CONTRIBUTION OF COLONOSCOPY IN PATIENTS COMPLAINING OF CONSTIPATION

Aims:

Constipation is a common gastrointestinal complaint. Its association with an organic colic disease, especially a colorectal cancer (CRC) is controversial.

Aim: to determine the yield of colonoscopy for constipation as the sole indication and to identify the risk factors for colonic neoplasia in patients with constipation.

Methods:

A retrospective study from january 2016 to march 2017 including patients who underwent a colonoscopy for constipation alone (group 1, n = 36) or associated with another indication or average-risk screening (group 2, n = 107). We compared the prevalence of significant findings on colonoscopy between the two groups. A significant finding was defined as a suspected malignant tumor or polyp > 9 mm.

Results:

A total of 143 colscopies were included, among which 36 performed for constipation alone. Mean age was 56.3 years (group 1) versus 61.2 years (group 2) (p = 0.4). The sex ratio was 1.11 and 1.14 respectively. In all indication groups, the colonoscopy was normal in 58.7% (80.5% in group 1) and showed a CRC in 4.8% (n = 7), polyps in 23.5% (n = 33), diverticulosis (7.7%, n = 11), endoscopic signs of inflammatory bowel disease (3.4%, n = 5) and angiodysplasia (2.1%, n = 3). In group 1 the prevalence of significant finding was 5.5% vs. 15.8% in group 2 (p = 0.02): one or more polyps > 9 mm was found in 5.5%, n = 2 (group 1) vs. 9.3%, n = 10 (group 2) (p = 0.05). No case of CRC was detected in group 1. The coloscopy revealed a tumor in 7 patients in group 2. In univariate and multivariate analysis, the factors associated with significant findings were an age over 50 years (p = 0.001) and the presence of rectal bleeding (p = 0.02).

Conclusions:

Colonoscopy for constipation alone has a lower yield for significant findings compared with average-risk screening and constipation with another indication. Colonoscopy in constipation may only be warranted in patients who are over 50 years of age or have rectal bleedng.