Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Dec 7;12(45):7304-8.
doi: 10.3748/wjg.v12.i45.7304.

Colonoscopic evaluation of hematochezia in low and average risk patients for colorectal cancer: a prospective study

Puglisi Carlo  1 , Russo-Francesco Paolo, Barbera Carmelo, Incarbone Salvatore, Aprile Giuseppe, Bonanno Giacomo, Russo Antonio
Affiliations

Colonoscopic evaluation of hematochezia in low and average risk patients for colorectal cancer: a prospective study

Puglisi Carlo et al. World J Gastroenterol. .

Abstract

Aim: To relate the endoscopic findings in patients with hematochezia with regard to age in "low and average risk" for colorectal cancer (CRC) and to localize significant lesions in order to identify patients who need sigmoidoscopy or total colonoscopy.

Methods: This prospective study was performed in an open access GI endoscopy unit. Out of 4322 consecutive patients undergoing colonoscopy, 918 reported hematochezia. The final study group comprized 180 patients aged below 45 and 237 over 45. Main exclusion criteria were a 1st-degree family history of colorectal carcinoma, patients reporting blood mixed with stools and/or progressive colonic symptoms, or patients who had undergone colon surgery for neoplastic lesions.

Results: Total colonoscopy could be performed in 96% of patients. Abnormal findings were observed in 34.3% of the younger and in 65.7% of the older ones. Findings were the presence of polyps in the distal colon (n = 2) and IBD in the proximal colon (n = 29) in the group of the younger patients, and polyps (n = 15), IBD (n = 13), and carcinoma (n = 6, 4 of the lesions were located proximal to the splenic flexure) in the elderly. Our findings suggest that the diagnostic potential of total colonoscopy in patients younger than 45 referring scant hematochezia, is not mandatory. By exploring only the distal tract of the colon we have misdiagnosed two cases of IBD located in the ascending colon. In this group of patients additional risk factors must be identified before performing a total colonoscopy. Regarding the patients older than 45 yr, the exploration of the distal colon would have led to our overlooking a carcinoma, two neoplastic polyps and one IBD located in the proximal colon.

Conclusion: Young patients with scant hematochezia but without risk factors for neoplasia do not need a total colonoscopy, whereas is mandatory performing a total colonoscopy in older patients even in the presence of anal pathology.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study profile.
Figure 2
Figure 2
Age-related location of "significant lesions" on the colonic mucosa.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Dent OF, Goulston KJ, Zubrzycki J, Chapuis PH. Bowel symptoms in an apparently well population. Dis Colon Rectum. 1986;29:243–247. - PubMed
    1. Crosland A, Jones R. Rectal bleeding: prevalence and consultation behaviour. BMJ. 1995;311:486–488. - PMC - PubMed
    1. Silman AJ, Mitchell P, Nicholls RJ, Macrae FA, Leicester RJ, Bartram CI, Simmons MJ, Campbell PD, Hearn CE, Constable PJ. Self-reported dark red bleeding as a marker comparable with occult blood testing in screening for large bowel neoplasms. Br J Surg. 1983;70:721–724. - PubMed
    1. Wauters H, Van Casteren V, Buntinx F. Rectal bleeding and colorectal cancer in general practice: diagnostic study. BMJ. 2000;321:998–999. - PMC - PubMed
    1. Sharma VK, Vasudeva R, Howden CW. Colorectal cancer screening and surveillance practices by primary care physicians: results of a national survey. Am J Gastroenterol. 2000;95:1551–1556. - PubMed