Mo1664 EXAMINATION OF LEFT-SIDED DIVERTICULOSIS AS A RISK FACTORS FOR DISTAL COLONIC POLYPS

Abstract

Previous studies examining the relationship between colonic polyps and diverticulosis (DV) demonstrated mixed results. Risk factors associated with adenoma detection significantly overlap factors associated with DV. In this large, single-center study, we hope to evaluate the relationship between rectosigmoid polyps (RSP) and colonic polyps (CP) with presence of DV, while controlling for risk factors associated with polyp detection. Records of all screening colonoscopies performed on patients with average risk in the Cleveland Clinic between January 2011-August 2017 were obtained. Information about patient demographics, comorbidities, procedural details, and pathology were extracted from patient electronic medical record. Differences in frequency of polyps and associated pathology were computed based on presence of diverticulosis. Significance was assessed using chi-square analysis. Next, multivariate analysis was performed to identify factors associated with presence of polyps or polyp pathology after adjusting for factors such as age, gender, race, BMI, insurance, comorbidities (diabetes, cirrhosis, dementia, stroke, constipation, coronary artery disease, heart failure), aspirin use, adequacy of bowel preparation, location, endoscopist specialty, presence of fellow, diverticulosis and withdrawal time. This analysis was done for both proximal colon (cecum to splenic flexure) and distal colon (descending colon to anus). N=52,269 patients were included (mean age =59 (St. dev. ± 8) and 25,155 (48%) were male. Frequencies of polyp distribution in proximal and distal colon based on presence of diverticulosis was computed (Table 1). In Table 1, it can be noted that presence of polyps, adenomas, advanced adenomas, and hyperplastic polyps are all significantly higher in patients with DV regardless of colonic location. However, patients with DV had greater proportion of all of these polyps in the distal colon. Additionally, as noted in adjusted analysis (Table 2), although patients with DV have increased risk of having any polyps, adenomas, hyperplastic polyps, and advanced adenomas on both sides, the magnitude of risk is greater in the distal colon for any polyps (OR=1.72 v. OR=1.23), adenomas (OR=1.62 v. OR=1.16), or advanced adenomas (OR=1.41 v. OR=1.18). WIth DV, SSPs and TV/villous occured more in the distal colon. After adjusting for multiple risk factors associated with polyps, this study demonstrates that left-sided diverticulosis is associated with greater risk of having distal polyps—especially polyps associated with high-risk of colon cancer. This is the largest study to-date to evaluate the phenomenon. While the pathophysiological mechanism is unclear, the findings of this study suggest need for closer examination for polyps in the distal colon and earlier surveillance periods for patients with diverticulosis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)