**4. Conclusions**

*Gastrointestinal Stomas*

The purpose of this study was to investigate the easiness of physician and the patient and the rate of discovering pathologic findings through sigmoidoscopy and full colonoscopy in patients under 50 years old with LGIB. According to the results of this study, doing proximal colonoscopy compared to sigmoidoscopy is easier for the patient and the physician, and the time spent was also less compared to sigmoidoscopy. It seems logical that sigmoidoscopy is more difficult for the patient and physician despite intubation and passing from the rectosigmoid area. According to the pathological findings, it is assumed that the full colonoscopy has been of more diagnostic value for patients because of finding important pathologies. The results were compared with sigmoidoscopy, which indicate a significant difference between the levels of pathological findings in colonoscopy compared to sigmoidoscopy. The pathological findings in colonoscopy were higher than sigmoidoscopy. LGIB or rectal bleeding is considered as a common concern in the young people, and there is difficulty in making decision about sigmoidoscopy or full colonoscopy. As a whole, it is accepted that full colonoscopy should be performed for the people older than 50 years old with rectal bleeding, but there is no consensus guideline for patients under 50 years yet. In many studies, the researchers have shown that due to this matter, the LGIB or rectal bleeding is considered a common concern in the young people and the benign anorectal pathologies such as hemorrhoids and other concerns are the cause of 90% of rectal bleeding; colorectal cancer increases with age, the method of sigmoidoscopy is sufficient, and there is no need for colonoscopy [11]. However, in several studies including the study performed by Wong et al. [13], 223 patients under 50 years old underwent colonoscopy. Among them, 4 patients (1.8%) had colon cancer in distal colon, 22 patients (9.9%) had adenoma, 6 patients had proximal polyps, and 60.5% of patients had hemorrhoids. They argued that colon cancer can occur in younger persons. Hence, in colonoscopy, it should be strongly considered that the results of this study are consistent with the current study [13], or in the study of Van Rosendaal et al. performed in 2002, from 66 patients, colonoscopy was done in 55 patients, and most of them had the lesion in 60 cm interval of the anus, but there was a cancerous and a polyp lesion upper than 60 cm [14]. In a study by Lewis et al. that was performed to investigate the cause of rectal bleeding in the young people, they concluded that doing colonoscopy in patients between 25 and 45 years is incremental cost-effectiveness [15]. Inconsistent with our study in the study of Aravindan [16], 516 patients were reviewed. They were treated by sigmoidoscopy because of rectal bleeding. Among them, 39 patients (39%) had polyps, and among them 31 cases were rectal, and 8 were sigmoid. Due to their histology, 1.7% was adenomatous, in one patient was rectal carcinoid, and in two patients (0.4%) was carcinoma, and in the other patients, there were hyperplastic polyps. The researchers showed that the prevalence of polyps with large size and advanced adenoma is very low in young people [16], or in another study performed by Khalid et al. [17], they showed that 379 patients who were under 40 years had LGIB and were treated by full colonoscopy. Among them, seven adenomatous polyps and malignant lesions were discovered that all were in the distal colon. In persons at the age of 40–50 years, ten polyps and malignant lesions were discovered that one of them was in the proximal colon. They concluded that most of the lesions were in the distal colon; therefore, flexible sigmoidoscopy is sufficient, and there was no need for full colonoscopy [17]. Furthermore, in another study performed by Nikpour et al. [18], 402 patients with rectal bleeding underwent colonoscopy. Among them, 54.2% had hemorrhoid, 14.2% had anal fissure, and 14.2 had ulcerative colitis which are the most prevalent pathologies. Among 121 patients, 30.1% had significant lesions, 6.5% had adenocarcinoma, and 7.5% had adenomatous

**3. Discussion**

**74**

With regard to this matter, if these patients were under full colonoscopy from the beginning, the satisfaction level in colonoscopy has statistically significant difference with sigmoidoscopy, and it is recommended that the patients under 50 years with rectal bleeding should be under full colonoscopy.
