[Rectoscopy and Hemoccult II in irritable colon. A prospective study]

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.