Introduction Colonoscopy is accepted as the gold standard imaging modality for colonic symptoms of altered bowel habit, anaemia, rectal bleeding and for the detection of colorectal cancer. Abdominal pain is a common presenting complaint in secondary care, and is generally accepted to be non-specific, with a low predictive value for significant pathology in the absence of other symptoms (altered bowel habit, bleeding). The American Society for Gastrointestinal Endoscopy in their guidelines for appropriate use of colonoscopy advise that this procedure is not indicated in “Chronic, stable, irritable bowel syndrome or chronic abdominal pain”. In observed practice, however, abdominal pain seems to be a common reason for referral for colonoscopy. For an endoscopy unit to be successful and with pressures of waiting times growing it is important not to overburden this with inappropriate referrals. We hypothesise that colonoscopy performed solely for abdominal pain has a low diagnostic yield and should therefore be avoided.
Methods The aim of the study was to assess abdominal pain as an indication for colonoscopy. A single centre, retrospective analysis of patients undergoing colonoscopy for abdominal pain in a North London NHS Hospital Trust was performed. Patients were identified using the Unisoft Endoscopy reporting software across a 5 year period (March 2010-March 2015 inclusive). Data was scrutinised for procedure findings and result of histology obtained. If abnormal, the patient’s electronic record was scrutinised for documentation of additional symptoms prior to colonoscopy.
Results A total of 1021 patients underwent colonoscopy for abdominal pain. 38 were diagnostic of Inflammatory Bowel Disease. 7 were diagnostic of adenocarcinoma. All of these patients had at least one other indication (diarrhoea, bleeding, weight loss or anaemia). Adenomatous polyp detection rate in this study was 6%, comparable to asymptomatic individuals.
Conclusion From this study we can conclude that a large number of colonoscopies are performed for patients with abdominal pain. When pathology is detected it is always with other symptoms. This study suggests that colonoscopy is not a useful investigation in patients presenting solely with abdominal pain, as the diagnostic yield is poor. Avoiding such a procedure in this group of patient would free up space within the endoscopy units and reduce waiting times. Colonoscopy as an investigation for abdominal pain as the sole indication should not be performed.
Disclosure of Interest None Declared
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