Colonoscopic Findings in Outpatients with Rectal Bleeding

Abstract

Introduction: Intermittent scant hematochezia is a common pattern of lower GI bleeding encountered in primary care. Two recent prospective trials, 1, 2 yielded conflicting results regarding the association with rectal bleeding and the finding of colorectal neoplasia. The aim of this study was to evaluate the endoscopic findings in a population of patients from the Omaha VA medical center (OVAMC), with hematochezia, referred from their primary care provider for colonoscopy. Methods: We analyzed all colonoscopies performed at the OVAMC, for the indication of hematochezia, from December 2000, through December 2005. We evaluated patient demographics, the presence of preoperative anemia or weight loss, endoscopic findings and relevant pathology. Results: 437 colonoscopies were performed for hematochezia between December 2000 and December 2005. The mean age was 59 years. There were 415 males and 22 females. The prevalence of colorectal neoplasia was 33.4% (adenocarcinoma 6.6%, adenomas 23.6%, villous adenomas 3.2%). Non-neoplastic polyps were found in 19%, while 14% of colonoscopies were normal. Overall 14% of patients with any neoplasia were anemic. Of those patients diagnosed with adenocarcinoma, 31% were anemic. Weight loss in the year preceding colonoscopy was documented in 39% of all patients. Of those patients diagnosed with adenocarcinoma 62% had weight loss in the preceding year. Weight loss of 10 pounds or more occurred in 9% overall, and in 21% of patients with adenocarcinoma. 93% of the adenocarcinomas were detected in the sigmoid or rectum, while 7% were found proximally (ascending colon or cecum). Of all adenomas and villous adenomas, 27% were <5 mm in size; 45% were 5 to 9 mm and 27% were ≥10 mm in size. 79% of all polyps with villous histology were ≥10 mm in size, 21% were 5 to 9 mm and there were no villous adenomas <5 mm in size. Conclusion: There is no standardized approach to the evaluation of lower GI bleeding. Estimates vary regarding the prevalence of endoscopic findings in patients with scant intermittent hematochezia, including neoplasia. Adenocarcinoma was surprisingly prevalent in our population. A high proportion of these patients had other easily identifiable signs and symptoms such as weight loss or anemia. Simple clinical tools may be helpful to identify patients at higher risk for colorectal neoplasia.