Colonoscopy: Evaluating Indications and Diagnostic Yield

Abstract

Background: Colonoscopic procedure is an accepted modality for the evaluation of colonic disease. Open-access versus restricted-access colonoscopy has been argued over in the recent literature. The aim of this retrospective analysis is to identify the yield of the major indications for the procedure, and the pattern of colon pathology in our community. Patients and Methods:We retrospectively analyzed our experience in 3000 colonoscopies over a five-year period. The patients comprised 1145 females (38%) and 1855 males (62%), and their ages ranged from 9 months to 95 years (mean 39.2). There were 2283 patients (76%) who were aged less than 55 years. Complete examination to the cecum was possible in 2850 cases (95%). Results: Pathological findings were identified in 640 patients (21%). The diagnostic yield of patients referred for lower abdominal pain and surveillance was low, at 7% and 17%, respectively. The yield was high for those with lower gastrointestinal bleeding (47%), non-bloody diarrhea (35%), iron deficiency anemia (30%), mass lesions identified by radiology (53%), and polyps identified by radiology (70%). Inflammatory bowel disease was diagnosed in 220 patients, carcinoma in 64 patients, and colonic polyps in 139 patients. Conclusion: Colonic diseases are not uncommon in our part of the world. Colonoscopy is a rewarding procedure in those patients referred with lower gastrointestinal bleeding, mass lesions, polyps and diarrhea. The procedure is less rewarding in patients with lower abdominal pain and in those undergoing surveillance colonoscopy. Patient selection on the basis of the presenting complaint may help to utilize the limited resources available to gastroenterologists. About 63% of the procedures were done for indications found to have a low yield. Inflammatory bowel disease is seen with increasing frequency in our population.

Colonoscopy at a tertiary healthcare facility in Southwest Nigeria: Spectrum of indications and colonic abnormalities

“…This was similar to the observation in other studies conducted in other parts of the country,[1113] as well as those conducted in other parts of the world. [1214] However, in the study by Sayeed et al .,[10] in Bangladesh, the most common indication was clinical suspicion of IBS whereas, Sahu et al .,[9] in India, Ogutu et al .,[15] in Kenya and Al-Shamali et al .,[16] in Kuwait found lower abdominal pain to be the most common indication for colonoscopy.…”

“…Furthermore, some studies in other parts of the world have reported much lower diagnostic yields than in this study. [912141619] Differences in indications, as well as the spectrum of colonic diseases in different parts of the world might also be of importance.…”

“…[10111213141618] Considering the fact that hematochezia was the most common indication for colonoscopy in this study, this might also be another reason for the high diagnostic yield observed.…”

“…Furthermore, in other parts of the world, Dakubo et al .,[18] Cahyono et al .,[12] and Al-Shamali et al .,[16] reported hemorrhoids, colorectal cancer, and inflammatory bowel disease, respectively as the most common diagnosis at colonoscopy. Reasons for varying findings at colonoscopy may be explained by differences in lifestyle, race, geographic locations, diets, behavioral, and environmental factors as well as the experience of the colonoscopist.…”

Adenomatous colorectal polyps in patients referred for colonoscopy in a regional hospital in Kuwait

“…An earlier study from Kuwait[13] reported a prevalence of 4.6% for various types of colorectal polyps. In our study, the overall prevalence was comparatively higher.…”