Is Colonoscopy Indicated in Young Patients with Hematochezia

Abstract

Background/Aims: While colonoscopy is indicated in patients >50 years old presenting with hematochezia, its role in those ≤50 remains debatable. This study aims to evaluate the role of colonoscopy in patients presenting with hematochezia who are ≤50 years old. Methods: A retrospective review of all patients aged ≤50 years who underwent colonoscopy for hematochezia in 2012 was conducted. Patient demographics, endoscopic details, and histological results were analyzed. Patients were stratified by age to compare differences in outcome. Results: A total of 361 patients with a median age of 44 (range, 18-50) years were reviewed. Hemorrhoid (n = 183, 69.6%) was the most common etiology. Seventy-two neoplastic polyps were identified in 48 (13.3%) patients. There was a significantly larger proportion of patients aged 41-50 years who had neoplastic polyps compared to those aged ≤40 (18.8 vs. 3.8%, p ≤ 0.001); 43.8% (n = 28) of the neoplastic polyps found in those aged 41-50 were proximal to the splenic flexure. The only 2 (0.5%) patients with malignancy were aged 41-50 years. Conclusion: Performing colonoscopy in patients presenting with hematochezia should be strongly considered for those aged 41-50 years in view of the significant likelihood of underlying neoplastic polyps compared to those aged ≤40 years.

Increasing rate of colorectal cancer in younger patients: a review of colonoscopy findings in patients under 50 at a tertiary institution

“…and Koh et al ., who had significant findings in 11–15% of procedures. The specific incidence of CRC was greater in our study, with 1.9% of patients compared to <1% in these studies 19–22 . This is also greater than the age‐specific incidence of 31.6 per 100 000 (0.03%) in 40–49‐year‐olds, which reduces for each younger age group, identified by the AIHW 1 .…”

“…This is consistent with findings by Koh et al . and reinforces the importance of complete investigation with colonoscopy rather than flexible sigmoidoscopy 22 …”

“…The specific incidence of CRC was greater in our study, with 1.9% of patients compared to <1% in these studies. [19][20][21][22] This is also greater than the age-specific incidence of 31.6 per 100 000 (0.03%) in 40-49-year-olds, which reduces for each younger age group, identified by the AIHW. 1 This difference is likely contributed to by variable populations amongst the studies, and the fact that our study population included mostly symptomatic patients or those with significant risk factors.…”

“…This is consistent with findings by Koh et al and reinforces the importance of complete investigation with colonoscopy rather than flexible sigmoidoscopy. 22 To further categorize patients based on their indication, a univariate logistic regression model was performed to see if any specific indication had significantly greater predictive value for CRC. Our results show that patients with abnormal imaging have greater odds of having CRC diagnosed.…”

Assessing Guidelines on the Need for Colonoscopy After Initial Flexible Sigmoidoscopy in Young Patients With Outlet-Type Rectal Bleeding

“…Good et al provided a small study that seems to agree with our conclusions, 22 whereas earlier reports by Eckardt et al 30 and Carlo et al 31 found a very low risk of proximal neoplasia in similar groups of patients. Koh et al 32 found that within the group of patients younger than 50 years, patients in their 40s with outlet-type rectal bleeding were at a higher risk of colorectal neoplasia than those who were younger, making the case for colonoscopy, at least in this older subgroup. Muller et al 33 performed colonoscopies in 187 consecutive patients younger than 50 years who presented with outlet-type rectal bleeding.…”