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Preferable colonic investigations for isolated abdominal pain
Christian P Selinger1, Javaid Iqbal, Robert P Willert
1Department of Gastroenterology Manchester Royal Infirmary, Manchester, United Kingdom. christian.selinger@web.de
Southern Medical Journal
|February 8, 2011
Summary
Colonic investigations for isolated abdominal pain frequently detect polyps, though these may not explain symptoms. Computed tomographic colonography (CTC) offers a less invasive alternative to optical colonoscopy (OC) with similar pathology detection rates.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Colorectal Cancer Screening
Background:
- Isolated abdominal pain is often considered a low-yield indication for colonic investigations.
- Published data on the diagnostic yield of optical colonoscopy (OC) for abdominal pain varies significantly.
- Establishing the efficacy of colonic investigations for isolated abdominal pain is crucial for optimizing patient care.
Purpose of the Study:
- To determine the diagnostic yield of colonic investigations for patients presenting with isolated abdominal pain.
- To compare the yield of optical colonoscopy (OC) and computed tomographic colonography (CTC) in detecting colonic pathology in this patient group.
Main Methods:
- Retrospective analysis of an endoscopy database for optical colonoscopies (OC) performed between 2000 and 2008.
- Comparison of OC yield for pathology detection (polyps, cancers, inflammatory bowel disease) across different indications: abdominal pain, chronic diarrhea, and anemia.
- Analysis of computed tomographic colonography (CTC) data from 2008 for patients with isolated abdominal pain to compare its yield with OC.
Main Results:
- Optical colonoscopy (OC) and computed tomographic colonography (CTC) were performed for isolated abdominal pain in 5.4% and 8.2% of cases, respectively.
- The overall pathology detection rate for OC in patients with abdominal pain (23.87%) was comparable to other indications (20.34-24.85%).
- CTC demonstrated a similar pathology detection yield (20.93%) to OC, with colonic polyps being the most common finding in both procedures.
Conclusions:
- Colonic investigations for isolated abdominal pain yield a significant rate of incidental colonic pathology, primarily polyps.
- While polyp detection is beneficial, it may not always explain the presenting abdominal pain.
- Computed tomographic colonography (CTC) provides a less invasive alternative to OC for detecting colonic pathology, potentially sparing 75% of patients from colonoscopy if used as a first-line investigation.
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