Towards an ecological reduce of unnecessary indications : what factors are associated with pathological colonoscopy?

Aims In the healthcare sector, endoscopy is the third largest contributor to waste generation. The most effective way to reduce the carbon footprint of endoscopy is to minimize the number of unnecessaryprocedures. Our study aims to identify factors associated with pathological findings in colonoscopy. This will help us reduce unnecessary colonoscopy indications from an ecological perspective.

Methods A retrospective descriptive and analytical study was conducted from January 2019 to August 2023, including all patients who underwent colonoscopy. Patients with chronic inflammatory bowel disease (IBD) were excluded from the study.

Results The study included 1,894 colonoscopies, of which 833 (44%) were pathological. The mean age was 57.6±14.98 years (ranging from 12 to 92 years), with a male-to-female ratio of 1.59. The most frequent indications for pathological colonoscopy were rectal bleeding in 31% of cases (n=587), diarrhea in 22% (n=416), constipation in 20.8% (n=394), iron deficiency anemia in 15.3% (n=289), and melena in 10.9% (n=208). The main diagnoses identified were colorectal polyps in 42% of cases (n=795), colitis in 21.7% (n=410), colorectal neoplasms in 14.4% (n=272), colonic diverticulosis in 12.9% (n=244), and colonic angiodysplasia in 9% of cases (n=170). After multivariate analysis, factors significantly associated with pathological colonoscopy findings were age>50 years (OR: 1.9, 95% CI: 1.4-2.5, p<0.001); male sex (OR: 1.7, 95% CI: 1.3-2.3, p<0.001); history of colorectal polyps (OR: 3.8, 95% CI: 2-7, p<0.001); good bowel preparation (OR: 1.4, 95% CI: 1-1.9, p=0.015); presence of iron deficiency anemia (OR: 0.7, 95% CI: 0.5-0.8, p=0.007); constipation (OR: 0.7, 95% CI: 0.5-0.9, p=0.037); and rectal bleeding (OR: 1.3, 95% CI: 1-1.8, p=0.038).

Conclusions In this study, rectal bleeding was the most common indication for colonoscopy. Presence of rectal bleeding, iron deficiency anemia, constipation, and diarrhea are associated with pathological colonoscopy findings, and can be considered when assessing indications for colonoscopy.

Publication History

Article published online:
27 March 2025