Two-year retrospective analysis of patients undergoing direct to procedure flexible sigmoidoscopy investigation with rectal bleeding as a primary complaint

Abstract

Background and aims Rectal bleeding affects ~15 % of the general population and is a common reason for referral to gastroenterologists by primary care physicians. Direct to procedure flexible sigmoidoscopy is an appealing modality to investigate rectal bleeding due its diagnostic yield, safety profile, and accessibility. Patients referred on a routine basis for direct to procedure clinic by primary care physicians with the sole complaint of rectal bleeding have not previously been studied. Our study aims to explore the spectrum of diagnoses and evaluate for potential clinical predictors of underlying pathology in this specific patient population. Methods In total, 528 charts of patients referred to the Kingston General Hospital and Hotel Dieu Hospital endoscopy units (Kingston, Canada) with the sole complaint of rectal bleeding were reviewed. All of these patients were referred on a routine basis to direct to procedure clinic from primary care physicians. The performance of various clinical variables in predicting significant pathology was assessed by univariate analysis. Results The diagnostic spectrum of the cohort studied included hemorrhoids (75.5 %), anal fissures (4 %), ulcerative colitis (3.2 %), Crohn’s disease (1.1 %), indeterminate proctitis/colitis (1.7 %), and colorectal malignancy (2.7 %). Of the various clinical variables assessed, only male sex predicted significant pathology (25.2 % of males vs 17.6 % of females, P < 0.05). Conclusion Our study highlights the need for a thorough investigation of rectal bleeding given the lack of clinical predictors. Future prospective studies with more patients are needed to fully assess the utility of various clinical variables in predicting pathology in this patient population. This would allow for more effective triaging of a routine rectal bleeding, a very common reason for patient referral to gastroenterologists by primary care physicians. Flexible sigmoidoscopy was not associated with complications or missed diagnosis in our study. As such, the technique appears to be a suitable initial investigative modality for patients with rectal bleeding.

Identification and Predictive Analysis of Colorectal Polyps Using Flexible Sigmoidoscopy: A Retrospective Cohort Study

“…Colorectal polyps are mucosal projections in the colon and rectum that differ from each other in the degree to which they can be developed into colorectal cancer [1]. These polyps are divided into the neoplastic ones which include the adenomatous and serrated polyps, and the non-neoplastic ones which are the hyperplastic, juvenile and inflammatory ones, the first ones being more dangerous and the second ones being less dangerous but still needing attention because of the symptoms and complications [2,3].The detection and removal of the polyps by the flexible sigmoidoscopy, a diagnostic tool that is quite minimally invasive, is especially useful for the lower part of the colon to be examined by patients who have symptoms like rectal bleeding and as part of routine screening in the older adults [4].…”

Randomized controlled trial of effects of a familiarization video and patient‐controlled Entonox inhalation on patient stress levels and clinical efficacy of flexible sigmoidoscopy without analgesia or sedation for investigation of fresh rectal bleeding

“…Flexible sigmoidoscopy (FS) without analgesia or sedation is commonly used to investigate fresh, outlet-type rectal bleeding. 1,2 It is relatively quick, safe, and cost-effective, usually allowing the bowel to be inspected as far as the descending colon and often further, and for colorectal polyps and other mucosal lesions to be biopsied/excised. [3][4][5] It also allows immediate post-procedure discharge from clinical supervision and return to normal daily activities.…”

Videoanuscopia: resultados do exame anal de rotina durante as colonoscopias

“…A vacinação contra o papilomavírus humano parece reduzir a taxa de NIA e possivelmente câncer anal 30 . É recomendado o exame do canal anal e região perianal durante a colonoscopia de rotina, principalmente para detecção de neoplasias e na pesquisa do sangramento anorretal 3,32 . O exame anal e a anuscopia, que são considerados de grande importância para a detecção de doenças anais e perianais, têm sido esquecidos nesta era da videocolonoscopia 1,31,33 .…”