title: Investigating painless rectal bleeding--is there scope for improvement?
abstract: BACKGROUND
  Most patients with recurrent painless rectal bleeding warrant endoscopic examination of the lower gastrointestinal tract. This is often limited to rectum or distal colon. The purpose of this study was to compare the diagnostic yield of limited colorectal endoscopy with total colonoscopy in children with recurrent painless rectal bleeding.
  
  
  METHODS
  Retrospective review of 314 patients aged 1 to 15 years who underwent colorectal endoscopy for recurrent rectal bleeding. Two hundred six underwent total colonoscopy, whereas 108 patients had endoscopy limited to the rectum in 22, sigmoid colon in 34, descending colon in 43, and transverse colon in 9. Diagnoses were recorded according to the endoscopic and histological findings.
  
  
  RESULTS
  After total colonoscopy, a diagnosis was established in 70% of children compared with 35% of those undergoing limited endoscopy (P < .001). This difference was most noticeable in children with inflammatory bowel disease. Juvenile polyps were diagnosed with similar frequency in both groups, reflecting the rectosigmoid distribution of most polyps.
  
  
  CONCLUSIONS
  For children presenting with painless rectal bleeding, a diagnosis can be established in the majority if total colonoscopy is performed. This is particularly true for inflammatory bowel disease. Unless a rectal polyp is suspected, full colonoscopy should be planned.
authors.affiliation: Royal Belfast Hospital for Sick Children, BT12 6BE, Belfast, Northern Ireland, UK.
authors.forename: Glen
authors.initials: G
authors.lastname: Clarke
authors.forename: Andrew
authors.initials: A
authors.lastname: Robb
authors.forename: Ian
authors.initials: I
authors.lastname: Sugarman
authors.forename: William A
authors.initials: WA
authors.lastname: McCallion
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D012809:Colon, Sigmoid / Q000473:pathology; D003111:Colonic Polyps / Q000150:complications / Q000175:diagnosis; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007223:Infant; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis; D008297:Male; D012007:Rectum / Q000473:pathology; D012008:Recurrence; D012680:Sensitivity and Specificity