Introduction The vast majority of patients referred for investigation of rectal bleeding have benign anal disease or proctitis. Flexible sigmoidoscopy (FS) has been widely used for the investigation of patients with rectal bleeding with same day single phospho-soda enema preparation prior to the examination. However, conversion to full colonoscopy is warranted if adenomatous polyps or colon cancer is detected to exclude synchronous lesions. We hypothesise that as the patients age at presentation of rectal bleeding increases, the prevalence of adenomatous polyps and colon cancer increases and thereby the requirement for evaluation of the entire colon. If this is established then we should recommend that patients undergoing FS for rectal bleeding should be scoped with full bowel preparation and converted to a colonoscopy if polyp or cancer is detected at the time of FS. The aim of the study was to assess the diagnostic yield of FS in detecting colon cancer/polyp in patients of different ages presenting with rectal bleeding.
Method A single centre, retrospective analysis of patients with rectal bleeding investigated with FS in a district general hospital from north London was performed. The patients were identified using the Unisoft Endoscopy reporting software over a period from June 2006 to March 2014. Data obtained during the study period was scrutinised for diagnosis and whether further full colonic imaging was indicated as judged by diagnosis of colon cancer or adenomatous polyp.
Results 1406 FS were performed in the study period. The table below demonstrates the findings at FS in patients with rectal bleeding according to age category. 25% of patients over 45 years of age have a cancer or polyp diagnosed that requires further full colonic imaging.
Conclusion 25% of patients over 45 years of age undergoing FS for rectal bleeding have a colon cancer or polyp diagnosed that require further colonic imaging. Preparing all patients for a full colonoscopy at the time of attendance for FS and conversion to colonoscopy if a polyp or cancer is detected would save reattendance in 25% of patients over the age of 45 for rectal bleeding. The prevalence of polyps and cancer however is low in patients under 45 years of age and these patients could continue to have FS with enema preparation just prior to the procedure.
Disclosure of interest None Declared.