Colonoscopy Identifies Increased Prevalence of Large Polyps or Tumors in Patients 40–49 Years Old With Hematochezia vs Other Gastrointestinal Indications

Abstract

Background & Aims There is an unclear role for colonoscopy in evaluation of symptomatic individuals younger than 50 years old. We aimed to determine the prevalence of large polyps (>9 mm) or tumors in individuals 40–49 years old who underwent colonoscopy for various signs and symptoms, and compare the results with those from average-risk individuals age 50–54 years old who underwent screening colonoscopy. Methods We collected data from a national endoscopy database, 2000 through 2012, and identified patients 40–49 years old who underwent colonoscopy for bleeding and nonbleeding indications. The prevalence of large polyps (>9 mm) or tumors was compared to the prevalence in a reference group (n=99,713 average-risk individuals age 50 to 54 undergoing screening colonoscopy). Results A total of 65,892 patients 40–49 years old underwent colonoscopy for a variety of indications. Significantly larger proportions of male and female patients with hematochezia without anemia or iron deficiency anemia (IDA) had large polyps or tumors (7.2%) compared to the reference group (men: 7.2% vs 6.2%; P=.0001 and women: 5.5% vs 4.1%; P<.0001). Patients with weight loss, anemia or IDA, or hematochezia with anemia or IDA did not have a significantly higher prevalence of large polyps or tumors than the reference group. Significantly lower proportions of patients with general gastrointestinal symptoms (pain, bloating, or change in bowel habits) had advanced neoplasia compared to the reference group (men: 3.9% vs 6.2%; P<.0001 and women: 2.7% vs 4.1%; P<.0001). Conclusions An analysis of a national endoscopy database supports the role of colonoscopy to evaluate hematochezia in patients 40–49 years old. A lower proportion of patients with anemia, weight loss, and general abdominal symptoms had large polyps or tumors compared to average-risk patients, 50–54 years old. A significantly lower proportion of patients younger than 50 years with general gastrointestinal symptoms had large polyps—these patients are therefore less likely to benefit from colonoscopy.

The Characterization and Outcomes of Colorectal Malignancy in Patients ≤40 Years of Age: A Single-Center Experience

“…Although there are multiple possible benign causes of rectal bleeding in the young population such as hemorrhoids or fissures, physicians need to be aware of early signs of malignancies or advanced adenomas in this population. 14,15 Delay in diagnosis is approximately 6 months and may affect disease stage and prognosis. 16 Younger patients <30 years of age were more likely to have recurrent disease and a trend toward worse survival as compared to those 30-40 years of age, likely because of higher percentages of poorly differentiated tumors, lymphovascular invasion, and perineural invasion, which are known high risk factors of recurrence and worse survival.…”

“…Although there are multiple possible benign causes of rectal bleeding in the young population such as hemorrhoids or fissures, physicians need to be aware of early signs of malignancies or advanced adenomas in this population. 14,15 Delay in diagnosis is approximately 6 months and may affect disease stage and prognosis. 16…”

Diagnosis of chronic anaemia in gastrointestinal disorders: A guideline by the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and the Italian Society of Paediatric Gastroenterology Hepatology and Nutrition (SIGENP)

“…Furthermore, despite the lack of evidence, the BSG guidelines recommend that young men (< 50 years old) with IDA should be investigated in the same manner as older men [3]. This recommendation is weakly supported by the few published studies, which have confirmed the infrequent presence of any significant lower GI pathology in young men with IDA [50][51][52]. A recent study compared colonoscopy findings in young patients (both male and female, aged 40-49 years) to the average-risk of individuals aged 50-54 years undergoing colonoscopy.…”

“…A recent study compared colonoscopy findings in young patients (both male and female, aged 40-49 years) to the average-risk of individuals aged 50-54 years undergoing colonoscopy. It concluded that young patients with IDA have a significant lower risk of advanced neoplasia, therefore it would be less likely that they were to benefit from colonoscopy [52]. Noteworthy, the possible increase in the DY by adding ileoscopy during standard colonoscopy has not been specifically investigated in the setting of anaemia; however, the potential usefulness of ileitis detection in this setting represents a potential indication.…”