Gomes A, Bara J, da Matta CHKT, Paiva PP, de Carvalho LM, Bononi BM, Pinto PCC, Rodrigues JMS, Borghesi RA. Anal neoplasm in colonoscopy: What endoscopists need to know. World J Gastrointest Endosc 2025; 17(10): 108729 [DOI: 10.4253/wjge.v17.i10.108729]
Corresponding Author of This Article
Alexandre Gomes, PhD, Adjunct Associate Professor, Department of Surgery, da Faculdade de Ciências Médicas e da Saúde da Pontifícia Universidade Católica de São Paulo, Rua Dr. Luiz Garcia Duarte 125, Sorocaba 18047-599, São Paulo, Brazil. endoclinic@endoclinic.med.br
Research Domain of This Article
Gastroenterology & Hepatology
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 16, 2025 (publication date) through Oct 19, 2025
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Publication Name
World Journal of Gastrointestinal Endoscopy
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1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Gomes A, Bara J, da Matta CHKT, Paiva PP, de Carvalho LM, Bononi BM, Pinto PCC, Rodrigues JMS, Borghesi RA. Anal neoplasm in colonoscopy: What endoscopists need to know. World J Gastrointest Endosc 2025; 17(10): 108729 [DOI: 10.4253/wjge.v17.i10.108729]
World J Gastrointest Endosc. Oct 16, 2025; 17(10): 108729 Published online Oct 16, 2025. doi: 10.4253/wjge.v17.i10.108729
Anal neoplasm in colonoscopy: What endoscopists need to know
Alexandre Gomes, Juliana Bara, Camila H K T da Matta, Pedro Paterno Paiva, Luiza M de Carvalho, Bárbara M Bononi, Pérsio C C Pinto, José M S Rodrigues, Ronaldo A Borghesi
Alexandre Gomes, Department of Surgery, da Faculdade de Ciências Médicas e da Saúde da Pontifícia Universidade Católica de São Paulo, Sorocaba 18047-599, São Paulo, Brazil
Juliana Bara, Camila H K T da Matta, Pedro Paterno Paiva, Luiza M de Carvalho, Bárbara M Bononi, Faculty of Medical Sciences and Health, Pontifical Catholic University of São Paulo, Sorocaba 18047-599, São Paulo, Brazil
Pérsio C C Pinto, José M S Rodrigues, Ronaldo A Borghesi, Department of Surgery, Faculty of Medical Sciences and Health, Pontifical Catholic University of São Paulo, Sorocaba 18047-599, São Paulo, Brazil
Author contributions: Gomes A contributed to original idea, design of the study, endoscopic diagnosis, supervision of the study and writing of the manuscript; Gomes A, Bara J, and da Matta CHKT contributed to analysis and interpretation of data; Bara J, da Matta CHKT, Paiva PP, de Carvalho LM, and Bononi BM contributed to acquisition of data and drafting of the article; Pinto PCC, Rodrigues JMS, and Borghesi RA contributed to manuscript review and final approval of the version.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Faculty of Medicine of Sorocaba, Pontifical Catholic University of São Paulo under decision number 6.753.770 and registered in Plataforma Brazil, CAAE 78588224.5.0000.5373.
Informed consent statement: This research was retrospective, and the requirement for informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alexandre Gomes, PhD, Adjunct Associate Professor, Department of Surgery, da Faculdade de Ciências Médicas e da Saúde da Pontifícia Universidade Católica de São Paulo, Rua Dr. Luiz Garcia Duarte 125, Sorocaba 18047-599, São Paulo, Brazil. endoclinic@endoclinic.med.br
Received: April 22, 2025 Revised: June 18, 2025 Accepted: September 1, 2025 Published online: October 16, 2025 Processing time: 177 Days and 20 Hours
Abstract
BACKGROUND
The question of whether a colonoscopist should evaluate anal diseases is relevant. Endoscopists need to be aware of the possibility of anal neoplasms during a colonoscopy, as they can be easily overlooked if not properly examined. Specifically, one must clarify the responsibility of the colonoscopist in the diagnosis of anal neoplasms. Anal cancer is relatively rare, accounting for less than 2% of all cases annually. Owing to its rarity, population screening for anal cancer is not indicated, and monitoring is limited to high-risk groups. However, the number of anal cancer cases in high-risk groups has increased over the past four decades worldwide.
AIM
To assess the results of anal examinations performed during routine colonoscopy and emphasize the importance of diagnosing anal neoplasms.
METHODS
This was a retrospective study of 16836 patients who were screened by colonoscopy and received a detailed anal examination by videoanoscopy between 2006 and 2024. Among several other findings, the presence of anal neoplasms and suspicious anal cancer lesions was observed. All examinations, including complete anal examination, inspection, digital rectal examination, and videoanoscopy, were performed, and images were recorded and reported. The examinations were individually viewed by the work group, and the findings were analyzed.
RESULTS
Among the 22676 colonoscopies performed, 16836 patients were identified, and 88 lesions suspected of neoplasia (0.52%) were found. Among them, there were 23 cases of neoplasia (0.13%), 9 cases of confirmed squamous cell carcinoma of the anal canal (0.05%), 5 cases of adenocarcinoma in the anal canal (0.03%), 3 cases of rare neoplasms (0.01%), and 6 cases of adenoma (0.03%).
CONCLUSION
The systematic performance of anal examinations and anoscopy during routine colonoscopy allows the identification of numerous anal diseases, including incidental cases of anal cancer.
Core Tip: Endoscopists have expressed concerns that the colonoscope does not provide an adequate view of the anal canal. The use of the anoscope and rectal retroflexion allows for perfect visualization of the anal canal. This approach has led to the diagnosis of important conditions through videoanoscopy. Although the incidence of squamous cell carcinoma is extremely low, the presence of several other benign and malignant lesions justifies routine examination of the anal region.
