B, et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. Feb 1990;98(2):371-9. [Medline].

  115. Odze RD, Farraye FA, Hecht JL, Hornick JL. Long-term follow-up after polypectomy treatment for adenoma-like dysplastic lesions in ulcerative colitis. Clin Gastroenterol Hepatol. Jul 2004;2(7):534-41. [Medline].

  116. Ouyang DL, Chen JJ, Getzenberg RH, Schoen RE. Noninvasive testing for colorectal cancer: a review. Am J Gastroenterol. Jun 2005;100(6):1393-403. [Medline].

  117. O'Connor SD, Summers RM, Yao J:. CT colonography with computer-aided polyp detection: volume and attenuation thresholds to reduce false-positive findings owing to the ileocecal valve. Radiology. Nov 2006;241(2):426-32. [Medline].

  118. Park SY, Lee SK, Kim BC, et al. Efficacy of chromoendoscopy with indigocarmine for the detection of ascending colon and cecum lesions. Scand J Gastroenterol. 2008;43(7):878-85. [Medline]. [Full Text].

  119. Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. Dec 4 2003;349(23):2191-200. [Medline].

  120. Pickhardt PJ, Hassan C, Laghi A, et al. Small and diminutive polyps detected at screening CT colonography: a decision analysis for referral to colonoscopy. AJR Am J Roentgenol. Jan 2008;190(1):136-44. [Medline]. [Full Text].

  121. Pineau BC, Paskett ED, Chen GJ, Espeland MA, Phillips K, Han JP, et al. Virtual colonoscopy using oral contrast compared with colonoscopy for the detection of patients with colorectal polyps. Gastroenterology. Aug 2003;125(2):304-10. [Medline].

  122. Pinsky PF, Schoen RE, Weissfeld JL, et al. The yield of surveillance colonoscopy by adenoma history and time to examination. Clin Gastroenterol Hepatol. Jan 2009;7(1):86-92. [Medline].

  123. Pohl J, Lotterer E, Balzer C, et al. Computed virtual chromoendoscopy versus standard colonoscopy with targeted indigocarmine chromoscopy: a randomised multicentre trial. Gut. Jan 2009;58(1):73-8. [Medline].

  124. Provenzale D, Garrett JW, Condon SE, Sandler RS. Risk for colon adenomas in patients with rectosigmoid hyperplastic polyps. Ann Intern Med. Nov 15 1990;113(10):760-3. [Medline].

  125. Pufulete M, Al-Ghnaniem R, Khushal A, Appleby P, Harris N, Gout S, et al. Effect of folic acid supplementation on genomic DNA methylation in patients with colorectal adenoma. Gut. May 2005;54(5):648-53. [Medline].

  126. Qi X, Pan Y, Hu Z, et al. Automated quantification of colonic crypt morphology using integrated microscopy and optical coherence tomography. J Biomed Opt. Sep-Oct 2008;13(5):054055. [Medline].

  127. Rabeneck L, Paszat LF, Hilsden RJ, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. Dec 2008;135(6):1899-1906, 1906.e1. [Medline].

  128. Radaelli F, Meucci G, Sgroi G, Minoli G, for the Italian Association of Hospital Gastroenterologists (AIGO). Technical performance of colonoscopy: the key role of sedation/analgesia and other quality indicators. Am J Gastroenterol. May 2008;103(5):1122-30. [Medline].

  129. Rastogi A, Bansal A, Wani S, et al. Narrow-band imaging colonoscopy--a pilot feasibility study for the detection of polyps and correlation of surface patterns with polyp histologic diagnosis. Gastrointest Endosc. Feb 2008;67(2):280-6. [Medline].

  130. Rembacken BJ, Fujii T, Cairns A, Dixon MF, Yoshida S, Chalmers DM, et al. Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet. Apr 8 2000;355(9211):1211-4. [Medline].

  131. Rex DK. Colonoscopy: a review of its yield for cancers and adenomas by indication. Am J Gastroenterol. Mar 1995;90(3):353-65. [Medline].

  132. Rex DK. Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology. Apr 2009;136(4):1174-81. [Medline].

  133. Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. Jan 1997;112(1):24-8. [Medline].

  134. Rex DK, Lehman GA, Hawes RH, Ulbright TM, Smith JJ. Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests. Gastroenterology. Jan 1991;100(1):64-7. [Medline].

  135. Rex DK, Lehman GA, Ulbright TM, Smith JJ, Pound DC, Hawes RH, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol. Jun 1993;88(6):825-31. [Medline].

  136. Rex DK, Overhiser AJ, Chen SC, Cummings OW, Ulbright TM. Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings. Am J Gastroenterol. Jan 2009;104(1):149-53. [Medline].

  137. Rhodes JM, Campbell BJ, Yu LG. Lectin-epithelial interactions in the human colon. Biochem Soc Trans. Dec 2008;36:1482-6. [Medline]. [Full Text].

  138. Roy HK, Bianchi LK. Colorectal cancer risk: black, white, or shades of gray?. JAMA. Sep 24 2008;300(12):1459-61. [Medline].

  139. Roy HK, Gomes A, Turzhitsky V, et al. Spectroscopic microvascular blood detection from the endoscopically normal colonic mucosa: biomarker for neoplasia risk. Gastroenterology. Oct 2008;135(4):1069-78. [Medline].

  140. Rozen P, Levi Z, Hazazi R, et al. Identification of colorectal adenomas by a quantitative immunochemical faecal occult blood screening test depends on adenoma characteristics, development threshold used and number of tests performed. Aliment Pharmacol Ther. Apr 15 2009;29(8):906-17. [Medline].

  141. Sali L, Falchini M, Bonanomi AG, et al. CT colonography after incomplete colonoscopy in subjects with positive faecal occult blood test. World J Gastroenterol. Jul 28 2008;14(28):4499-504. [Medline]. [Full Text].

  142. Sawhney MS, Cury MS, Neeman N, et al. Effect of institution-wide policy of colonoscopy withdrawal time > or = 7 minutes on polyp detection. Gastroenterology. Dec 2008;135(6):1892-8. [Medline].

  143. Schatzkin A, Lanza E, Corle D, Lance P, Iber F, Caan B, et al. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. Polyp Prevention Trial Study Group. N Engl J Med. Apr 20 2000;342(16):1149-55. [Medline].

  144. Seeff LC, Manninen DL, Dong FB, Chattopadhyay SK, Nadel MR, Tangka FK, et al. Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States?. Gastroenterology. Dec 2004;127(6):1661-9. [Medline].

  145. Serlie IW, de Vries AH, van Vliet LJ, et al. Lesion conspicuity and efficiency of CT colonography with electronic cleansing based on a three-material transition model. AJR Am J Roentgenol. Nov 2008;191(5):1493-502. [Medline]. [Full Text].

  146. Shimizu M, Fukutomi Y, Ninomiya M, et al. Green tea extracts for the prevention of metachronous colorectal adenomas: a pilot study. Cancer Epidemiol Biomarkers Prev. Nov 2008;17(11):3020-5. [Medline]. [Full Text].

  147. Sidransky D, Tokino T, Hamilton SR, Kinzler KW, Levin B, Frost P, et al. Identification of ras oncogene mutations in the stool of patients with curable colorectal tumors. Science. Apr 3 1992;256(5053):102-5. [Medline].

  148. Sikka S, Ringold DA, Jonnalagadda S, Banerjee B. Comparison of white light and narrow band high definition images in predicting colon polyp histology, using standard colonoscopes without optical magnification. Endoscopy. Oct 2008;40(10):818-22. [Medline].

  149. Simon JB. Occult blood screening for colorectal carcinoma: a critical review. Gastroenterology. Mar 1985;88(3):820-37. [Medline].

  150. Singh H, Demers AA, Xue L, Turner D, Bernstein CN. Time trends in colon cancer incidence and distribution and lower gastrointestinal endoscopy utilization in Manitoba. Am J Gastroenterol. May 2008;103(5):1249-56. [Medline].

  151. Sosna J, Sella T, Sy O, et al. Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps > or = 6 mm in the era of CT colonography. AJR Am J Roentgenol. Feb 2008;190(2):374-85. [Medline]. [Full Text].

  152. Sousa Andrade C, Figueiredo P, Lopes S, et al. [A thousand total colonoscopies: what is the relationship between distal and proximal findings?] [Portugese]. Acta Med Port. Sep-Oct 2008;21(5):461-6. [Medline].

  153. Stergiou N, Frenz MB, Menke D, Riphaus A, Wehrmann T. Reduction of miss rates of colonic adenomas by zoom chromoendoscopy. Int J Colorectal Dis. Sep 2006;21(6):560-5. [Medline].

  154. Stoffel EM, Turgeon DK, Stockwell DH, et al. Chromoendoscopy detects more adenomas than colonoscopy using intensive inspection without dye spraying. Cancer Prev Res (Phila Pa). Dec 2008;1(7):507-13. [Medline]. [Full Text].

  155. Stoffel EM, Turgeon DK, Stockwell DH, et al, for the Great Lakes-New England Clinical Epidemiology and Validation Center of the Early Detection Research Network. Missed adenomas during colonoscopic surveillance in individuals with Lynch Syndrome (hereditary nonpolyposis colorectal cancer). Cancer Prev Res (Phila Pa). Nov 2008;1(6):470-5. [Medline]. [Full Text].

  156. Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology. Nov 1987;93(5):1009-13. [Medline].

  157. Sturt NJ, Gallagher MC, Bassett P, Philp CR, Neale KF, Tomlinson IP, et al. Evidence for genetic predisposition to desmoid tumours in familial adenomatous polyposis independent of the germline APC mutation. Gut. Dec 2004;53(12):1832-6. [Medline].

  158. Sung HY, Cheung DY, Cho SH, et al. Polyps in the gastrointestinal tract: discrepancy between endoscopic forceps biopsies and resected specimens. Eur J Gastroenterol Hepatol. Feb 2009;21(2):190-5. [Medline].

  159. Taylor SA, Charman SC, Lefere P, et al. CT colonography: investigation of the optimum reader paradigm by using computer-aided detection software. Radiology. Feb 2008;246(2):463-71. [Medline]. [Full Text].

  160. Taylor SA, Greenhalgh R, Ilangovan R, et al. CT colonography and computer-aided detection: effect of false-positive results on reader specificity and reading efficiency in a low-prevalence screening population. Radiology. Apr 2008;247(1):133-40. [Medline]. [Full Text].

  161. Taylor SA, Iinuma G, Saito Y, Zhang J, Halligan S. CT colonography: computer-aided detection of morphologically flat T1 colonic carcinoma. Eur Radiol. Aug 2008;18(8):1666-73. [Medline].

  162. Teichmann J, Weickert U, Riemann JF. Gastric fundic gland polyps and colonic polyps - is there a link, really?. Eur J Med Res. May 26 2008;13(5):192-5. [Medline].

  163. Tischendorf JJ, Wasmuth HE, Koch A, et al. Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study. Endoscopy. Dec 2007;39(12):1092-6. [Medline].

  164. Triadafilopoulos G, Li J. A pilot study to assess the safety and efficacy of the Third Eye retrograde auxiliary imaging system during colonoscopy. Endoscopy. Jun 2008;40(6):478-82. [Medline].

  165. Ullah N, Qureshi K, Hatfield J, Sochacki P, David D, Albataineh H, et al. Small early tubular adenomas and mixed colonic polyps found on screening flexible sigmoidoscopy do not predict proximal neoplasia in males. Clin Gastroenterol Hepatol. Mar 2004;2(3):246-51. [Medline].

  166. Van Gelder RE, Nio CY, Florie J, Bartelsman JF, Snel P, De Jager SW, et al. Computed tomographic colonography compared with colonoscopy in patients at increased risk for colorectal cancer. Gastroenterology. Jul 2004;127(1):41-8. [Medline].

  167. van Kouwen MC, Drenth JP, van Krieken JH, van Goor H, Friederich P, Oyen WJ, et al. Ability of FDG-PET to detect all cancers in patients with familial adenomatous polyposis, and impact on clinical management. Eur J Nucl Med Mol Imaging. Mar 2006;33(3):270-4. [Medline].

  168. [Best Evidence] van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. Feb 2006;101(2):343-50. [Medline].

  169. Venesio T, Molatore S, Cattaneo F, Arrigoni A, Risio M, Ranzani GN. High frequency of MYH gene mutations in a subset of patients with familial adenomatous polyposis. Gastroenterology. Jun 2004;126(7):1681-5. [Medline].

  170. Villavicencio RT, Rex DK. Colonic adenomas: prevalence and incidence rates, growth rates, and miss rates at colonoscopy. Semin Gastrointest Dis. Oct 2000;11(4):185-93. [Medline].

  171. Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, et al. Genetic alterations during colorectal-tumor development. N Engl J Med. Sep 1 1988;319(9):525-32. [Medline].

  172. Weingarten MA, Zalmanovici A, Yaphe J. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database Syst Rev. Jan 23 2008;CD003548. [Medline].

  173. White TJ, Avery GR, Kennan N, et al. Virtual colonoscopy vs conventional colonoscopy in patients at high risk of colorectal cancer--a prospective trial of 150 patients. Colorectal Dis. Feb 2009;11(2):138-45. [Medline].

  174. Winawer SJ, Shike M. Dietary factors in colorectal cancer and their possible effects on earlier stages of hyperproliferation and adenoma formation. J Natl Cancer Inst. Jan 15 1992;84(2):74-5. [Medline].

  175. Winawer SJ, Stewart ET, Zauber AG, Bond JH, Ansel H, Waye JD, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med. Jun 15 2000;342(24):1766-72. [Medline].

  176. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O'Brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. May 2006;130(6):1872-85. [Medline].

  177. Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. Dec 30 1993;329(27):1977-81. [Medline].

  178. Winawer SJ, Zauber AG, O'Brien MJ, Ho MN, Gottlieb L, Sternberg SS, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med. Apr 1 1993;328(13):901-6. [Medline].

  179. Yoshida D, Kono S, Moore MA, et al. Colorectal polypectomy and risk of colorectal cancer by subsite: the Fukuoka Colorectal Cancer study. Jpn J Clin Oncol. Aug 2007;37(8):597-602. [Medline]. [Full Text].

  180. Yoshida I, Suzuki A, Vallee M, Matano Y, Masunaga T, Zenda T, et al. Serum insulin levels and the prevalence of adenomatous and hyperplastic polyps in the proximal colon. Clin Gastroenterol Hepatol. Oct 2006;4(10):1225-31. [Medline].

  181. Young GP, Cole SR. Which fecal occult blood test is best to screen for colorectal cancer?. Nat Clin Pract Gastroenterol Hepatol. Mar 2009;6(3):140-1. [Medline].

  182. Yucel C, Lev-Toaff AS, Moussa N, Durrani H. CT colonography for incomplete or contraindicated optical colonoscopy in older patients. AJR Am J Roentgenol. Jan 2008;190(1):145-50. [Medline]. [Full Text].

  183. Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, et al. Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. Nov 4 2008;149(9):659-69. [Medline]. [Full Text].

 
Previous
Next
 
Intestinal polypoid adenomas. Endoscopic view of pedunculated polyp.
Intestinal polypoid adenomas. Endoscopic view of sessile polyp.
Intestinal polypoid adenomas. Tubular adenoma, low-power view. Courtesy of G. Warren, MD, Rose Medical Center, Denver, Colo.
Intestinal polypoid adenomas. Villous adenoma, low-power view. Courtesy of G. Warren, MD, Rose Medical Center, Denver, Colo.
Intestinal polypoid adenomas. High-power view of adenomatous polyp with low-grade dysplasia. Courtesy of G. Warren, MD, Rose Medical Center, Denver, Colo.
Intestinal polypoid adenomas. Villous adenoma with grade IV invasive carcinoma. Courtesy of G. Warren, Rose Medical Center, Denver, Colo.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.