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Diagnostic yield of colonoscopy for constipation as the sole indication
1Lerner College of Medicine, Department of Gastroenterology and the Cleveland Clinic, Cleveland, Ohio 44195, USA.
Summary
Routine colonoscopy for constipation alone has a low yield of neoplastic lesions. This procedure may be best reserved for patients over 50 years old, as older age is a risk factor for polyps.
Area of Science:
- Gastroenterology
- Colorectal Cancer Screening
- Diagnostic Endoscopy
Background:
- Constipation as an isolated symptom is a debated indication for diagnostic colonoscopy.
- Assessing the prevalence of colonic neoplasia and associated risk factors in such patients is crucial.
Purpose of the Study:
- To determine the prevalence of abnormal pathology detected via colonoscopy in patients presenting with constipation as their sole symptom.
- To identify risk factors for colonic neoplasia in this specific patient group, excluding those with high-risk symptoms.
Main Methods:
- A cross-sectional study involving 786 patients who underwent colonoscopy for constipation between 2005 and 2008.
- Review of standardized endoscopic and pathology reports.
- Univariable and multivariable analyses to assess risk factors.
Main Results:
- Of 786 patients, 5.5% had polyps (19 hyperplastic, 19 adenomas); no cancers were detected.
- Adenoma detection rates were 2.9% in patients under 40 and 1.7% under 50.
- Older age was significantly associated with polyp detection, while gender, ethnicity, and smoking were not.
Conclusions:
- Diagnostic colonoscopy for constipation as the sole indication yields fewer neoplastic lesions compared to routine screening.
- The study suggests that colonoscopy for constipation may be most warranted in patients aged 50 and above.
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