Distribution of colon neoplasia in Chinese patients: implications for endoscopic screening strategies

Objectives Our aim was to measure the prevalence and distribution of colonic neoplasia in Chinese adults, and to estimate the sensitivity of sigmoidoscopic screening strategies for detecting those with advanced neoplasia. Methods Asymptomatic, average-risk Chinese adults aged 50 years or older underwent screening colonoscopy. The prevalence and distribution of colonic neoplasia and advanced neoplasia (defined as an adenoma >= 10 mm or with villous, high-grade dysplastic, or malignant features) were reviewed retrospectively and the outcomes of various sigmoidoscopic screening strategies estimated. Results Of 1382 individuals (833 men, 549 women; mean age 58.8 years) included, 243 (18%) had colorectal neoplasia and 72 (5.2%) had advanced neoplasia. Neoplasia prevalence was significantly higher in male and older patients. No significant differences were observed in neoplasia distribution between men and women. Overall, 24 patients had advanced neoplasia in the proximal colon, of whom four had synchronous distal neoplasia. The estimated sensitivity for detecting patients with advanced neoplasia was 72% if we assumed screening sigmoidoscopy was performed, with follow-up colonoscopy for those with distal neoplasia; 165 patients would need to undergo colonoscopy. If, instead, we assumed follow-up colonoscopy was done only for patients with distal advanced neoplasia, the estimated sensitivity would decrease slightly to 71%, but the number of colonoscopies would decrease substantially to 51. Conclusion In average-risk Chinese adults, screening sigmoidoscopy is estimated to detect more than two-thirds of patients with advanced neoplasia. In Chinese societies with limited health-care resources, performing colonoscopy only on patients with distal advanced neoplasia is a screening approach that optimizes the return rate on colonoscopic capacity.