Abstract
Objective: Patients with rectal bleeding are being over investigated because of the fear of missing colorectal cancers. This study aimed to identify the percentage of patients <45 years of age who undergo flexible sigmoidoscopy for rectal bleeding, and to assess and compare the incidence of colorectal cancers and polyps above and below this age.
Methods: Patients who underwent flexible sigmoidoscopy for rectal bleeding between 1 January 2000 and 31 December 2002 were reviewed. Patients were divided into two groups: group 1 consisted of patients aged ⩾45 years and group 2 patients <45 years. The histopathology of biopsy specimens taken was also studied.
Results: Altogether 18.9% of the patients who had flexible sigmoidoscopy for rectal bleeding were <45 years. The incidence of colorectal cancers in group 1 was 3.5%; all these cases were confirmed on histopathology. Only one patient in group 2 was diagnosed with colorectal cancer on flexible sigmoidoscopy, but the histopathology disproved it. The incidence of polyps was 16.6% in group 1 and 7.9% in group 2. Following histopathology, the incidence of adenomatous polyps was 6.8% in group 1 and 2.1% in group 2. There was a significant difference between the two groups, with a p value of <0.0001.
Conclusion: The incidence of colorectal cancers and adenomatous polyps in patients aged <45 years with rectal bleeding is very low. A flexible sigmoidoscopy costs approximately £330. If new guidelines are implemented considering the age of the patient, considerable cost savings could be made, and the available resources could be appropriately used in groups with high incidences of colorectal cancers.
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Selected References
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- Church J. M. Analysis of the colonoscopic findings in patients with rectal bleeding according to the pattern of their presenting symptoms. Dis Colon Rectum. 1991 May;34(5):391–395. doi: 10.1007/BF02053689. [DOI] [PubMed] [Google Scholar]
- Douek M., Wickramasinghe M., Clifton M. A. Does isolated rectal bleeding suggest colorectal cancer? Lancet. 1999 Jul 31;354(9176):393–393. doi: 10.1016/s0140-6736(99)02296-5. [DOI] [PubMed] [Google Scholar]
- Fijten G. H., Starmans R., Muris J. W., Schouten H. J., Blijham G. H., Knottnerus J. A. Predictive value of signs and symptoms for colorectal cancer in patients with rectal bleeding in general practice. Fam Pract. 1995 Sep;12(3):279–286. doi: 10.1093/fampra/12.3.279. [DOI] [PubMed] [Google Scholar]
- Fine K. D., Nelson A. C., Ellington R. T., Mossburg A. Comparison of the color of fecal blood with the anatomical location of gastrointestinal bleeding lesions: potential misdiagnosis using only flexible sigmoidoscopy for bright red blood per rectum. Am J Gastroenterol. 1999 Nov;94(11):3202–3210. doi: 10.1111/j.1572-0241.1999.01519.x. [DOI] [PubMed] [Google Scholar]
- Helfand M., Marton K. I., Zimmer-Gembeck M. J., Sox H. C., Jr History of visible rectal bleeding in a primary care population. Initial assessment and 10-year follow-up. JAMA. 1997 Jan 1;277(1):44–48. [PubMed] [Google Scholar]
- Sladden M. J., Thomson A. N. How do general practitioners manage rectal bleeding? Aust Fam Physician. 1998 Jan-Feb;27(1-2):78–82. [PubMed] [Google Scholar]
- Talley N. J., Jones M. Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking. Am J Gastroenterol. 1998 Nov;93(11):2179–2183. doi: 10.1111/j.1572-0241.1998.00530.x. [DOI] [PubMed] [Google Scholar]
- Van Rosendaal G. M., Sutherland L. R., Verhoef M. J., Bailey R. J., Blustein P. K., Lalor E. A., Thomson A. B., Meddings J. B. Defining the role of fiberoptic sigmoidoscopy in the investigation of patients presenting with bright red rectal bleeding. Am J Gastroenterol. 2000 May;95(5):1184–1187. doi: 10.1111/j.1572-0241.2000.02007.x. [DOI] [PubMed] [Google Scholar]