Document Detail


Is Whole Colonic Imaging Necessary for Symptoms of Change in Bowel Habit and/or Rectal Bleeding?
MedLine Citation:
PMID:  22176613     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Aim:  Following introduction of 2 week-wait (2ww) cancer pathway many units are triaging patients with change in bowel habit (CIBH) and/or rectal bleeding (RB) straight to colonoscopy. Evidence suggests that right-sided colonic cancer does not present with these symptoms, hence imaging the left colon only is satisfactory. If this were substantiated, patients could be offered a flexible sigmoidoscopy (FS) alone. This study aimed to review presenting symptoms of patients diagnosed with a right-sided colonic malignancy and assess whether their tumours would be missed based on this practice. Method:  This is a retrospective analysis of patients who underwent curative resection for a proximal colonic malignancy over a 4-year period. 2ww referral proforma and case notes were analysed for mode of presentation. Results:  Of 206 elective right hemicolectomies performed, 20/206 (9.7%) patients presented in the absence of either iron deficiency anaemia or palpable abdominal mass. 12 patients had polyposis identified in the left colon and 8 patients had no left-sided colonic pathology. 1 patient had a strong family history of colon cancer (2 first degree relatives) in the group absent of left-sided pathology. Conclusion:  12 patients who had left sided polyposis and one patient with a strong family history would have undergone WCI based on current CRC management guidelines. The remaining seven patients with right-sided cancer would have been missed if FS were the only investigation used. Patients presenting on the 2ww with symptoms of a CIBH and or RB can be adequately investigated with a FS with a 3% chance of missing a proximal cancer.
Authors:
Sarit Badiani; Anant Desai; Mark As Chapman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-18
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  -     ISSN:  1463-1318     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 The Association of Coloproctology of Great Britain and Ireland.
Affiliation:
Department of Colorectal Surgery, Heart of England NHS Foundation Trust, Birmingham, B9 5SS.
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