Colonoscopic Findings in Patients Age 40-49 Presenting with Hematochezia or Occult Blood (OB) Positive Stool

Abstract

Purpose: While screening colonoscopy is recommended after the age of 50, the use of colonoscopy in patients under 50 is usually done only for indications. We sought to define the utility of colonoscopy in patients age 40-49 presenting with hematochezia or occult blood positive stool. Methods: We retrospectively reviewed the colonoscopic findings and pathology results of 388 consecutive patients with hematochezia and 194 consecutive patients with occult blood positive stool as a chief complaint in a three-year period among endoscopists in a single university group. The colonoscopic findings were categorized to high-risk lesions: cancer, villous adenoma, adenomas with severe dysplasia, and adenomas larger than 1 cm. Low risk lesions were defined as hyperplastic polyps and tubular adenomas less than 1 cm. Results: 388 consecutive patients with hematochezia as a chief complaint underwent colonoscopy. 23 (6%) patients were identified with high risk lesions: 6 patients with carcinoma, 10 pts. villous polyps, 5 pts. tubular adenoma larger than 1 cm and 2 polyps with high-grade dysplasia. 133 patients (34%) were identified with low risk lesions including 74 (19%) with hyperplastic polyps and 59 (15%) with tubular adenomas less than 1 cm. 232 (60%) had no pathological findings. 194 with OB positive stool underwent colonoscopy; 94 (48%) had pathological findings. 16 (8%) with high risk lesions, one patient had cancer, 11 were identified with villous polyps and 4 with adenomas larger than 1 cm. 78 (40%) were identified with low risk lesions: 41 (21%) with hyperplastic polyps and 37 (19%) with tubular adenomas. 30% of all cancers and advanced premalignant lesions were found proximal to the splenic flexure. Conclusions: Diagnostic colonoscopy in patients age 40-49 in the presence of hematochezia or OB positive stool frequently find neoplastic conditions and results in polypectomy in nearly half of the patients examined. 30% of all cancers and high risk lesions were found proximal to the splenic flexure. A complete evaluation of the colon is necessary in patients 40-49 years old in the presence of hematochezia or OB positive stool.