Do we need colonoscopy in patients with gastric adenoma? The risk of colorectal adenoma in patients with gastric adenomas R3 Kim Jungwook Moon Hee Yang, MD, Hee Jung Son, MD, Jun Haeng Lee, MD, Min Hyung Kim, MD, Jin Yong Kim, MD,Young-Ho Kim, MD, Dong Kyung Chang, MD, Poong-Lyul Rhee, MD, Jae J. Kim, MD, Jong Chul Rhee, MD Seoul, Korea 2010 Apr 71(4):774-81

Background Adenoma in one region of the GI tract ≈ additional adenomas in another region Detecting synchronous adenomas in another region ⇒ effective diagnosis and therapy Gastric polyps in various colonic polyposis syndrome : Peutz-Jeghers syndrome, juvenile polyposis, Cronkhite-Canada syndrome, Gardener’s syndrome, Cowden’s disease, MYH-associated polyposis

Background Patients with gastric fundic-gland polyp Eur J Med Res 2008 ;13:192-5 ⇒ risk of colonic cancer ↑ Eur J Med Res 2008 ;13:192-5 Colorectal cancer ⇒ m/c synchronous neoplasm a/w gastric cancer ⇒ should undergo surveillance colonoscopy Korean J Gastroenterol. 2006;47:191-7 J Clin Gastroenterol. 2010;44:102-5

Background Aims ① to investigate the prevalence rate of colorectal adenoma in patients with gastric adenoma ② to determine the association between the presence of gastric adenomas and synchronous colorectal adenoma

Patients & Methods Retrospectively reviewed the clinical records - Jan 2001 ~ Dec Jan 2001 ~ Dec As a routine check-up, At the Center for Health Promotion - As a routine check-up, At the Center for Health Promotion - underwent EGD & colonoscopy simultaneously or within 6 Mo - underwent EGD & colonoscopy simultaneously or within 6 Mo - 19,019 participants (13,533 men and 5,486 women) - 19,019 participants (13,533 men and 5,486 women)Patients - the diagnosis of gastric adenoma was confirmed by histology - the diagnosis of gastric adenoma was confirmed by histology - controls (age- / sex- matched ) - controls (age- / sex- matched ) 15,307 participants (did not have a gastric adenoma) 15,307 participants (did not have a gastric adenoma) - exclusion - exclusion : a history of gastric or colon cancer, prior gastric surgery or : a history of gastric or colon cancer, prior gastric surgery or colon resection, a history of FAP and IBD colon resection, a history of FAP and IBD

MethodsAssessments (number, size, location and histology of adenoma) (number, size, location and histology of adenoma) - distribution of colonic adenoma - distribution of colonic adenoma : Proximal (Cecum ~ T-colon), distal (splenic flexure ~ rectum) : Proximal (Cecum ~ T-colon), distal (splenic flexure ~ rectum) - Size : eye measurement by using open biopsy forceps - Size : eye measurement by using open biopsy forceps - Histology - Histology : High-grade dysplasia(HGD), Low-grade dysplasia(LGD) : High-grade dysplasia(HGD), Low-grade dysplasia(LGD) - Advanced colonic adenomas - Advanced colonic adenomas : tubular adenomas with diameters of > 1cm : tubular adenomas with diameters of > 1cm or adenoma with villous component, or adenoma with HGD or adenoma with villous component, or adenoma with HGD

Results

Conclusion The risk of colorectal adenoma increases significantly in patients with gastric adenomas and in patients over age 55. A screening colonoscopy may be necessary for patients with gastric adenomas to detect colorectal adenomas.