Full Colonoscopy in Patients under 50 Years Old with Lower Gastrointestinal Bleeding

*Mahsa Khodadoostan, Ahmad Shavakhi, Reihaneh Padidarnia, Alireza Shavakhi and Mehdi Ahmadian*

## **Abstract**

The aim of this study is to compare sigmoidoscopy with full colonoscopy in these patients. In this cross-sectional study, 120 eligible patients under 50 years old with acute rectal bleeding were enrolled. Pain, the comfort of the test by physician and patient, duration of the procedure, and pathologic findings were recorded during sigmoidoscopy and proximal colonoscopy (from splenic flexure to ileocecal valve) in the same patient. The variables in the two stages were compared with each other. There were 66 women (55%) and 54 men (45%), and the mean of age was 41 ± 7.9 years. Proximal colonoscopy from splenic flexure to reach cecum was relatively easier for the physician and the patient than sigmoidoscopy (*P* < 0.001). Furthermore, the time spent to carry out proximal colonoscopy was less than the time taken for sigmoidoscopy (*P* < 0.001). Pathologic findings recorded in full colonoscopy were more than sigmoidoscopy (*P* < 0.001). Therefore, full colonoscopy that includes sigmoidoscopy and proximal colonoscopy is relatively easier than sigmoidoscopy for patients, and it also proves to be more advantageous than sigmoidoscopy for physicians to perform in Iranian patients because of the more tortuous and elongated sigmoid colon in these patients.

**Keywords:** colonoscopy, gastrointestinal bleeding, sigmoidoscopy

## **1. Introduction**

Lower gastrointestinal bleeding (LGIB) is one of the most common problems that gastroenterologists and surgeons encountered [1]. LGIB prevalence increases with aging, using aspirin, anticoagulants, and nonsteroidal anti-inflammatory drugs (NASIDs). LGIB is associated with death, hospitalization, and medical costs [2]. Therefore, diagnosis of the cause of LGIB and its proper management are of critical importance [3]. These causes include bleeding from the diverticulum, ischemic colitis, angiodysplasia, hemorrhoids, colorectal cancer, inflammatory bowel disease, infectious colitis, NSAID, radiation, and solitary ulcers [4, 5]. For diagnosing the causes of lower bleeding (LGIB), there are different modalities such as total colonoscopy, radionuclide scan, angiography, computed tomography angiography, and sigmoidoscopy [6].

Some authors believe that in 90% of patients <50 years who present with LGIB, most causes are benign anorectal diseases, and on the other hand, the prevalence of colorectal cancer increases with aging. Hence, patients <50 years who present

with LGIB are examined excessively in whom there is no need for total colonoscopy and sigmoidoscopy alone is enough [7, 8]. In some researches, it is expressed that total examination of the colon in these individuals through total colonoscopy will impose stress on them and longer hospitalization [9]. On the other hand, some researchers believe that colonoscopy should be applied on all individuals who present with LGIB for its high authority in diagnosing other damages such as polyp and colorectal cancers [10]. Furthermore, they believe that in patients who were under sigmoidoscopy, performing colonoscopy is causing more diagnosing dangerous and deadly diseases through neoplasms, but, in total colonoscopy, it is required for complete preparation and totally clean intestines which may impose strong pain. In some circumstances, there arises the need for using anesthetics and longtime hospitalization [11]. Currently, there is no any definite consensus about whether the patients with LGIB would be under total colonoscopy or only sigmoidoscopy can be enough. The purpose of this study is to analyze and compare the methods of colonoscopy and sigmoidoscopy regarding the additional findings and easiness of them for patients and physician in patients <50 years with LGIB.

In this cross-sectional study performed from January 2016 to November 2016 in Al-Zahra Hospital in Isfahan, 120 patients with LGIB were referred, and informed consent for participation was obtained.

Ethical consideration is ir.mui.rec. 1394.3.606, the size of samples calculated according to the Cochran formula. That was 120 samples.

Participants aged <50 years and having LGIB in the form of hematochezia or rectorrhagia and with stable hemodynamic were included in the study. Participants with hemodynamic instability, history of colorectal cancer, history of consumption aspirin or anticoagulant, history of previous major abdominal surgery, fair colon preparation, intolerance to free sedation colonoscopy, advance heart and lung disease, documented acute diverticulitis, fulminant colitis, and definitive or suspected perforation were excluded from the study [12]. After cleaning the colon with polyethylene glycol powder with 4–6 l, all colonoscopies were performed without sedation by an experienced gastroenterologist using a Fujinon 4400 Tokyo, Japan Video Scope. If the patients had severe pain and hence used an analgesic, they were excluded. Endoscopic procedures were done in the left lateral position to inhibit aspiration. Details of bowel-cleansing preparation of the colon, initially the patients underwent sigmoidoscopy considered it by getting the scope of colonoscopy from anal canal to splenic flexure by the end of this stage; the levels of the pain and the comfort of the test by physician and patient were measured with visual analog scale from 0 to 10 (10: without discomfort and 0: the most discomfort), duration of procedure were calculated in minutes, and pathologic finding were registered and considered as sigmoidoscopy group. In same patients, the procedure continued until the splenic flexure passed in the ileocecal valve, and this stage was considered as proximal colonoscopy and then from the splenic flexure to ileocecal valve easy performance of this test for the physician and the patient were measured with visual analog scale from zero to ten (10: without discomfort and 0: the most discomfort), duration of procedure to the minute and diagnosed lesions were recorded.

### **1.1 Statistical analysis**

Data were analyzed using IBM SPSS/PC statistical software version 20, the descriptive analysis was based on mean ± standard deviation, and quantitative variable analysis was based on number (%). Compression of comfort for patient and physician and time taken in sigmoidoscopy from splenic flexure to reach ileocecal valve were analyzed by paired *t*-test, and comparisons between the pathologic findings in sigmoidoscopy and full colonoscopy were analyzed by McNemar test.

**73**

**Table 2.**

**Table 1.**

*valve.*

*Full Colonoscopy in Patients under 50 Years Old with Lower Gastrointestinal Bleeding*

During this study, 120 patients were studied, among which 66 women (55%) and 54 men (45%) participated. The mean of age participants in this study was

According to **Table 1**, and using paired *t*-test, proximal colonoscopy from splenic flexure to reach cecum was relatively easier for the physician and the patient than sigmoidoscopy (*P* < 0.001). Furthermore, the time spent to carry out proximal

In **Table 2**, and using McNemar test, pathologic findings were compared to each other on the basis of doing sigmoidoscopy alone from the anal phase to the splenic flexure or doing a complete colonoscopy from the anus to the cecum. The findings of sigmoidoscopy and the second phase of the procedure (from the splenic flexure to the cecum) have been gathered, and we infer that, based on the table, pathologic findings in full colonoscopy and the findings of sigmoidoscopy showed a significant difference. It means that if the patients underwent full colonoscopy, the pathologic findings show statistically significant differences compared to doing sigmoidoscopy alone.

*Compression of feasibility for patient and physician and time in sigmoidoscopy with splenic flexure till ileocecal* 

*The comparison between the pathologic findings in sigmoidoscopy and full colonoscopy.*

colonoscopy was less than the time taken for sigmoidoscopy (*P* < 0.001).

*DOI: http://dx.doi.org/10.5772/intechopen.84484*

**2. Results**

41 ± 7.9 years.

*Full Colonoscopy in Patients under 50 Years Old with Lower Gastrointestinal Bleeding DOI: http://dx.doi.org/10.5772/intechopen.84484*
