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[Rectoscopy and Hemoccult II in irritable colon. A prospective study]
C P Hovendal1, O Kronborg, J Hem
1Kirurgisk gastroenterolgoisk afdeling K, Odense Sygehus.
Insights
The Hemoccult-II test (H-II) can help reduce unnecessary colon examinations for irritable bowel syndrome patients with normal initial findings. A negative H-II result suggests a low priority for further colonic investigation.
Area of Science:
- Gastroenterology
- Colorectal Cancer Screening
- Diagnostic Accuracy
Background:
- Irritable bowel syndrome (IBS) patients often undergo extensive investigations.
- The utility of the Hemoccult-II test (H-II) in guiding colonic examinations for IBS is not fully established.
- Normal rigid proctoscopy and negative H-II may indicate a lower risk of significant colonic pathology.
Purpose of the Study:
- To evaluate if the Hemoccult-II test (H-II) can reduce the need for colonic examinations in patients with irritable bowel syndrome (IBS) and normal proctoscopic findings.
- To determine the diagnostic yield of colonic examinations based on H-II results in this patient group.
Main Methods:
- Prospective study involving patients with IBS and normal rigid proctoscopy.
- Random allocation to colonoscopy or double contrast barium enema following H-II testing.
- Follow-up clinical examination after one year.
Main Results:
- Among 299 patients with a negative H-II, 10 colonic adenomas and 1 early sigmoid cancer were detected. Three rectal adenomas, 1 rectal cancer, 1 rectal carcinoid, and 1 cecal cancer were also found.
- Among 9 patients with a positive H-II, 2 colonic cancers and 1 adenoma were detected.
- All patients with positive H-II underwent colonoscopy.
Conclusions:
- Colonic examination has low priority for IBS patients with negative H-II and normal proctoscopy by an experienced examiner.
- Total colonoscopy is recommended for patients with a positive H-II.
- Endoscopy services should be prioritized over diagnostic radiology for colonic evaluations.
Abstract:
It was investigated whether Hemoccult-II test (H-II) could reduce the number of colonic examinations in patients with the irritable bowel syndrome, with normal rigid proctoscopic findings. A negative H-II was obtained in 299 patients from general practice and a positive test in nine. Colonoscopy was done in 157 and double contrast barium enema in 142 after random allocation. The nine patients with positive H-II all had colonoscopy. Among the 299 with negative H-II, colonic adenomas were detected in ten and an early cancer in an adenoma in the sigmoid colon; overlooked rectal adenomas were found in three, rectal cancer in one, rectal carcinoid in another and a coecal cancer, which could be palpated, in a third patient. Two patients with colonic cancer and one with adenoma were detected among those with positive H-II. All patients were followed by clinical examination after one year. In conclusion, colonic examination should carry a low priority in patients with symptoms of irritable bowel, negative Hemoccult-II and normal rigid proctoscopic findings performed by an experienced examiner. The investigation confirmed the recommendation of total colonoscopy in patients with a positive H-II and added support for increasing number of endoscopy services in contrast to those of diagnostic radiology, which should be reduced.