Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer.
OBJECTIVE
To assess the prevalence of clinically significant lesions in patients with minimal bright red bleeding per rectum (BRBPR).


METHODS
Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim Hospital, Tehran. Minimal BRBPR was defined as small amounts of red blood after wiping or in the toilet bowl. Patients with the following alarm signs were excluded: Positive personal history of colorectal neoplasms or inflammatory bowel disease (IBD), positive first degree family history of colorectal neoplasms, history of altered bowel habits, recent significant weight loss, and presence of iron deficiency anemia. Neoplastic polyps, colorectal carcinoma, and IBD were defined as significant lesions.


RESULTS
A total of 402 patients (183 female and 219 male, aged 43.6 +/- 15.7 years) were studied. Hemorrhoids (54.2%), anal fissures (14.2%) and ulcerative colitis (14.2%) were the most common lesions and colonoscopy was normal in 8.0%. Significant lesions were found in 121 (30.1%) patients, including 26 patients (6.5%) with adenocarcinoma and 30 (7.5%) with adenomatous polyps. Almost all patients with significant lesions had at least one lesion in the distal colon; an adenocarcinoma and an adenomatous polyp in the proximal colon were found in 2 patients with hemorrhoids.


CONCLUSIONS
Flexible sigmoidoscopy appears to be sufficient for the evaluation of average risk patients with minimal BRBPR. Rigid sigmoidoscopy may be used as an alternative in patients less than 40 years of age in settings where the former is not available. The choice of colonoscopy over flexible sigmoidoscopy in patients aged over 50 years should be individualized.
Nikpour
Shahriar
S
Department of Internal Medicine, Loghman Hakim Hospital, Kamali Street, South Kargar Ave., Tehran, 1333631151, Iran.
Ali Asgari
Ali
A
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D018256:Adenomatous Polyps / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis; D003111:Colonic Polyps / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005401:Fissure in Ano / Q000150:complications / Q000175:diagnosis; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006484:Hemorrhoids / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012007:Rectum; D018570:Risk Assessment; D012812:Sigmoidoscopy; D055815:Young Adult