CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(08): E1059-E1064
DOI: 10.1055/a-0600-2157
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Two-year retrospective analysis of patients undergoing direct to procedure flexible sigmoidoscopy investigation with rectal bleeding as a primary complaint

Henry H. Nguyen
1  Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary AB, Canada
,
Robert Bechara
2  Gastrointestinal Diseases Research Unit (GIDRU), Department of Medicine, Queen’s University, Kingston ON, Canada
,
William G. Paterson
2  Gastrointestinal Diseases Research Unit (GIDRU), Department of Medicine, Queen’s University, Kingston ON, Canada
,
Lawrence C. Hookey
2  Gastrointestinal Diseases Research Unit (GIDRU), Department of Medicine, Queen’s University, Kingston ON, Canada
› Author Affiliations
Further Information

Publication History

submitted 17 March 2017

accepted after revision 08 September 2017

Publication Date:
10 August 2018 (online)

Abstract

Background and aims Rectal bleeding affects ~15 % of the general population and is a common reason for referral to gastroenterologists by primary care physicians. Direct to procedure flexible sigmoidoscopy is an appealing modality to investigate rectal bleeding due its diagnostic yield, safety profile, and accessibility. Patients referred on a routine basis for direct to procedure clinic by primary care physicians with the sole complaint of rectal bleeding have not previously been studied. Our study aims to explore the spectrum of diagnoses and evaluate for potential clinical predictors of underlying pathology in this specific patient population.

Methods In total, 528 charts of patients referred to the Kingston General Hospital and Hotel Dieu Hospital endoscopy units (Kingston, Canada) with the sole complaint of rectal bleeding were reviewed. All of these patients were referred on a routine basis to direct to procedure clinic from primary care physicians. The performance of various clinical variables in predicting significant pathology was assessed by univariate analysis.

Results The diagnostic spectrum of the cohort studied included hemorrhoids (75.5 %), anal fissures (4 %), ulcerative colitis (3.2 %), Crohn’s disease (1.1 %), indeterminate proctitis/colitis (1.7 %), and colorectal malignancy (2.7 %). Of the various clinical variables assessed, only male sex predicted significant pathology (25.2 % of males vs 17.6 % of females, P < 0.05).

Conclusion Our study highlights the need for a thorough investigation of rectal bleeding given the lack of clinical predictors. Future prospective studies with more patients are needed to fully assess the utility of various clinical variables in predicting pathology in this patient population. This would allow for more effective triaging of a routine rectal bleeding, a very common reason for patient referral to gastroenterologists by primary care physicians. Flexible sigmoidoscopy was not associated with complications or missed diagnosis in our study. As such, the technique appears to be a suitable initial investigative modality for patients with rectal bleeding.