Age and distal colonic findings determine the yield of advanced proximal neoplasia in Chinese patients with rectal bleeding.
OBJECTIVE
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.


CONCLUSIONS
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.
Liou
Jyh-Ming
JM
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Lin
Jaw-Town
JT
Wang
Hsiu-Po
HP
Huang
Shih-Pei
SP
Lin
Jou-Wei
JW
Wu
Ming-Shiang
MS
D000236:Adenoma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging; D044466:Asian People; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003113:Colonoscopy / Q000191:economics; D003362:Cost-Benefit Analysis; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D015995:Prevalence; D012007:Rectum; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012812:Sigmoidoscopy / Q000191:economics