Colonic Neoplasia In Patients Research Articles

P172 Examining dysplasia surveillance in Inflammatory Bowel Disease and Primary Sclerosing Cholangitis - a real world experience

Abstract Background Patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) are at high risk of developing colorectal cancer (CRC). Current guidelines recommend annual colonoscopic surveillance immediately following the diagnosis of PSC. This study aimed to assess the surveillance strategy and outcomes in IBD-PSC patients undergoing surveillance for colonic neoplasia (CN). Methods We performed a retrospective audit of all patients with IBD-PSC at an IBD and liver transplantation referral centre from 2013–2021, to determine the prevalence and management of dysplasia and CRC and evaluate the adequacy of colonoscopic surveillance. Surveillance was considered up-to-date if colonoscopy was performed at 12 month intervals +/- 3 months. Results Ninety-three patients diagnosed with IBD-PSC were identified. Patients who had undergone colectomy prior to enrolment or had colonoscopy performed externally were excluded. Sixty-nine patients were included in the final analysis. Thirty-three percent (23/69) of the cohort developed CN, with an overall rate of dysplasia of 25% (17/69) and CRC in 10% (7/69). Median time to development of CN from IBD diagnosis was 18 years (IQR 10.5–23.75). Only 23% (12/53) of patients were up-to-date with annual colonoscopic surveillance and following detection of neoplasia, chromoendoscopy was utilised in 9% of patients (2/23). The rate of CN in patients with up-to-date surveillance was 6/12 (50%), three with low grade dysplasia (LGD) and three indefinite for dysplasia (IND), versus 10/41 (24%, p=0.89) in those without up-to-date surveillance, 6 with LGD, 1 with IND and 2 with CRC. Rates of CN were not significantly different between patients who had or had not undergone liver transplantation (18/44 (41%) vs 6/25 (24%), p=0.16). Most patients were managed in Liver Transplant Unit (LTU) clinic (33/69, 48%). Forty-one percent (28/69) were seen in both LTU and IBD clinics, whilst a small number were seen in General Liver clinic (3/69, 4%) and IBD clinic (5/69, 7%) only. The rate of up-to-date surveillance was highest amongst those who were seen in both LTU and IBD clinics (8/28, 29%). In patients with CN, surgery was performed in 46% of cases (11/24): 25% (6/24) underwent sub-total colectomy; whereas, 21% (5/24) underwent segmental colectomy. Two patients developed recurrent dysplasia following segmental colectomy. Conclusion In this cohort of IBD-PSC, rates of dysplasia and CRC were high. Adherence to annual colonoscopy surveillance and chromoendoscopy was low. Surgical management of dysplasia or CRC varied. Multidisciplinary coordination between hepatology and IBD specialist services should be implemented to optimise dysplasia surveillance and management.

Nancy Index Scores of Chronic Inflammatory Bowel Disease Activity Associate With Development of Colorectal Neoplasia

The degree of histologic and endoscopic disease activity has been associated with an increased risk of colorectal neoplasia (CRN) in patients with inflammatory bowel diseases (IBDs), but no histologic scoring systems have been validated for determining risk of CRN. We investigated the association between histologic and endoscopic disease activity and risk of first CRN in patients with IBD who had negative findings from a surveillance colonoscopy. We performed a retrospective analysis of consecutive patients who underwent at least 2 colonoscopies at Saint Antoine Hospital in France from January 1, 1996, through March 1, 2015, and whose first procedure was a surveillance colonoscopy. Histologic IBD activity was assessed by the Nancy histologic index. Patients were followed up for a mean 5.7 ± 3.3 years. Logistic regression and generalized estimating equations were used to identify clinical, endoscopic, and histologic factors associated with detection of neoplasia in the inflamed colon mucosa. Among 398 patients who underwent 1277 colonoscopies, we identified 45 patients with CRN. Factors associated with CRN were primary sclerosing cholangitis (odds ratio [OR], 2.65; 95% CI, 1.06-6.61; P= .04), age (OR per 1-year increase, 1.04; 95% CI, 1.01-1.07; P= .003), and mean Nancy histologic index during follow-up evaluation (per 1-unit increase, OR, 1.69; 95% CI, 1.29-2.21; P < .001). After adjustment for established factors, chronic disease activity defined as detection of ulcerations at more than 50% of colonoscopies was not associated with an increased risk of CRN (OR, 1.24; 95% CI, 0.53-2.91; P= .62). In addition to established risk factors, we associated Nancy histologic index scores with development of CRN. Histologic findings based on the Nancy histologic index therefore should be included in determining the risk of colonic neoplasia in patients with IBD.

P334 Chromoendoscopy is superior to white light endoscopy for the detection of advanced colonic neoplasia in patients with inflammatory bowel disease

P334 Chromoendoscopy is superior to white light endoscopy for the detection of advanced colonic neoplasia in patients with inflammatory bowel disease

The Incidence of Colonic Neoplasia in Patients With Microscopic Colitis and Chronic Diarrhea: A Retrospective Case Control Study

The Incidence of Colonic Neoplasia in Patients With Microscopic Colitis and Chronic Diarrhea: A Retrospective Case Control Study

Su1674 Incidence of Colonic Neoplasia in Patients With Breast Cancer: Updated Systematic Review and Meta-Analysis

Su1674 Incidence of Colonic Neoplasia in Patients With Breast Cancer: Updated Systematic Review and Meta-Analysis Jennifer H. Lai, Gavin Park, Lauren B. Gerson* Gastroenterology, California Pacific Medical Center, San Francisco, CA; Internal Medicine, California Pacific Medical Center, San Francisco, CA Background: Patients with breast cancer are advised to undergo screening for colon cancer every 5 years due to a perceived increase in cancer risk. Methods: We searched Pubmed (1970-2014) and Cochrane Central Registry of Clinical Trials and included the following search terms: “colorectal neoplasms,” “genes, BRACA1”, “genes BRCA2,” “breast neoplasms,” as well as title words “breast and colorectal” with text word “screening.” The initial analysis included cohort studies that assessed prevalence of colorectal cancer (CRC) in patients with breast cancer. Subsequent analysis focused on case-control studies that assessed prevalence of advanced colonic adenomas and/or cancer in patients with breast cancer. We used Comprehensive Meta-Analysis (CMA, Version 3, Biostat, Inc) to perform the statistical analysis including construction of Forest plots, and assessment of heterogeneity and/or publication bias. For cohort studies, results were reported as pooled prevalence rates with 95% confidence intervals (CI). We determined odds ratios (OR) for casecontrol studies using random effects modeling. Subjects with a diagnosis of breast cancer who had undergone subsequent screening colonoscopy examinations after the initial cancer diagnosis were included. Results: The search yielded 93 articles. We included 30 cohort studies and 9 case-control studies in the analysis. The 30 cohort studies included 2,228,229 patients with breast cancer of whom 21353 (0.9%) developed subsequent colorectal cancer. The pooled prevalence rate of CRC was 0.9% (95% CI 0.7-1%, pZ0). There was significant heterogeneity between studies (IZ99%, pZ0.0) but no evidence of publication bias. In the 4 case-control studies (including 17,827 breast cancer patients and 70,242 controls) reporting numbers of patients subsequently diagnosed with CRC, a non-significant increase in CRC was reported for breast cancer patients (OR 1.2, 95% CI 0.4-3.3, pZ0.7). There were 4 case-control studies assessing risk of adenomatous polyps (including 610 patients with breast cancer and 882 controls) demonstrating an increased risk of advanced adenoma that was not statistically significant (OR 1.8, 95% CI 0.9-3.8, pZ0.08) with moderate heterogeneity between studies (IZ70%, pZ0.003) There was insufficient data to perform subgroup analyses on the usage of tamoxifen and subsequent CRC risk or mean patient age for cases compared to controls. Conclusions: The overall rate of colorectal cancer did not appear to be increased in patients with breast cancer. Colorectal cancer screening in these patients should occur according to current society guidelines.

The role of colonoscopy in managing diverticular disease of the colon.

Diverticulosis of the colon is frequently found on routine colonoscopy, and the incidence of diverticular disease and its complications appears to be increasing. The role of colonoscopy in managing this disease is still controversial. Colonoscopy plays a key role in managing diverticular bleeding. Several techniques have been effectively used in this field, but band ligation seems to be the best in preventing rebleeding. Colonoscopy is also effective in posing a correct differential diagnosis with other forms of chronic colitis involving colon harbouring diverticula (in particular with Crohn's disease or Segmental Colitis Associated with Diverticulosis). The role of colonoscopy to confirm diagnosis of uncomplicated diverticulitis is still under debate, since the risk of advanced colonic neoplasia in patients admitted for acute uncomplicated diverticulitis is not increased as compared to the average-risk population. On the contrary, colonoscopy is mandatory if patients complain of persistent symptoms or after resolution of an episode of complicated diverticulitis. Finally, a recent endoscopic classification, called Diverticular Inflammation and Complications Assessment (DICA), has been developed and validated. This classification seems to be a promising tool for predicting the outcome of the colon harboring diverticula, but further, prospective studies have to confirm its predictive role on the outcome of the disease.

Mechanisms of Immune Signaling in Colitis-Associated Cancer

The inflammatory bowel diseases ulcerative colitis and Crohn’s disease are associated with an increased risk for the development of colorectal cancer. During recent years, several immune signaling pathways have been linked to colitis-associated cancer (CAC), largely owing to the availability of suitable preclinical models. Among these, chronic intestinal inflammation has been shown to support tumor initiation through oxidative stress–induced mutations. A proinflammatory microenvironment that develops, possibly as a result of defective intestinal barrier function and host–microbial interactions, enables tumor promotion. Several molecular pathways such as tumor necrosis factor/nuclear factor-κB or interleukin 6/signal transducer and activator of transcription 3 signaling have been identified as important contributors to CAC development and could be promising therapeutic targets for the prevention and treatment of CAC.

Exam 1: Incidence of Colonic Neoplasia in Patients With Serrated Polyposis Syndrome Who Undergo Annual Endoscopic Surveillance

Exam 1: Incidence of Colonic Neoplasia in Patients With Serrated Polyposis Syndrome Who Undergo Annual Endoscopic Surveillance

Mo1076 Should Serum Ferritin Be Used as a Predictive Marker for Colonic Neoplasia in Patients With Iron Deficiency Anemia?

Mo1076 Should Serum Ferritin Be Used as a Predictive Marker for Colonic Neoplasia in Patients With Iron Deficiency Anemia?

Incidence of Colonic Neoplasia in Patients With Serrated Polyposis Syndrome Who Undergo Annual Endoscopic Surveillance

Patients with serrated polyposis syndrome (SPS) are advised to undergo endoscopic surveillance for early detection of polyps and prevention of colorectal cancer (CRC). The optimal surveillance and treatment regimen is unknown. We performed a prospective study to evaluate a standardized endoscopic treatment protocol in a large cohort of patients with SPS. We followed a cohort of patients with SPS who received annual endoscopic surveillance at the Academic Medical Centre in Amsterdam, The Netherlands from January 2007 through December 2012. All patients underwent clearing colonoscopy with removal of all polyps ≥3 mm. After clearance, subsequent follow-up colonoscopies were scheduled annually. The primary outcomes measure was the incidence of CRC and polyps. Secondary outcomes were the incidence of complications and the rate of preventive surgery. Successful endoscopic clearance of all polyps ≥3 mm was achieved in 41 of 50 (82%) patients. During subsequent annual surveillance, with a median follow-up time of 3.1 years (interquartile range, 1.5-4.3 years), CRC was not detected. The cumulative risks of detecting CRC, advanced adenomas, or large (≥10 mm) serrated polyps after 3 surveillance colonoscopies were 0%, 9%, 34%, respectively. Twelve patients (24%) were referred for preventive surgery; 9 at initial colonoscopy and 3 during surveillance. Perforations or severe bleeding did not occur. Annual surveillance with complete removal of all polyps ≥3 mm with timely referral of selected high-risk patients for prophylactic surgery prevents development of CRC in SPS patients without significant morbidity. Considering the substantial risk of polyp recurrence, close endoscopic surveillance in SPS seems warranted. www.trialregister.nl ID NTR2757.

Inflammation Is an Independent Risk Factor for Colonic Neoplasia in Patients With Ulcerative Colitis: A Case–Control Study

An association between inflammatory activity and colorectal neoplasia (CRN) has been documented in patients with ulcerative colitis (UC). However, previous studies did not address the duration of inflammation or the effects of therapy on risk for CRN. We investigated the effects of inflammation, therapies, and characteristics of patients with UC on their risk for CRN. We collected data from 141 patients with UC without CRN (controls) and 59 matched patients with UC who developed CRN (cases), comparing disease extent and duration and patients' ages. We used a new 6-point histologic inflammatory activity (HIA) scale to score biopsy fragments (n = 4449). Information on medications, smoking status, primary sclerosing cholangitis, and family history of CRN were collected from the University of Chicago Inflammatory Bowel Disease Endoscopy Database. Relationships between HIA, clinical features, and CRN were assessed by conditional logistic regression. Cases and controls were similar in numbers of procedures and biopsies, exposure to steroids or mesalamine, smoking status, and family history of CRN. They differed in proportion of men vs women, exposure to immune modulators, and primary sclerosing cholangitis prevalence. In univariate analysis, HIA was positively associated with CRN (odds ratio [OR], 2.56 per unit increase; P = .001), whereas immune modulators (including azathioprine, 6-mercaptopurine, and methotrexate) reduced the risk for CRN (OR, 0.35; P < .01). HIA was also associated with CRN in multivariate analysis (OR, 3.68; P = .001). In a case-control study, we associated increased inflammation with CRN in patients with UC. Use of immune modulators reduced the risk for CRN, indicating that these drugs have chemoprotective effects. On the basis of these data, we propose new stratified surveillance and treatment strategies to prevent and detect CRN in patients with UC.

Does acetylsalicylic acid or warfarin affect the accuracy of fecal occult blood tests?

Current guidelines for screening of colorectal cancer do not offer specific recommendations for cessation of antithrombotic agents prior to fecal occult blood test (FOBT). To asess the accuracy of FOBT in patients taking acetylsalicylic acid (ASA) or warfarin. A literature search was conducted for studies that investigated the accuracy of FOBT in patients taking ASA and warfarin. The primary outcome was the pooled relative risk (RR) for true positive FOBT for detecting significant colonic neoplasia in patients taking ASA or warfarin compared with controls. The secondary outcome was a pooled RR for true positive in guaiac FOBT (g-FOBT) compared with immunochemical FOBT (i-FOBT). Five observational studies included 759 patients taking ASA and 1652 control subjects. In patients taking ASA, pooled RR for true positive FOBT was 0.82 (95% confidence interval [CI] 0.73-0.93, P=0.0009), pooled RR for true positive g-FOBT was 0.69 (95% CI 0.60-0.79, P<0.0001), whereas pooled RR for true positive i-FOBT was 1.013 (95% CI 0.81-1.30, P=0.8182). Five observational studies included 806 patients taking warfarin and 10 338 control subjects. In patients taking warfarin, pooled RR for true positive FOBT was 1.559 (95% CI 1.349-1.801, P<0.0001). The results of our meta-analysis demonstrate that in patients taking ASA, there is a decrease in the positive predictive value (PPV) of g-FOBT but no significant difference in the PPV of i-FOBT compared with control subjects for detecting significant neoplasia. In patients taking warfarin, the PPV of FOBT was increased for detection of colorectal cancer compared with control subjects.

Mo1574 Increased Risk of Colonic Neoplasia in Patients With Sporadic Duodenal Adenomas

although colorectal neoplasia is recognized to occur more frequently in patients with familial adenomatous polyposis (FAP), association with sporadic duodenal adenomas (SDA) has not been clearly established.

Colonic neoplasia in young patients with inflammatory bowel disease and primary sclerosing cholangitis

Current guidelines recommend annual surveillance for colorectal cancer (CRC) in all patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC). The aim of our study was to validate the need for annual surveillance for colon neoplasia in patients ≤45 of age with a combined diagnosis of PSC and IBD. We identified patients, ≤45 years of age with a combined diagnosis of PSC and IBD, who were seen at the Mayo Clinic between 1995 and 2010. We then reviewed the medical records of the patients who developed colonic neoplasia defined as cancer, high-grade dysplasia (HGD) or dysplasia-associated lesion or mass (DALM). In the population of 784 patients ≤45 years of age with a combined diagnosis of PSC and IBD, 10 (1.3%) of 784 developed colonic neoplasia during the follow-up period. Seven patients had colon cancer, one had HGD and two had a DALM. Colonic neoplasia is uncommon in young patients (≤45 years of age) with a combined diagnosis of PSC and IBD. We suggest delaying surveillance in young patients and propose that studies should be carried out to clarify the cost-effectiveness of annual or biannual surveillance colonoscopies according to patient age.

Ursodeoxycholic acid in patients with ulcerative colitis and primary sclerosing cholangitis for prevention of colon cancer: a meta-analysis

Colon cancer risk is high in patients with ulcerative colitis (UC) and primary sclerosing cholangitis (PSC). Ursodeoxycholic acid has been shown to have some promise as a chemopreventive agent. A meta-analysis was performed to compare the efficacy of ursodeoxycholic acid in the prevention of colonic neoplasia in patients with UC and PSC. Multiple databases were searched (January 2011). Studies examining the use of ursodeoxycholic acid vs. no ursodeoxycholic acid or placebo in adult patients with UC and PSC were included. Data were extracted in standard forms by two independent reviewers. Meta-analysis for the effect of ursodeoxycholic acid was performed by calculating pooled estimates of adenoma or colon cancer formation by odds ratio (OR) with random effects model. Heterogeneity was assessed by calculating the I (2) measure of inconsistency. RevMan 5 was utilized for statistical analysis. Four studies (n = 281) met the inclusion criteria. The studies were of adequate quality. Ursodeoxycholic acid demonstrated no overall improvement in adenoma (OR 0.53; 95 % CI: 0.19-1.48, p = 0.23) or colon cancer occurrence (OR 0.50; 95 % CI: 0.18-1.43, p = 0.20) as compared to no ursodeoxycholic acid or placebo in patients with UC and PSC. Ursodeoxycholic acid use in patients with UC and PSC does not appear to decrease the risk of adenomas or colon cancer.

Diagnostic yield of colonoscopy for constipation as the sole indication

There is controversy over whether constipation as the only symptom should be an indication for routine diagnostic colonoscopy. The study was carried out to assess the prevalence of abnormal pathology on colonoscopy and to assess the risk factors for colonic neoplasia in patients with constipation but without 'high risk symptoms'. A cross-sectional, single-centre study was conducted on individuals who underwent colonoscopy for constipation as the sole indication between 2005 and 2008. Standardized endoscopic and pathology reports were reviewed. Univariable and multivariable analyses were performed. A total of 786 patients (595 women, 75.7%; mean age, 57.4±13.5 years) underwent diagnostic colonoscopy for constipation. Forty-three (5.5%) had polyps, of whom 19 (2.4%) had hyperplastic polyps and 19 (2.4%) adenomas. No cancers were found. In patients with adenoma, the detection rate was 2.9% for patients below age 40 years and 1.7% for patients below age 50 years. Older age was associated with a polyp in both univariate and multivariate analysis. Gender, ethnicity and smoking were not associated with polyp or adenoma. Colonoscopy for patients with constipation as the sole indication had a lower yield of neoplastic lesions than that for patients undergoing routine screening colonoscopy. Colonoscopy in constipation may only be warranted in patients who are over 50 years of age.

Ursodiol Use for the Chemoprevention of Colorectal Cancer in Patients with Ulcerative Colitis and Primary Sclerosing Cholangitis: A Metaanalysis

Purpose: In patients with ulcerative colitis (UC) and primary sclerosing cholangitis (PSC), the risk of colon cancer is elevated. Many modalities have been utilized to decrease the occurrence of colon cancer in these patients, from surveillance colonoscopy to chemoprevention. Ursodiol has been shown to have some promise as a chemopreventive agent; however, results have varied and trials have been small. Therefore, a meta-analysis was performed comparing the efficacy of ursodiol at prevention of colonic neoplasia in patients with UC and PSC. Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, CINAHL, PubMed, and recent abstracts from major conferences were searched (4/11). Studies examining the use of ursodiol versus no ursodiol or placebo in adult patients with UC and PSC were included. Standard forms were used to extract data by two independent reviewers. Meta-analysis for the effect of ursodiol or no ursodiol was performed by calculating pooled estimates of adenoma or colon cancer formation by odds ratio (OR) with random effects model. Heterogeneity was assessed by calculating the I2 measure of inconsistency. RevMan 5.1 was utilized for statistical analysis. Results: Four studies (N=281) met the inclusion criteria. Although a trend was noted for improvement, ursodiol demonstrated no overall statistically significant improvement in adenoma occurrence (OR 0.53; 95% CI: 0.19-1.48, p=0.23) or colon cancer occurrence (OR 0.50; 95% CI: 0.18-1.43, p=0.20) as compared to no ursodiol or placebo in patients with UC and PSC. Conclusion: Ursodiol use in patients with UC and PSC does not appear to significantly decrease the risk of adenomas or colon cancer. Further randomized controlled trials are required to fully investigate the use of ursodiol in patients with UC and PSC.

High-dose ursodeoxycholic acid is associated with risk of colonic neoplasia in patients with PSC and ulcerative colitis

Primary sclerosing cholangitis: High-dose ursodeoxycholic acid is associated with risk of colonic neoplasia in patients with PSC and ulcerative colitis

Incidence of Colonic Neoplasia in Patients with a Family History of Colorectal Cancer

Purpose: In 2005 we reported the incidence of colonic neoplasia in patients of average risk undergoing their first colonoscopy. We found that 24.2% had adenomas and 15.8% had hyperplastic polyps. Only 0.23% were diagnosed with cancer. The intent of this study was to determine the incidence of neoplasia in patients with a family history of colorectal cancer (CRC). Methods: This study was a retrospective chart review of patients undergoing their initial colonoscopy that have a family history of CRC. The primary objective was to determine the incidence of colorectal neoplasia in patients with a first degree relative with CRC. The secondary objective was to determine the incidence of neoplasia in patients with a second degree relative with CRC. All patients had a complete colonoscopy by one of the authors and all histology was reviewed by a single division of gastrointestinal pathologists. Results: 432 patient charts were available for review from a 4 year period. 254 patients were female and 178 male. The mean age was 57.2 years. 377 had first degree relatives with CRC and 55 had second degree relatives. Of the first degree patients 180 (47.75%) had one or more adenomas. 57 (15.12%) had hyperplastic polyps and 4 had CRC (1.06%). In patients with second degree relatives, 22 (40%) had one or more adenomas and 5 (9.09%) had hyperplastic polyps. None had CRC. Conclusion: 1. Patients with first degree family members having CRC are at a significant risk for having adenomas. The rate of 47.75% is nearly twice that found in average risk patients (24.2%). 2. The incidence of hyperplastic polyps is essentially the same between the first degree family group (15.12%) and the average-risk population (15.8%). 3. Though the numbers of second degree patients were low, this data suggest they also are at an increased risk (40% vs. 24.2%) compared to the average-risk population. 4. These findings should serve as an excellent educational tool in counseling patients about CRC screening with a positive family history.

Increased risk of colonic neoplasia in patients with sporadic duodenal adenoma

Recent studies have shown an increased risk of colorectal neoplasia in patients with duodenal neoplasia. The aim of this retrospective case-control study was to confirm this risk. Rate of colorectal neoplasia in 29 patients with one or more duodenal adenomas were compared with controls matched for gender and age, but without duodenal adenomas (one case to two controls). Patients with neoplasia of the ampulla, familial adenomatous polyposis or other known hereditary conditions of the digestive tract were excluded. Indications for upper and lower gastrointestinal endoscopy in controls were abdominal pain or changes in bowel habits. Controls with anemia or digestive bleeding were not included. Neoplastic lesions found at colonoscopy were classified as adenomas, advanced adenomas (size > or =10 mm, villous component, high-grade dysplasia), cancers and advanced neoplasia (cancers and advanced adenomas). Comparison between groups was by Fisher's exact test or Student's t test. Odds-ratios (OR) and 95% confidence intervals were calculated, if the difference was significant. Mean age of the 29 cases (seven women, 22 men) was 63.2 years and that of the 58 controls (14 women, 44 men) was 62.5 years. First-degree family history of colorectal cancer was present in four cases (13.8%) and eight controls (13.8%) (NS). Colonoscopy showed at least one adenoma in 15 cases (51.7%) and 11 controls (19%) (P=0.0027; OR 1.87, 1.0-3.49), advanced adenomas in four cases (13.8%) and three controls (5.2%) (NS), and colonic adenocarcinoma in three cases (10.3%) and no controls (0%) (P=0.03). Advanced neoplasia was present in seven cases (24.1%) and three controls (5.2%) (P=0.014; OR 2.86, 0.96-8.52). Results were not significantly modified after the exclusion of patients with a family history of colorectal cancer. Although lacking in statistical power, these results confirm that patients with sporadic duodenal adenoma are at high risk of colonic adenoma and advanced neoplasia, warranting systematic colonoscopy.