Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2024; 16(4): 1248-1255
Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1248
Should we perform sigmoidoscopy for colorectal cancer screening in people under 45 years?
Waiian Leong, Jia-Qi Guo, Chun Ning, Fei-Fei Luo, Rui Jiao, Dong-Ye Yang
Waiian Leong, Jia-Qi Guo, Chun Ning, Dong-Ye Yang, Division of Gastroenterology & Hepatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, Guangdong Province, China
Waiian Leong, Department of Accident & Emergency, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, Guangdong Province, China
Fei-Fei Luo, Rui Jiao, Department of Anatomical Pathology, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, Guangdong Province, China
Dong-Ye Yang, Endoscopy Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, Guangdong Province, China
Author contributions: Leong W and Yang D designed and performed the research and wrote the paper; Guo J and Ning C contributed to collect data; Leong W and Ning C contributed to analysis data; Lo F and Jiao R provided clinical advice; Yang D supervised the report.
Supported by Shenzhen Science and Technology Innovation Commission Key Program of Fundamental Research, China, No. JCYJ20210324120200001; and Shenzhen Science and Technology Program of Shenzhen Clinical Research Center for Digestive Diseases, China, No. 20220822182953001.
Institutional review board statement: The need for ethics committee or institutional review board approval was not necessary because this manuscript is a retrospective observational study that is not involved any genetic testing clinical trials and unconventional clinical practice or treatments. The analysis used anonymous clinical data.
Informed consent statement: In this retrospective observational study, patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that there is no conflict of interests.
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: Dong-Ye Yang, MD, PhD, Professor, Division of Gastroenterology & Hepatology, The University of Hong Kong-Shenzhen Hospital, No. 1 Haiyuan Street, Shenzhen 518053, Guangdong Province, China. yangdy@hku-szh.org
Received: October 13, 2023
Peer-review started: October 13, 2023
First decision: January 5, 2024
Revised: January 19, 2024
Accepted: February 28, 2024
Article in press: February 28, 2024
Published online: April 15, 2024
Processing time: 180 Days and 9.1 Hours
Abstract
BACKGROUND

The strategy for preventing colorectal cancer is screening by colonoscopy, which offers a direct way for detection and removal of adenomatous polyps (APs). American College of Gastroenterology guidelines recommend that people aged ≥ 45 years should undergo colonoscopy; however, how to deal with people aged ≤ 45 years is still unknown.

AIM

To compare the prevalence of APs and high-grade neoplasia between the left and right colon in patients ≤ 45 years.

METHODS

A retrospective observational study was conducted at a single tertiary III hospital in China. This study included patients aged 18–45 years with undergoing initial colonoscopy dissection and pathological diagnosis AP or high-grade neoplasia between February 2014 and January 2021. The number of APs in the entire colon while screening and post-polypectomy surveillance in following 1–3 years were evaluated.

RESULTS

A total of 3053 cases were included. The prevalence of APs in the left and right colon was 55.0% and 41.6%, respectively (OR 1.7, 95%CI 1.6–2.4; P < 0.05). For APs with high-grade neoplasia, the prevalence was 2.7% and 0.9%, respectively (OR 3.0, 95%CI 2.0–4.6; P < 0.05). Therefore, the prevalence of APs and high-grade neoplasia in the left colon was significantly higher than in the right colon in patients aged ≤ 45 years. There were 327 patients who voluntarily participated in post-polypectomy surveillance in following 1–3 years, and APs were found in 216 cases (66.1%); 170 cases had 1–3 polyps (52.0%) and 46 cases had > 3 polyps (14.1%; OR 0.3, 95%CI 0.1–0.6; P < 0.05).

CONCLUSION

This study suggests that flexible sigmoidoscopy would be an optimal approach for initial screening in people aged ≤ 45 years and would be a more cost-effective and safe strategy.

Keywords: Adenomatous polyps; High-grade neoplasia; Colonoscopy; Flexible sigmoidoscopy

Core Tip: This was a retrospective observational study to investigate the prevalence of adenomatous polyps (APs) and high-grade neoplasia and establish the significant difference between the left and right colon in patients aged ≤ 45 years. The prevalence of APs and high-grade neoplasia in the left colon was significantly higher than that in the right colon. This suggests that flexible sigmoidoscopy would be an optimal approach for the initial screening in people aged ≤ 45 years and would be a more cost-effective and safe strategy. Colonoscopy for post-polypectomy surveillance could be conducted at an appropriate interval of approximately 3 years.