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[Role of Colonoscopy in Patients with Hematochezia]
Young Wook Kim1, Hwang Choi1, Gi Jun Kim1
1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Insights
Colonoscopy has limited value for diagnosing hematochezia, as most causes are below the sigmoid colon. Sigmoidoscopy is a more effective initial diagnostic tool for evaluating rectal bleeding.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Diagnostic Endoscopy
Background:
- Hematochezia is a common clinical presentation.
- Colonoscopy is frequently recommended for hematochezia in Korea, despite not being the primary indication.
- The diagnostic yield of colonoscopy for hematochezia requires evaluation.
Purpose of the Study:
- To assess the diagnostic value of colonoscopy in patients presenting with hematochezia.
- To determine the prevalence and location of pathologies found via colonoscopy in this patient group.
Main Methods:
- Retrospective review of colonoscopy data from January 2010 to December 2010.
- Analysis of 321 colonoscopies performed for hematochezia evaluation (10.6% of total colonoscopies).
- Exclusion of patients with prior colorectal surgery or polypectomy; definition of advanced neoplastic polyps.
Main Results:
- Hemorrhoids were the most frequent diagnosis (67.6%).
- Neoplastic polyps were found in 29.0% of patients, with advanced neoplastic polyps in only 4.4%.
- Colorectal cancers (5.6%) and diverticuli (12.8%) were diagnosed, primarily in the lower colon; only one suspected diverticular bleed was noted.
Conclusions:
- Colonoscopy offers limited diagnostic value for hematochezia due to the lower location of most pathologies.
- Sigmoidoscopy is recommended as the preferred initial diagnostic procedure for evaluating hematochezia.
Background/Aims:
Although colonoscopy is not indicated in patients with hematochezia, many surgeons, internists, and physicians are recommending colonoscopy for these patients in Korea. The aim of this study is to evaluate the diagnostic value of colonoscopy for patients with hematochezia.
Methods:
We retrospectively reviewed the data of colonoscopy between January 2010 and December 2010. A total of 321 patients among 3,038 colonoscopies (10.6%) underwent colonoscopy to evaluate the cause of hematochezia. The patients with previous colorectal surgery (2) or polypectomy (5) were excluded. We analyzed endoscopic diagnoses. Advanced neoplastic polyps were defined as adenomas with villous histology or high grade dysplasia, or adenomas more than 10 mm in diameter.
Results:
Hemorrhoid was the most common diagnosis (217 cases, 67.6%). Polyps were detected in 93 patients (29.0%), but advanced neoplastic polyps were found in only 14 cases (4.4%). Colorectal cancers were diagnosed in 18 patients (5.6%) including 14 rectal cancers. There was no cancer located above sigmoid-descending junction. Diverticuli were detected in 41 patients (12.8%) but there was only one case of suspected diverticular bleeding. Colitis was diagnosed in 24 patients (7.5%). Other lesions included acute anal fissure, rectal tumor, stercoral ulcer, and radiation proctitis.
Conclusions:
The colonoscopy had little value in patients with hematochezia because the most pathologic lesions were located below sigmoid colon. The first choice of diagnosis in patients with hematochezia is sigmoidoscopy.
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