Publication:

The value of flexible sigmoidoscopy in the evaluation of rectal bleeding in the young

Background Rectal bleeding is a frequent symptom in the young and often over- investigated. We reviewed the diagnostic yield of flexible sigmoidoscopy in younger patients in a district general hospital in UK.

Methods All consecutive flexible sigmoidoscopies carried out between 2010-2013 for bright red rectal bleeding in patients younger than 45 years were analysed. Referrals included direct access, two-week waits, urgent out-patient and in-patient referrals. Routine and follow-up cases were excluded from the review. The extent of examination, diagnosis and procedure related complications were reviewed.

Results 516 procedures were carried out in the study period with a mean age of 34 (range 17-44). There was no endoscopy-related complications. 8 procedures were incomplete due to poor bowel preparation and 39 (6.7%) had polyps (31 rectal, 8 sigmoid). On histology, 9 (1.7%) were adenomatous with two larger than 1 cm, 2 had no polyp tissue, one rectal carcinoid and two carcinoma (0.4%) (rectum and sigmoid). The rest were hyperplastic polyps.

Conclusions Prevalence of size significant polyps and advanced adenoma is very low (1-2%) in younger patients. A flexible sigmoidoscopy for bright red rectal bleeding alone in younger patients with no associated symptoms and an identifiable anorectal cause for bleeding by proctoscopy or rigid sigmoidoscopy is a huge strain on resources and cost limiting especially with a polyp incidence of 1.7% and carcinoma detection of 0.4%.   Keywords: Rectal bleeding, Flexible sigmoidoscopy, Polyps, Carcinoma