ポルトガルで、右側結腸の大腸腺腫が増加しているという報告があった。

 
 １

United European Gastroenterol J. 2015 Aug; 3(4): 353–357.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528209/

Is there a proximal shift in the distribution of colorectal adenomas?

Ana Maria Freire de Oliveira,corresponding author Vera Anapaz, Luís Lourenço, Catarina Graça Rodrigues, Sara Folgado Alberto, Alexandra Martins, João Ramos de Deus, and Jorge Reis

Department of Gastroenterology, Prof Doutor Fernando Fonseca Hospital, Amadora, PortugalDepartment of Gastroenterology, Prof Doutor Fernando Fonseca Hospital, Amadora, Portugal

 

 

Abstract

Introduction

Several studies have shown a proximal shift of colorectal cancer (CRC) during the last decades. However, few have analyzed the changing distribution of adenomas over time.

Aim

The aim of this study was to compare the site and the characteristics of colorectal adenomas, in a single center, during two periods.

Methods

We conducted a retrospective, observational study in a single hospital of adenomas removed during a total colonoscopy in two one-year periods: 2003 (period 1) and 2012 (period 2).

Patients with inflammatory bowel disease, familial adenomatous polyposis, hereditary non-polyposis colorectal cancer syndrome, or history of CRC were excluded from the study.

The χ2 statistical test was performed.

P values less than 0.05 were considered statistically significant.

Results

During the two considered periods, a total of 864 adenomas from 2394 complete colonoscopies were analyzed: 333 adenomas from 998 colonoscopies during period 1 and 531 adenomas from 1396 colonoscopies during period 2.

There was a significant increase in the proportion of adenomatous polyps in the proximal colon from period 1 to 2 (30.6% to 38.8% (p = 0.015)).

Comparing the advanced features of adenomas between the two periods, it was noted that in period 2, the number of adenomas with size ≥1 cm (p = 0.001), high-grade dysplasia (p = 0.001), and villous features (p < 0.0001) had a significant increase compared to period 1.

Conclusion

Incidence of adenomatous polyps in the proximal colon as well as adenomas with advanced features has increased in the last years. This finding may have important implications regarding methods of CRC screening.

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この現象は、ルーマニアでも生じている。

 

 

http://www.ncbi.nlm.nih.gov/pubmed/24949606

 

J Gastrointestin Liver Dis. 2014 Jun;23(2):147-51.

Increasing prevalence of right-sided colonic adenomas in a high-volume endoscopy department in Romania: implications for colorectal cancer screening.

Visovan II1, Tantau M2, Ciobanu L2, Pascu O2, Tantau A

·         1Medical enter of Gastroenterology and Hepatology, Cluj-Napoca, Romania. matantau@gmail.com.

·         23rd Medical Clinic, University of Medicine and Pharmacy Iuliu Haţieganu;Regional Institute of Gastroenterology and Hepatology Octavian Fodor;Cluj-Napoca, Romania.

·         3Medical Center of Gastroenterology and Hepatology,4th Medical Clinic, University of Medicine and Pharmacy Iuliu Haţieganu Cluj-Napoca, Romania.

 

Abstract

BACKGROUND & AIMS:

A gradual shift of colorectal adenoma and carcinoma location toward the proximal colon has been recently observed both in the United States and Europe. We aimed to study the polyp and adenoma detection rate in a major endoscopy center of northwestern Romania over a 16-year period, and to characterize the distribution and the pathological features of the removed polyps according to age and sex, in order to assess the trend of proximal adenoma prevalence in our population.

METHODS:

We retrospectively analyzed 9,230 consecutive colonoscopies performed between 1996 and 2011 in a high-volume outpatient clinic in Cluj-Napoca, Romania. We analyzed 2,436 complete colonoscopies that detected 3,642 polyps in two time periods: 1996 to 2003 and 2004 to 2011. We compared the number, size and histopathological features of the polyps removed from the right-sided colon and the left sided-colon in the two periods.

RESULTS:

An increasing trend of polyp detection rate in the right-sided colon was observed, from 9.36% in the first period to 12.17% in the second period (p<0.001). The prevalence of right-sided colon adenomas also presented an increased trend (OR 1.45; CI95% 1.02-2.05; p=0.03). High-grade dysplasia (HGD) was found in 8.6% of the adenomas and in 4.1% of the diminutive polyps. Advanced neoplasia was detected in 1.5% of persons younger than 50 years. Multivariate logistic regression analysis evidenced that the right-sided polyps were significantly associated with the last time period (OR 1.3; p=0.001; CI95% 1.12-1.56), male gender (OR-1.3; p=0.001; CI95% 1.1-1.5) and age above 48 years (OR 1.3; p=0.006: CI95% 1-1.6).

CONCLUSION:

An increasing trend of polyp detection rate in the right-sided colon was documented, with an increasing prevalence of right-sided adenomas. The evaluation of the proximal colon is particularly important in males aged over 48. A clear-cut risk of HGD in the diminutive polyps and in the middle age subjects has been also observed.

 

 

日本の研究では、加齢とともに右側結腸の大腸腺腫が増加することが報告されている。

 

Relationship between age and site of colorectal cancer based on colonoscopy findings.

Okamoto M, Shiratori Y, Yamaji Y, Kato J, Ikenoue T, Togo G, Yoshida H, Kawabe T, Omata M.

Gastrointest Endosc. 2002 Apr;55(4):548-51.

 

 

Right-side shift of metachronous colorectal adenomas after polypectomy.

Yamaji Y, Mitsushima T, Yoshida H, Watabe H, Okamoto M, Ikuma H, Wada R, Kawabe T, Omata M.

Scand J Gastroenterol. 2007 Dec;42(12):1466-72.

 

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一方、大腸憩室と大腸腺腫がリンクしているという報告がある。

 

Risk of colorectal adenomas, advanced adenomas and cancer in patients with colonicdiverticular disease: A systematic review and meta-analysis.

Jaruvongvanich V, Sanguankeo A, Wijarnpreecha K, Upala S.

Dig Endosc. 2016 Jul 25. doi: 10.1111/den.12701. [Epub ahead of print]

 


 

以上から、
 

欧米の白人において右結腸の憩室が増加してくる可能性がある。

 

また、大腸腺腫の原因として、内的因子ではなく、何らかの外的因子が示唆される。