Video anoscopy: results of routine anal examination during colonoscopies

Abstract

Background and study aims Anal examination and video anoscopy (VA) are rarely performed during colonoscopies. The aim of this study is to demonstrate that anal examination and VA provide important information in all routine colonoscopies. Patients and methods A cross-sectional study was conducted on 12,151 patients screened by VA which were performed during routine outpatient colonoscopy between 2006 and 2018. The aspects studied were: normal examination; hemorrhoidal disease; thrombosed hemorrhoids; anal fissure; perianal Crohn’s Disease; perianal fistula; condyloma; polyps; neoplasms; stenosis; bleeding. Results Of the colonoscopies performed on 12,151 patients, 9,364 cases (77.06 %) presented some alterations. Internal I degree hemorrhoids (5911 – 48.65 %); internal hemorrhoids of II, III and IV degrees (2362 – 19.44 %); thrombosed hemorrhoids (120 – 0.99 %); bleeding (56 – 0.46 %); fissure (415 – 3.42 %); perianal fistula (42 – 0.35 %); perianal Crohn’s Disease (34 – 0.28 %); condylomas (18 – 0.15 %); anal stenosis (30 – 0.25 %); other findings (310 – 2.55 %); polyps (62 – 0.51 %), one of which was adenomatous with high-grade dysplasia; four cases of anal canal neoplasia (0.03 %): two cases of squamous cell carcinoma and two cases of adenocarcinoma. Conclusion The association of routine video anoscopy during colonoscopy improved diagnosis of neoplastic anal lesions, allowed correct classification of the degree of hemorrhoidal disease, helped to confirm the bleeding site and detected other anal pathologies. The main findings were hemorrhoidal diseases, fissures and perianal fistulas. The study suggests that VA should be used in all colonoscopies.

Sexually Transmitted Infections Lesions Found during Colonoscopies

“…The evaluation of the perianal region and the anal canal enables the diagnosis, treatment, and follow-up of condylomatosis and premalignant lesions related to HPV. 21…”

“…The evaluation of the perianal region and the anal canal enables the diagnosis, treatment, and follow-up of condylomatosis and premalignant lesions related to HPV. 21 The treatment of anal HPV is based on three principles: a) reduction of the local viral load with chemical ablation (podophyllin 25%) followed by thermal ablation of residual lesions; b) increase in systemic immunity with tetravalent vaccine; c) increase in local immunity with an immunomodulator (imiquimod 3 times a week for 16 weeks). 11 Fig.…”

Hemorrhoids as a risk factor for colorectal adenomas on colonoscopy

“…The endoscopic removal of precancerous colorectal polyps can prevent colorectal cancer 3 . Hemorrhoids are common outpatient gastrointestinal disorders 4 in the United States and can be accurately diagnosed in retroflexed view colonoscopy 5 6 . The classification of hemorrhoids based on colonoscopy findings reflects the severity of symptoms, such as hematochezia and anal prolapse 7 8 .…”

Identification and Reporting of Anal Pathology during Routine Colonoscopies

“…An early detection of anal cancer improves patient survival, as the tumor diameter impacts the prognosis. 4 In a study by Gomes et al 5 including 12,151 patients submitted to routine colonoscopy with anoscopy, 77% were diagnosed with anal pathology. The most common were hemorrhoids, with internal grade-I hemorrhoids being identified in 48.6% and internal grades-II, III, and IV hemorrhoids observed in 19.4% of patients.…”