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Hakimian S, Jawaid S, Guilarte-Walker Y, Mathew J, Cave D. Video capsule endoscopy as a tool for evaluation of obscure overt gastrointestinal bleeding in the intensive care unit. Endosc Int Open 2018; 6:E989-E993. [PMID: 30083589 PMCID: PMC6075946 DOI: 10.1055/a-0590-3940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/21/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Video capsule endoscopy (VCE) is a minimally invasive tool that helps visualize the gastrointestinal tract from the esophagus to the right colon without the need for sedation or preparation. VCE is safe with very few contraindications. However, its role and safety profile in the intensive care unit (ICU) population have not been reported. The aim of this study is to evaluate the safety, efficacy, and feasibility of VCE use in ICU patients. PATIENTS AND METHODS We conducted a single-center retrospective observational study of patients who underwent VCE for evaluation of obscure overt gastrointestinal bleeding in the ICU between 2008 and 2016. RESULTS This study included 48 patients who were admitted to the UMass Memorial Medical Center ICUs for gastrointestinal bleeding. VCE was successfully completed in 43/48 (90 %) patients. The entire length of small bowel could be evaluated in 75 % and the source of bleeding was identified in 44 % of the patients. The most commonly identified source of bleeding included small bowel angioectasias, duodenal erosions/ulcers, and small bowel polyps. No major complications could be attributed to the VCE. Only 1 capsule was retained after 2 wk; however, there was no incidence of bowel obstruction, perforation, or capsule aspiration. CONCLUSIONS This observational retrospective study demonstrates that VCE may be a safe, feasible, and effective diagnostic tool in evaluation of gastrointestinal bleeding in the ICU population with few complications. VCE may be a safe diagnostic prelude and be a guide to the correct therapeutic procedure if needed, in the context of patients who are seriously ill.
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Affiliation(s)
- Shahrad Hakimian
- Department of Medicine, UMass Memorial Medical Center, Worcester, MA,Corresponding author Shahrad Hakimian, MD UMass Memorial Medical CenterDepartment of Internal Medicine55 Lake Avenue NorthWorcesterMA 01655United States+1-508-8563981
| | - Salmaan Jawaid
- Division of Gastroenterology, UMass Memorial Medical Center, Worcester, MA
| | - Yurima Guilarte-Walker
- Division of Data Sciences and Technology, Information Technology, UMass Medical School, Worcester, MA
| | - Jomol Mathew
- Division of Data Sciences and Technology, Information Technology, UMass Medical School, Worcester, MA
| | - David Cave
- Division of Gastroenterology, UMass Memorial Medical Center, Worcester, MA
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Atkin W, Wooldrage K, Shah U, Skinner K, Brown JP, Hamilton W, Kralj-Hans I, Thompson MR, Flashman KG, Halligan S, Thomas-Gibson S, Vance M, Cross AJ. Is whole-colon investigation by colonoscopy, computerised tomography colonography or barium enema necessary for all patients with colorectal cancer symptoms, and for which patients would flexible sigmoidoscopy suffice? A retrospective cohort study. Health Technol Assess 2017; 21:1-80. [PMID: 29153075 PMCID: PMC5712787 DOI: 10.3310/hta21660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND For patients referred to hospital with suspected colorectal cancer (CRC), it is current standard clinical practice to conduct an examination of the whole colon and rectum. However, studies have shown that an examination of the distal colorectum using flexible sigmoidoscopy (FS) can be a safe and clinically effective investigation for some patients. These findings require validation in a multicentre study. OBJECTIVES To investigate the links between patient symptoms at presentation and CRC risk by subsite, and to provide evidence of whether or not FS is an effective alternative to whole-colon investigation (WCI) in patients whose symptoms do not suggest proximal or obstructive disease. DESIGN A multicentre retrospective study using data collected prospectively from two randomised controlled trials. Additional data were collected from trial diagnostic procedure reports and hospital records. CRC diagnoses within 3 years of referral were sourced from hospital records and national cancer registries via the Health and Social Care Information Centre. SETTING Participants were recruited to the two randomised controlled trials from 21 NHS hospitals in England between 2004 and 2007. PARTICIPANTS Men and women aged ≥ 55 years referred to secondary care for the investigation of symptoms suggestive of CRC. MAIN OUTCOME MEASURE Diagnostic yield of CRC at distal (to the splenic flexure) and proximal subsites by symptoms/clinical signs at presentation. RESULTS The data set for analysis comprised 7380 patients, of whom 59% were women (median age 69 years, interquartile range 62-76 years). Change in bowel habit (CIBH) was the most frequently presenting symptom (73%), followed by rectal bleeding (38%) and abdominal pain (29%); 26% of patients had anaemia. CRC was diagnosed in 551 patients (7.5%): 424 (77%) patients with distal CRC, 122 (22%) patients with cancer proximal to the descending colon and five patients with both proximal and distal CRC. Proximal cancer was diagnosed in 96 out of 2021 (4.8%) patients with anaemia and/or an abdominal mass. The yield of proximal cancer in patients without anaemia or an abdominal mass who presented with rectal bleeding with or without a CIBH or with a CIBH to looser and/or more frequent stools as a single symptom was low (0.5%). These low-risk groups for proximal cancer accounted for 41% (3032/7380) of the cohort; only three proximal cancers were diagnosed in 814 low-risk patients examined by FS (diagnostic yield 0.4%). LIMITATIONS A limitation to this study is that changes to practice since the trial ended, such as new referral guidelines and improvements in endoscopy quality, potentially weaken the generalisability of our findings. CONCLUSIONS Symptom profiles can be used to determine whether or not WCI is necessary. Most proximal cancers were diagnosed in patients who presented with anaemia and/or an abdominal mass. In patients without anaemia or an abdominal mass, proximal cancer diagnoses were rare in those with rectal bleeding with or without a CIBH or with a CIBH to looser and/or more frequent stools as a single symptom. FS alone should be a safe and clinically effective investigation in these patients. A cost-effectiveness analysis of symptom-based tailoring of diagnostic investigations for CRC is recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN95152621. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Wendy Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kate Wooldrage
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Urvi Shah
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kate Skinner
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jeremy P Brown
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Willie Hamilton
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Ines Kralj-Hans
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Michael R Thompson
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Karen G Flashman
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Steve Halligan
- University College London Centre for Medical Imaging, University College London, London, UK
| | - Siwan Thomas-Gibson
- Department of Surgery and Cancer, Imperial College London, London, UK
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
| | - Margaret Vance
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
| | - Amanda J Cross
- Department of Surgery and Cancer, Imperial College London, London, UK
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Cha JM, Kozarek RA, La Selva D, Gluck M, Ross A, Chiorean M, Koch J, Lin OS. Findings of diagnostic colonoscopy in young adults versus findings of screening colonoscopy in patients aged 50 to 54 years: a comparative study stratified by symptom category. Gastrointest Endosc 2015; 82:138-45. [PMID: 25843617 DOI: 10.1016/j.gie.2014.12.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/21/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The threshold for diagnostic colonoscopy in symptomatic patients aged <50 years remains controversial. Previous studies on the prevalence of neoplasia or other serious pathology in young patients mostly have been uncontrolled, providing only limited data on the risk associated with specific symptoms. OBJECTIVE To compare colonoscopy findings in patients aged <50 years who have various symptoms (diagnostic cohort) against those of concurrent patients aged 50 to 54 years who are asymptomatic (screening cohort). DESIGN Retrospective controlled cohort study. SETTING Teaching hospital. PATIENTS Symptomatic patients aged between 18 and 49 years and asymptomatic patients aged between 50 and 54 years. INTERVENTIONS Colonoscopy. MAIN OUTCOME MEASUREMENTS Prevalence of advanced neoplasia. RESULTS During the study period, 1638 patients underwent colonoscopy in the screening cohort (mean [± standard deviation{SD}] age 51.7 ± 1.4 years) and 1266 underwent colonoscopy in the diagnostic cohort (40.4 ± 8.0 years). Despite the age difference, the prevalence of advanced neoplasia in patients with rectal bleeding was comparable with that in the screening controls: 28 of 472 (5.9%) versus 113 of 1638 patients (6.9%) (P = .459). Furthermore, 10 patients (2.1%) with rectal bleeding were newly diagnosed with inflammatory bowel disease. In contrast, other symptoms that commonly lead to colonoscopy, such as abdominal pain, changes in bowel habits, and weight loss, were associated with much lower risks for neoplasia. As a result, the overall prevalences of neoplasia and advanced neoplasia were significantly higher in the screening cohort than in the diagnostic cohort: 467 of 1638 patients (28.5%) versus 179 of 1266 patients (14.1%), and 113 patients (6.9%) versus 48 patients (3.8%), respectively (both P < .001). LIMITATIONS No data on duration of symptoms; discrepant sex ratios between cohorts. CONCLUSION The threshold for diagnostic colonoscopy in symptomatic young adults should be individualized for each symptom category. Rectal bleeding warrants colonoscopy to detect advanced neoplasia or inflammatory bowel disease in most young patients, especially those aged 40 to 49 years, whereas non-bleeding symptoms, including some traditionally regarded as "alarm" symptoms, were associated with a much lower risk for neoplasia compared with the risk in screening patients aged 50 to 54 years.
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Affiliation(s)
- Jae-Myung Cha
- Gastroenterology Division, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, South Korea; Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Richard A Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Danielle La Selva
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael Gluck
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew Ross
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael Chiorean
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Johannes Koch
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Otto S Lin
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
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Bijpuria P, Thor S, Parsa L, Schlachterman A, Ahmad A. Do medicine residents triage patients with gastrointestinal bleeding appropriately? Hosp Pract (1995) 2015; 43:31-35. [PMID: 25659954 DOI: 10.1080/21548331.2015.1008379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Gastrointestinal specialists depend on internal medicine (IM) teams to accurately identify acute gastrointestinal bleeding (GIB). We evaluated whether IM residents' assessment of GIB correlated with the impressions of GI specialists during consultations at an inner-city university teaching hospital. METHODS A questionnaire was distributed to house staff requesting GIB consultations and to the GI fellows performing the consults between August 2011 and April 2012. Residents and fellows were asked to assess GIB, specifically melena, using a stool color card and digital rectal examination (DRE) findings. Fellow DRE findings served as controls for stool color identification. RESULTS Eighty-seven GI consults were eligible for the study. Residents and fellows completed 81 and 86 questionnaires, respectively. A total of 76 questionnaires were included for analysis. A DRE was performed by medical staff before calling a consult in 65% of cases compared with fellows (97% of cases, P = 0.0001). Residents more frequently labeled stool as melena (42%) in patients as compared with fellows (12%, P = 0.0001). Residents inaccurately identified melenic stools in 22 patients (11 based on stool color and 11 based on DRE findings). Residents were more likely to label a consult as emergent than fellows (13.5% vs 4%, P < 0.05). CONCLUSION Residents are less likely to perform DRE during an evaluation for GIB and to accurately identify melena based on stool color or DRE findings. There appears to be a need to educate residents on the appropriate terminology for stool color and the importance of DRE to accurately triage patients with acute GIBs.
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Abstract
The symptoms and signs of colorectal cancer vary from the general population to primary care and in the referred population to secondary care. This review aims to address the diverse symptoms, signs and combinations with relevance to colorectal cancer at various points in the diagnostic pathway and tries to shed light on this complex and confusing area. A move towards a lower threshold for referral and increased use of diagnostics might be a more reliable option for early diagnosis.
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Affiliation(s)
- S K P John
- General Surgery, Northern Deanery, Newcastle upon Tyne UK.
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Jiwa M, Spilsbury K, Duke J. Do Pharmacists Know Which Patients with Bowel Symptoms Should Seek Further Medical Advice? A Survey of Pharmacists Practicing in Community Pharmacy in Western Australia. Ann Pharmacother 2010; 44:910-7. [DOI: 10.1345/aph.1m701] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: Pharmacists in Australia are routinely asked to advise people with lower bowel symptoms. Clinical, demographic, and working environment parameters may affect whether appropriate referral for advanced care is advised by pharmacists. OBJECTIVE: To characterize how selected clinical, demographic, and working environment variables affect the likelihood of a pharmacist providing a referral for patients with lower bowel symptoms to consult a general practitioner, and to investigate factors associated with agreement with an expert panel and colorectal cancer guidelines. METHODS: Self-administered questionnaires were distributed to a random sample of 300 pharmacists in Western Australia. Vignettes were constructed around 6 clinical variables and pharmacists were asked to describe a referral pathway. Logistic regression was used to identify factors associated with odds of referral and agreement with an expert panel. RESULTS: One hundred sixty-seven completed surveys were returned, giving a response rate of 56%. The odds of referral to a general practitioner were mostly associated with presenting symptoms, although lower odds of referral were observed with increasing volumes of weekly prescriptions. The odds of pharmacists agreeing with the expert panel for an urgent referral were 70% (95% CI 50 to 80) lower for weight loss as the presenting symptom compared to rectal bleeding. The expert panel considered weight loss or rectal bleeding of 4 weeks' duration as meriting an urgent referral, but 63% and 30% of pharmacists, respectively, disagreed. In contrast to cancer guidelines, over 60% of respondents did not consider persistent diarrhea in a 65-year-old patient as a likely symptom of significant bowel pathology. CONCLUSIONS: In general, pharmacists' patterns of referral were influenced by clinical symptoms and not by demographic or working environment variables. They over-referred patients with diarrhea but under-referred those with weight loss and rectal bleeding, according to the expert panel. This is a cause for concern because any unexplained rectal bleeding should be referred for further investigation.
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Affiliation(s)
- Moyez Jiwa
- Moyez Jiwa MD MA MRCGP FRACGP, Professor of Health Innovation, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Western Australia
| | - Katrina Spilsbury
- Katrina Spilsbury PhD MBiostats BSc, Senior Research Fellow, Curtin Health Innovation Research Institute Centre for Population Health Research, Curtin University of Technology
| | - Janine Duke
- Janine Duke PhD GradDipClinEpi BPharm, Research Fellow, Curtin Health Innovation Research Institute Centre for Population Health Research
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Kim CY, Suhocki PV, Miller MJ, Khan M, Janus G, Smith TP. Provocative Mesenteric Angiography for Lower Gastrointestinal Hemorrhage: Results from a Single-institution Study. J Vasc Interv Radiol 2010; 21:477-83. [DOI: 10.1016/j.jvir.2009.11.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 10/26/2009] [Accepted: 11/30/2009] [Indexed: 12/21/2022] Open
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Effect of misdiagnosis on the prognosis of anorectal malignant melanoma. J Cancer Res Clin Oncol 2010; 136:1401-5. [PMID: 20130908 DOI: 10.1007/s00432-010-0793-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 01/14/2010] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Anorectal malignant melanoma (AMM) is frequently subjected to misdiagnosis. Here the effect of misdiagnosis on the prognosis of AMM was investigated. METHODS Between 1995 and 2007, 79 patients managed for AMM were reviewed; 46 (58.23%) of them had been misdiagnosed during the symptoms, while 33 (41.77%) cases had been diagnosed exactly not more than 1 week after the first visit. Diseases misdiagnosed were categorized as cancer, hemorrhoids, polyps and other diseases. Data were statistically analyzed by using the life tables and Kaplan-Meier curves. The software used was SPSS 16.0 for Windows. RESULTS The 1-, 2-, 3- and 5-year survival rates of AMM patients were 58, 33, 24 and 16%, respectively, and the median survival time was 14.0 months; 1-, 2-, 3- and 5-year survival rates of the misdiagnosed patients were 61, 22, 22 and 11%, respectively, and the median survival time was 14.0 months; 1-, 2-, 3- and 5-year survival rates of the patients not misdiagnosed were 55, 44, 25 and 25%, respectively, and the median survival time was 12.0 months. Analyses based on Kaplan-Meier curves revealed no significant effect of misdiagnosis on the survival of AMM patients (P > 0.05). Nevertheless, the diseases misdiagnosed significantly affect the prognosis (P = 0.009); AMM misdiagnosed as hemorrhoids had a poor prognosis, with a 1-year survival rate of only 29% and the median survival of only 6.0 months. CONCLUSIONS The misdiagnosed patients had relatively poor prognosis, but the effect of misdiagnosis on the prognosis was not significant; however, misdiagnosis of AMM as hemorrhoids seriously affected the prognosis.
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Hematochezia in the young patient: a review of health-seeking behavior, physician attitudes, and controversies in management. Dig Dis Sci 2010; 55:233-9. [PMID: 19238544 DOI: 10.1007/s10620-009-0750-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 01/27/2009] [Indexed: 12/09/2022]
Abstract
Hematochezia, defined as the passage of blood or clots from the rectum, is common and can be quite alarming. Few patients in general consult their physicians for this symptom. Various reasons have been explored for this behavior. Physician attitudes also shed some light onto why some patients are referred and others are not. Hematochezia may be associated with an anal cause in most healthy young adults (<50 years of age), but some may end up being diagnosed with colorectal cancer (CRC). Many studies have looked at the usefulness of clinical presentation in helping to decide which patients need further evaluation and what the optimal mode of investigation should be. Of note, studies on patients less than 50 years of age presenting with rectal bleeding have been few and far between. The results of these studies have been contradictory to the point where, today, there is no single set of consensus guidelines on the approach to hematochezia in young patients. In this review, the value of clinical symptoms and the underlying risk of CRC in guiding this clinical decision will be discussed.
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Harish K, Harikumar R, Sunilkumar K, Thomas V. Videoanoscopy: useful technique in the evaluation of hemorrhoids. J Gastroenterol Hepatol 2008; 23:e312-7. [PMID: 17854422 DOI: 10.1111/j.1440-1746.2007.05143.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Rigid proctoscopy, the gold standard for detecting hemorrhoids, has become a neglected procedure in the era of flexible endoscopy. Evaluation of hemorrhoids is often done with the retroflexed fiberoptic colonoscope. The aim of this study was to evaluate the technique of videoanoscopy in comparison with retroflexion of colonoscope in the rectum to detect hemorrhoids and to correlate objective findings of hemorrhoids and their relation to bleeding. METHODS In total, 544 patients were screened and 358 patients were evaluated by the technique of videoanoscopy and retroflexion of colonoscope in the rectum. The video images of both the procedures were independently analyzed by two observers for the presence or absence of hemorrhoids. The videoanoscopy images were also analyzed for number of columns of hemorrhoids, size and presence of red-color sign. RESULTS Videoanoscopy detected hemorrhoids in a significantly higher number of subjects when compared with retroflexion of colonoscope in the rectum by both observers (P < 0.05). The average kappa value was 0.637 and 0.779 for retroflexed colonoscopy and videoanoscopy, respectively. Red-color sign was present in 80.5% of patients with bleeding compared with only 30.3% in the non-bleeding group. The majority (71%) of patients in the bleeding group had larger hemorrhoids. Red-color sign and size of hemorrhoidal columns correlated with bleeding (P < 0.05). CONCLUSION Videoanoscopy is a simple technique with increased sensitivity to detect hemorrhoids compared with intrarectal retroflexion of colonoscope and yields valuable objective information about the presence and condition of hemorrhoids. It should be performed as an extension of standard colonoscopy.
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Affiliation(s)
- Kareem Harish
- Department of Gastroenterology, Calicut Medical College, Kozhikode, Kerala, India.
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Liou JM, Lin JT, Wang HP, Huang SP, Lin JW, Wu MS. Age and distal colonic findings determine the yield of advanced proximal neoplasia in Chinese patients with rectal bleeding. J Gastroenterol Hepatol 2007; 22:1780-5. [PMID: 17914950 DOI: 10.1111/j.1440-1746.2006.04607.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Few data were available on the optimal diagnostic strategy for Chinese patients with hematochezia. We aimed to evaluate the impact of age and distal colonic findings on the yield of diagnostic strategies in young Chinese patients with hematochezia. METHODS Consecutive outpatients aged less than 50 years were analyzed using a hypothesized mixed diagnostic strategy to determine the optimal cut-off age for the use of sigmoidoscopy and colonoscopy. The efficacy and cost of the diagnostic strategy and the number of colonoscopies needed to detect one advanced proximal neoplasm (APN) using different cut-off ages were assessed. RESULTS In the hypothesized mixed diagnostic strategy for young patients, the sensitivities for the detection of APN were 100%, 92% and 75% if the cut-off ages were 30, 35 and 40 years, respectively. The cost needed to detect one APN would be $US 3155, $US 3179 and $US 3497 if the cut-off ages were 30, 35 and 40 years, respectively. Colonoscopy would be performed in 84%, 69% and 51% of patients if the cut-off ages were 30, 35 and 40 years, respectively. CONCLUSION Colonoscopy should be considered for Chinese patients with rectal bleeding who are aged > or =35 years or those aged <35 years who have adenoma in the distal colon.
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Affiliation(s)
- Jyh-Ming Liou
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Spinzi G, Fante MD, Masci E, Buffoli F, Colombo E, Fiori G, Ravelli P, Ceretti E, Minoli G. Lack of colonic neoplastic lesions in patients under 50 yr of age with hematochezia: a multicenter prospective study. Am J Gastroenterol 2007; 102:2011-5. [PMID: 17521401 DOI: 10.1111/j.1572-0241.2007.01332.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It is still not clear what is the best way of evaluating rectal bleeding in young people. Our aim was to examine the prevalence of neoplastic colonic lesions in these patients. METHODS This prospective, multicenter study enrolled 622 patients aged 30-50 yr (F 232/M 390) consecutively seen in 14 open-access endoscopy departments for hematochezia, defined as bright red blood from the rectum, red blood noted either in the feces, on toilet paper, or in the toilet bowl. At colonoscopy, pathology was stratified as either proximal or distal to the splenic flexure. Exclusion criteria were a history of colitis, colorectal cancer, polyps, anemia, significant weight loss, severe bleeding, or strong family history of colorectal cancer. RESULTS Malignant polyps were found in two patients (0.6%), aged 30-40 yr, one in the rectum and one in the sigmoid. A malignant polyp of the cecum was found in a 41-yr-old patient. Another, aged 47, had a malignant granular-cell tumor of the rectum. A total of 35 advanced adenomas were identified in 18 patients. In 7 patients (2.2 %) within the 30-40 yr age bracket we found 8 advanced adenomas (all in the rectum/sigmoid). The other 27 advanced adenomas were in 11 patients (3.5%) in the 41-50 yr age bracket. In this age group we observed 3 patients with 10 isolated proximal advanced adenomas. CONCLUSIONS In patients younger than 40 yr with hematochezia, advanced neoplastic lesions are rare and usually located in the rectum and sigmoid colon. Sigmoidoscopy appears to be sufficient for evaluation in these patients.
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Bjerregaard NC, Tøttrup A, Sørensen HT, Laurberg S. Evaluation of the Danish national strategy for selective use of colonoscopy in symptomatic outpatients without known risk factors for colorectal cancer. Scand J Gastroenterol 2007; 42:228-36. [PMID: 17327943 DOI: 10.1080/00365520600815662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE A diagnostic strategy implemented in Denmark in 2002 recommends selective use of colonoscopy in outpatients without known colorectal cancer (CRC) risk factors who are referred with symptoms consistent with possible CRC. Selection of patients for colonoscopy was based on the presenting symptom(s) and findings at the initial examination (flexible sigmoidoscopy/faecal occult blood test). The aim of this study was to evaluate the strategy by assessing the prevalence of patients with diagnosed CRC, the frequency of patients with missed CRC, the adherence to the strategy and the number of examinations performed. MATERIAL AND METHODS We prospectively studied patients aged 40 years and older without known risk factors for CRC, referred to two surgical outpatient clinics during a period of 15-16 months. Examinations, findings at the examinations, the final diagnoses and date of discharge were recorded. Missed CRCs were identified by follow-up in hospital discharge registries. RESULTS CRC was diagnosed in 126 (5.3%; 95% CI: 4.5-6.3%) of the 2361 patients included during the diagnostic work-up. Two additional cancers identified at follow-up were both missed during colonoscopy (1.5%; 95% CI: 0.2-5.4%). The adherence to the strategy was 75.7%, and 125 of the 126 patients with a CRC were examined in conformity with the recommended strategy. Almost 60% of the patients underwent colonoscopy and almost 50% underwent both flexible sigmoidoscopy and colonoscopy. CONCLUSIONS The diagnostic strategy is an acceptable alternative to initial colonoscopy, with a low probability of missing a CRC; however, a considerable proportion of the patients undergo colonoscopy and multiple examinations.
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Carlo P, Paolo RF, Carmelo B, Salvatore I, Giuseppe A, Giacomo B, Antonio R. Colonoscopic evaluation of hematochezia in low and average risk patients for colorectal cancer: A prospective study. World J Gastroenterol 2006; 12:7304-8. [PMID: 17143945 PMCID: PMC4087487 DOI: 10.3748/wjg.v12.i45.7304] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Puglisi Carlo
- Azienda Ospedaliero Universitaria Policlinico, Via S. Sofia N 78, Catania 95100, Italy.
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16
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Paterson WG, Depew WT, Paré P, Petrunia D, Switzer C, van Zanten SJV, Daniels S. Canadian consensus on medically acceptable wait times for digestive health care. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2006; 20:411-23. [PMID: 16779459 PMCID: PMC2659924 DOI: 10.1155/2006/343686] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Delays in access to health care in Canada have been reported, but standardized systems to manage and monitor wait lists and wait times, and benchmarks for appropriate wait times, are lacking. The objective of the present consensus was to develop evidence- and expertise-based recommendations for medically appropriate maximal wait times for consultation and procedures by a digestive disease specialist. METHODS A steering committee drafted statements defining maximal wait times for specialist consultation and procedures based on the most common reasons for referral of adult patients to a digestive disease specialist. Statements were circulated in advance to a multidisciplinary group of 25 participants for comments and voting. At the consensus meeting, relevant data and the results of voting were presented and discussed; these formed the basis of the final wording and voting of statements. RESULTS Twenty-four statements were produced regarding maximal medically appropriate wait times for specialist consultation and procedures based on presenting signs and symptoms of referred patients. Statements covered the areas of gastrointestinal bleeding; cancer confirmation and screening and surveillance of colon cancer and colonic polyps; liver, biliary and pancreatic disorders; dysphagia and dyspepsia; abdominal pain and bowel dysfunction; and suspected inflammatory bowel disease. Maximal wait times could be stratified into four possible acuity categories of 24 h, two weeks, two months and six months. FUTURE DIRECTIONS Comparison of these benchmarks with actual wait times will identify limitations in access to digestive heath care in Canada. These recommendations should be considered targets for future health care improvements and are not clinical practice guidelines.
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Affiliation(s)
- William G Paterson
- Queen’s University, Hotel Dieu Hospital, Kingston, Ontario
- Correspondence: Dr William G Paterson, Queen’s University, 166 Brock Street, Kingston, Ontario K7L 5G2. Telephone 613-544-3400 ext 3376, fax 613-544-3114, e-mail
| | | | - Pierre Paré
- Université Laval, Hôpital du St-Sacrement, Québec City, Québec
| | | | - Connie Switzer
- University of Alberta, Grey Nuns Community Hospital, Edmonton, Alberta
| | | | - Sandra Daniels
- Canadian Association of Gastroenterology, Oakville, Ontario
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17
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Rudd J. The misdiagnosis of ischaemic colitis. Radiography (Lond) 2006. [DOI: 10.1016/j.radi.2005.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Esrailian E, Gralnek IM. Nonvariceal upper gastrointestinal bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am 2005; 34:589-605. [PMID: 16303572 DOI: 10.1016/j.gtc.2005.08.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nonvariceal upper gastrointestinal bleeding remains an important cause of patient morbidity, mortality, and use of considerable health care resources. An early and accurate diagnosis is critical for guiding appropriate management and facilitating patient care. This article reviews the most recent epidemiologic data on acute nonvariceal upper gastrointestinal bleeding and outlines important aspects of making the diagnosis.
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Affiliation(s)
- Eric Esrailian
- David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, UCLA/VA Center for Outcomes Research and Education, CA 90073, USA
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19
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Lieberman DA, Holub J, Eisen G, Kraemer D, Morris CD. Utilization of colonoscopy in the United States: results from a national consortium. Gastrointest Endosc 2005; 62:875-83. [PMID: 16301030 DOI: 10.1016/j.gie.2005.06.037] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 06/07/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND To assess capacity for colonoscopy, we need to understand current utilization of colonoscopy in diverse clinical practice settings. The objective of this study was to determine the utilization of colonoscopy in diverse clinical practice settings. METHODS The Clinical Outcomes Research Initiative (CORI) data repository, which receives endoscopy reports from 73 diverse adult practice sites in the United States was used. Colonoscopy reports from January 2000 to August 2002 were analyzed to determine the demographic characteristics of adult patients who received a colonoscopy and the procedure indication. The relationship of age, race, gender, and procedure indication was analyzed. RESULTS Results of colonoscopies in 146,457 unique patients were analyzed. Of the reports, 68% came from nonacademic settings. Patients less than 50 years of age accounted for 20% of colonoscopies. The most common indications were rectal bleeding (33.6%), irritable bowel symptoms (23.8%), or screening because of a positive family history of colorectal cancer (22.4%) and screening with a primary colonoscopy or a fecal occult blood test (FOBT) (12.8%). In patients 50 years and older, asymptomatic screening (average-risk screening colonoscopy, positive family history, or FOBT positivity) accounted for 38.1% of all colonoscopies. Surveillance colonoscopy in patients with previous cancer or polyps accounted for 21.9% of colonoscopies performed in this age group. Differences in utilization were noted, based on gender and race. CONCLUSIONS Colonoscopy utilization varies based on age, gender, and race. Colonoscopy often is performed in patients less than 50 years old for irritable bowel symptoms; rectal bleeding; or average-risk screening, for which benefits are uncertain. In patients older than 50 years, surveillance after polyp removal is a common indication and may be overused. Understanding utilization can lead to further study to determine outcomes, to optimize utilization, and to provide a basis for shifting limited resources.
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Affiliation(s)
- David A Lieberman
- Division of Gastroenterology; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon 97239, USA
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20
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Abstract
Lower gastrointestinal bleeding is one of the most common gastrointestinal indications for hospital admission, particularly in the elderly. Diverticulosis accounts for up to 50% of cases, followed by ischemic colitis and anorectal lesions. Though most patients stop bleeding spontaneously and have favorable outcomes, long-term recurrence is a substantial problem for patients with bleeding from diverticulosis and angiodysplasia. The management of LGIB is challenging because of the diverse range of bleeding sources, the large extent of bowel involved, the intermittent nature of bleeding, and the various complicated and often invasive investigative modalities. Advances in endoscopic technology have brought colonoscopy to the forefront of the management of LGIB. However, many questions remained to be answered about its usefulness in routine clinical practice. More randomized controlled trials comparing available diagnostic strategies for LGIB are needed.
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21
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Lewis R, Flynn A, Dean ME, Melville A, Eastwood A, Booth A. Management of colorectal cancers. Qual Saf Health Care 2004; 13:400-4. [PMID: 15465947 PMCID: PMC1743890 DOI: 10.1136/qhc.13.5.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The management of colorectal cancers, published in a recent issue of Effective Health Care, is reviewed.
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Affiliation(s)
- R Lewis
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
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22
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Mathew J, Shankar P, Aldean IM. Audit on flexible sigmoidoscopy for rectal bleeding in a district general hospital: are we over-loading the resources? Postgrad Med J 2004; 80:38-40. [PMID: 14760179 PMCID: PMC1757955 DOI: 10.1136/pmj.2003.008284] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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 >or=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 pound 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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Affiliation(s)
- J Mathew
- Department of Surgery, Trafford General Hospital, Manchester, UK.
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23
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Ferraris R, Senore C, Fracchia M, Sciallero S, Bonelli L, Atkin WS, Segnan N. Predictive value of rectal bleeding for distal colonic neoplastic lesions in a screened population. Eur J Cancer 2004; 40:245-52. [PMID: 14728939 DOI: 10.1016/j.ejca.2003.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim of this study was to determine the diagnostic value of rectal bleeding for distal colorectal cancer (CRC), or large (> or =10 mm) adenomas among an average-risk population. A cross-sectional survey was conducted among individuals aged 55-64 years, who attended sigmoidoscopy (FS) screening in the context of a multicentre randomised trial of FS screening for CRC. Sensitivity, specificity and positive predictive value (PPV) of rectal bleeding for large distal adenomas or CRC were calculated. Rectal bleeding was reported by 8.8% of 8507 patients examined (15% of those with large adenomas and 29% of those with CRC). The risk of CRC was increased when bleeding was associated with an altered bowel habit: odds ratio (OR)=10.42; 95% Confidence Interval (CI): 4.08-26.59; the corresponding OR for isolated bleeding was 5.29 (95% CI: 2.28-12.30). Rectal bleeding carries an increased risk of distal neoplastic lesions. However, most lesions are detected among asymptomatic subjects. This finding suggests that screening represents the optimal strategy to detect CRC or large adenomas in the distal colon in the targeted age range.
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Affiliation(s)
- R Ferraris
- Unit of Gastroenterology, Mauriziano Umberto I Hospital, Turin, Italy
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24
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García Sánchez MV, Naranjo Rodríguez A, Gónzalez Galilea A, Gálvez Calderon C, de Dios Vega JF. [How can we optimize the diagnosis and treatment of lower gastrointestinal bleeding?]. GASTROENTEROLOGIA Y HEPATOLOGIA 2004; 27:167-71. [PMID: 14998470 DOI: 10.1016/s0210-5705(03)79118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Panzuto F, Chiriatti A, Bevilacqua S, Giovannetti P, Russo G, Impinna S, Pistilli F, Capurso G, Annibale B, Delle Fave G. Symptom-based approach to colorectal cancer: survey of primary care physicians in Italy. Dig Liver Dis 2003; 35:869-75. [PMID: 14703882 DOI: 10.1016/j.dld.2003.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colorectal cancer is a frequent cause of mortality in Western countries, including Italy, where a definite screening policy has not yet been adopted. It is likely that most patients with colorectal cancer refer, first of all, to their primary care physician at onset of symptoms. AIM To perform a survey on the approach, of primary care physicians, to patients with symptoms suggesting the presence of colorectal cancer. METHODS A total of 280 consecutive symptomatic patients without previous diagnosis of organic colon disease or recent colon investigation in whom, after consulting, 159 primary care physicians in Lazio (Italy) prescribed colonoscopy or double-contrast barium enema. RESULTS Most frequent presenting symptoms were lower abdominal pain (79.6%), bloating (59.6%), constipation (47.8%), diarrhoea (30.3%), iron deficiency anaemia (24.6%), change in bowel habits (20.3%) and weight loss (15%). Colonoscopy and barium enema were equally advised by physicians to rule out the presence of cancer (56% versus 44%, P = ns). Cancer was found in 14.6% of patients. Age > 50 years and iron deficiency anaemia were the only independent variables associated with colorectal cancer (Odds ratios 9.0 and 8.8 at multivariate analysis, respectively). CONCLUSION The symptom-based selection criteria used by primary care physicians have been shown to be scarcely effective. Colonic investigation should be requested, irrespective to the symptoms, in patients aged > 50 years with iron deficiency anaemia.
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Affiliation(s)
- F Panzuto
- Department of Digestive and Liver Disease, II School of Medicine, Sant' Andrea Hospital, 'La Sapienza' University, Rome, Italy
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26
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Taylor SA, Halligan S, Vance M, Windsor A, Atkin W, Bartram CI. Use of multidetector-row computed tomographic colonography before flexible sigmoidoscopy in the investigation of rectal bleeding. Br J Surg 2003; 90:1163-4. [PMID: 12945088 DOI: 10.1002/bjs.4211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Selective colonography may reduce need for colonoscopy
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Affiliation(s)
- S A Taylor
- Department of Intestinal Imaging, St Mark's Hospital, Watford Road, London HA1 3UJ, UK
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27
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Loren DE, Lewis J, Kochman ML. Colon cancer: detection and prevention. Hematol Oncol Clin North Am 2003. [DOI: 10.1016/s0889-8588(03)00022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Colorectal cancer is the second leading cause of death from cancer in the United States. It is third leading cause of cancer death in men behind lung and prostate respectively, and behind lung and breast in cancer deaths among women. More than 130,000 cases are diagnosed each year with over 56,000 of those patients dying. Six percent of the United States population will develop colorectal cancer in their lifetime.
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Abstract
Recent data have advanced our ability to detect, survey, and manage patients with colonic neoplasia. Current studies and consensus statements increasingly support the role of colonoscopic screening over less invasive testing such as FOBT or FS for appropriately selected individuals. There are many issues, however, that remain unresolved. What is the appropriate surveillance of an individual with a single family member who had colon cancer at an early age? How should family members of suspected HNPCC kindreds be managed? There has yet to be a prospective cohort validation of the Bethesda criteria in directing clinical practice, with the endpoint of mortality reduction. Questions regarding prophylaxis with dietary supplements and medications are exciting areas that are currently under study. As newer technologies become clinically available for molecular diagnostics and screening, and virtual colonoscopy with computed tomography and magnetic resonance disseminates, there will undoubtedly be new questions to be answered regarding their ability to aid in the detection and management of colon cancer.
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Affiliation(s)
- David E Loren
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, 3 Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA
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30
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Abstract
BACKGROUND Chronic, bright red, rectal bleeding is a common symptom in our community and the aetiology is frequently benign anal disease. The aim of the present study was to determine the efficacy of performing a flexible sigmoidoscopy on patients with chronic, bright red, rectal bleeding who are at low risk for colorectal neoplasia and who, on rigid sigmoidoscopy, are found to have an identifiable anal cause (e.g. haemorrhoids, fissure) for their bleeding. METHODS A prospective study was conducted on patients presenting with chronic, bright red, rectal bleeding. Patients were considered at low risk for colorectal neoplasia if they fulfilled the following criteria: (i) less than 55 years of age; (ii) no past or family history of colorectal neoplasia or inflammatory bowel disease; (iii) no symptoms of altered bowel habit or abdominal pain; and (iv) a source of bleeding identified (e.g. haemorrhoids, fissure) on rigid sigmoidoscopy. All patients underwent a flexible sigmoidoscopy. RESULTS Eighty-two patients were entered into the trial, mean age 39 +/- 9 years (range: 22-55 years), and the ratio of men:women was 1.8:1. The anal cause of bleeding was haemorrhoids in 96%, and anal fissure in 4%. At flexible sigmoidoscopy, five patients were found to have adenomatous polyps. Rigid sigmoidoscopy missed diminutive neoplastic lesions in 6% of patients. CONCLUSIONS Flexible sigmoidoscopy results in a low yield of colorectal neoplasia in patients presenting with chronic, bright red, rectal bleeding who are at low risk for colorectal neoplasia and who have an identifiable anal cause for their bleeding.
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Affiliation(s)
- D Mehanna
- Department of Surgery, University of Western Australia, Fremantle Hospital, Fremantle, Australia
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31
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Macrae F. Investigating rectal bleeding: red faced or reliable? ANZ J Surg 2001; 71:699-700. [PMID: 11906379 DOI: 10.1046/j.1445-1433.2001.test.2282.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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