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An approach to haemorrhoids.

T Tang¹, P B Lim, R Miller

¹Colorectal Service, Addenbrooke's NHS Trust, Addenbrooke's Hospital, Cambridge, UK.

Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland

|February 22, 2005

Summary

A clinical approach for hemorrhoid patients is safe and does not miss colorectal cancer (CRC). Most patients with hemorrhoids do not require further investigation, reducing unnecessary procedures.

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Area of Science:

Gastroenterology
Colorectal Surgery
Oncology

Background:

Patients with hemorrhoids often undergo extensive investigations due to concerns about missing colorectal cancer (CRC).
A clinical assessment may be sufficient for managing hemorrhoid patients, potentially avoiding unnecessary invasive procedures.

Purpose of the Study:

To evaluate the safety and efficacy of a primarily clinical approach in patients diagnosed with hemorrhoids.
To determine if this approach leads to missed diagnoses of colorectal cancer.

Main Methods:

Prospective data collection from 589 consecutive hemorrhoid patients.
Clinical assessment including rigid sigmoidoscopy and treatment (phenol injection or banding).
Patients categorized into 'One Stop SOS', outpatient review, or investigation groups, with follow-up via questionnaire/telephone and database cross-referencing.

Main Results:

No colorectal cancer (CRC) was detected in patients managed with the 'one-stop' clinical approach.
Five (0.8%) patients were diagnosed with CRC after investigations were initiated for suspicious symptoms.
One case of distal transverse colon cancer had a delayed diagnosis due to initial flexible sigmoidoscopy.

Conclusions:

A primarily clinical approach is safe for the majority of patients presenting with hemorrhoids.
Routine investigation for colorectal cancer in all hemorrhoid patients is not necessary.
This strategy can help avoid unnecessary investigations and associated healthcare costs.

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