Prioritization of patients with rectal bleeding for urgent outpatient colonoscopy--a pilot study

Rectal bleeding is a common symptom in general practice and may be associated with colorectal neoplasia. Waiting-lists for outpatient colonoscopies and first specialist appointments are long. The aim of our study was to determine the value of presenting signs and symptoms in prioritising patients with rectal bleeding for urgent colonoscopy.

Patients were asked to fill out a 'Bowel symptoms Assessment Questionnaire' at their first visit to a Colorectal Clinic. Patients were then assessed by clinicians who referred them for further investigations as appropriate. Factors from the questionnaire (e.g. age, family history, perianal symptoms, and so on) were analysed to assess correlation with colorectal cancer or neoplasia. These were analysed using logistic regression, SPSS Answertree and 2x2 tables.

105 patients completed the questionnaire. Thirty patients had colonoscopy/barium enema. Fifteen patients had colorectal cancer (CRC) or neoplasia detected. There was a significant increase in risk of developing CRC or neoplasia in patients above the age of 67 or if they had a positive family history of CRC or neoplasia.

We conclude that patients with rectal bleeding, above the age of 67 or those with a positive family history are at a higher risk of neoplasia and should receive priority access to colonoscopy prior to first specialist assessment.