Introduction Demand for colonoscopy has risen over the years and many hospital trusts in the UK are struggling to cope with the demand. This causes many deserving patients waiting longer for the procedure resulting in increasing patient anxiety along with potential clinical risks of delayed diagnosis. We were interested in looking at the correlation between indications and findings at colonoscopy and to explore the possibility of refining the referral criteria to improve diagnostic yield and to reduce demand. We had a specific interest in rectal bleeding as a symptom.
Methods Colonoscopy data for 2013 was sought giving us a total of 2021 porcedures which was retrospectively analysed by using the reporting software. This number was then filtered by indications for colonoscopy which included rectal bleeding with or without associated factors which left 378. We analysed all the pathology in particular that which was proximal to the splenic flexure and whether the findings showed a causal link to the indication.
Results There were 52 (13.8%) procedures among these which found pathology proximal to splenic flexure and therefore beyond the extent of examination of flexible sigmoidoscopy that can directly be linked to the symptoms. Of these 52, 12 (3.2%) were attributed to the indication for the referral. 86.2% of colonic pathology could be found potentially using flexible sigmoidoscopy. Looking at the indications in detail in relation to significant pathology proximal to the splenic flexure only; diarrhoea (8/69) 11.6%, iron deficiency anaemia (1/30) 3.3% and bleeding only (2/89) 2.2% had significance.
Conclusion Colonic pathology proximal to splenic flexure with a causal link to the indication is rare when investigating rectal bleeding unless associated with diarrhoea. Flexible sigmoidoscopy may be more appropriate in other instances.
Disclosure of Interest None Declared.
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