An analysis of site‐specific attributable pathologies for colorectal symptoms: diagnostic yield of colonoscopy

Zbar,; Pignatelli, Massimo; Sherman,; Toomey,; Kmiot,

doi:10.1046/j.1463-1318.1999.00053.x

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…Forty papers provided information about the relationship between bleeding (of any type) and colorectal cancer [ 13 - 21 , 23 - 28 , 30 , 32 , 33 , 35 , 37 , 41 , 42 , 45 - 47 , 50 , 51 , 54 - 56 , 60 - 66 , 69 , 72 , 73 ], and 23 of these papers [ 13 - 17 , 20 , 21 , 23 , 24 , 26 , 28 , 30 , 33 , 41 , 42 , 46 , 47 , 54 , 56 , 61 , 63 , 72 , 73 ] also provided information about the relationship between bleeding and polyps.…”

Section: Resultsmentioning

confidence: 99%

Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

et al. 2011

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BackgroundBowel symptoms are often considered an indication to perform colonoscopy to identify or rule out colorectal cancer or precancerous polyps. Investigation of bowel symptoms for this purpose is recommended by numerous clinical guidelines. However, the evidence for this practice is unclear. The objective of this study is to systematically review the evidence about the association between bowel symptoms and colorectal cancer or polyps.MethodsWe searched the literature extensively up to December 2008, using MEDLINE and EMBASE and following references. For inclusion in the review, papers from cross sectional, case control and cohort studies had to provide a 2×2 table of symptoms by diagnosis (colorectal cancer or polyps) or sufficient data from which that table could be constructed. The search procedure, quality appraisal, and data extraction was done twice, with disagreements resolved with another reviewer. Summary ROC analysis was used to assess the diagnostic performance of symptoms to detect colorectal cancer and polyps.ResultsColorectal cancer was associated with rectal bleeding (AUC 0.66; LR+ 1.9; LR- 0.7) and weight loss (AUC 0.67, LR+ 2.5, LR- 0.9). Neither of these symptoms was associated with the presence of polyps. There was no significant association of colorectal cancer or polyps with change in bowel habit, constipation, diarrhoea or abdominal pain. Neither the clinical setting (primary or specialist care) nor study type was associated with accuracy.Most studies had methodological flaws. There was no consistency in the way symptoms were elicited or interpreted in the studies.ConclusionsCurrent evidence suggests that the common practice of performing colonoscopies to identify cancers in people with bowel symptoms is warranted only for rectal bleeding and the general symptom of weight loss. Bodies preparing guidelines for clinicians and consumers to improve early detection of colorectal cancer need to take into account the limited value of symptoms.

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Section: Resultsmentioning

confidence: 99%

Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

et al. 2011

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“…Neoplastic polyps or cancer were found at colonoscopy in 24% of those being investigated for rectal bleeding, 24% for anemia, 43% for polyp follow-up, 13.6% for cancer, but only 7.1% and 7.8%, respectively, of those being investigated for pain or altered bowel habit [17]. When colonoscopy resources are limited, its use for bleeding, anemia, or neoplasia follow-up should take precedence.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity of double contrast barium enema and colonoscopy for the detection of colorectal neoplasms

Smith

O’Dwyer

2001

Surg Endosc

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Background: Double contrast barium enema (DCBE) is the examination carried out most frequently for investigation of patients with large bowel symptoms. The aim of this study was to compare the sensitivity of DCBE and colonoscopy for the detection of colorectal cancer and neoplastic polyps Ն1 cm. Methods: All patients undergoing DCBE (1389) or colonoscopy (1081) as the primary investigation for large bowel symptoms or for cancer or polyp surveillance in the first 9 months of 1997 at a large teaching hospital were included in this study. At 1 and 2 years following investigation, a computerized search of appropriate diagnosis and procedure codes to detect any missed cancers or polyps was performed for all patients with a normal investigation. Results: Almost 19% of patients in both groups went on to have an additional large bowel investigation over the 2-year period. In the DCBE group, 47 patients (3.5%) had a cancer diagnosed; eight of them had been missed at the primary investigation (sensitivity 83%). In the colonoscopy group, 37 patients (3.4%) had a cancer; one of them had been missed at the primary investigation (sensitivity 97.5%). Neoplastic polyps Ն1 cm were diagnosed in 1.6% of the DCBE group and in 7.7% of the colonoscopy group, with sensitivities of 21.7% and 91.4%, respectively. Nine patients (0.6%) had a false positive diagnosis of cancer in the DCBE group; one had an iatrogenic bowel perforation following flexible sigmoidoscopy. Conclusions: Where adequate facilities and expertise exist, colonoscopy should be the investigation of choice for most patients with large bowel symptoms suggestive of neoplastic disease.Colorectal cancer is the second most common cause of cancer death in the United Kingdom [10]. Despite improvements in surgery and chemotherapy, survival rates over the last 50 years have remained static. One reason for this is that Ն35% of patients are at an advanced stage when first diagnosed [4]. Early detection of colorectal cancer and neoplastic polyps is therefore the key to improvement in this disease, since cure can be effected by surgery and polypectomy may prevent the development of colorectal cancer [16].Double contrast barium enema (DCBE) is the examination carried out most frequently for patients with large bowel symptoms [2]. Its sensitivity for Dukes' A and B colorectal cancer ranges from 55% to 85% [9]. Some authors have suggested that this rate can be improved to 96-98% if combined with flexible sigmoidoscopy [5,6]. National Health Service (NHS) Executive guidelines [9], however, acknowledge colonoscopy as the gold standard for the detection of cancer and polyps, with a reported sensitivity of 96.5% and 94%, respectively [11,15]. In addition, the wider use of colonoscopy has recently been shown to improve the detection rate for early colorectal cancer [7]. The 5-year survival for such lesions is 97.6% [7]; thus, colonoscopy offers real hope for cure of this disease.There have been no large randomized prospective trials comparing the sensitivity of DCBE and colonoscopy for detec...

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Colonoscopy in asymptomatic individuals with a family history of colorectal cancer

Syrigos

Charalampopoulos

et al. 2002

Annals of Surgical Oncology

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An analysis of site‐specific attributable pathologies for colorectal symptoms: diagnostic yield of colonoscopy

Abstract: Colonoscopy is valuable as a routine investigation in patients presenting with rectal bleeding or iron deficiency anaemia.

Cited by 4 publications

References 12 publications

Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

Sensitivity of double contrast barium enema and colonoscopy for the detection of colorectal neoplasms

Colonoscopy in asymptomatic individuals with a family history of colorectal cancer

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