The yield of lower endoscopy in patients with constipation: Survey of a university hospital, a public county hospital, and a Veterans Administration medical center

doi:10.1016/S0016-5107(02)70033-3

Gastrointestinal Endoscopy

Volume 56, Issue 3, September 2002, Pages 325-332

Presented at the Annual Scientific Meeting of the American College of Gastroenterology, October 22-24, 2001, Las Vegas, Nevada.

https://doi.org/10.1016/S0016-5107(02)70033-3 Get rights and content

Abstract

Background: The role of endoscopy in the evaluation of constipation is controversial. The aim of this study was to clarify the yield of lower endoscopy in patients with constipation. Methods: Endoscopic databases from 3 diverse hospitals were searched for procedures with constipation as an indication. Detection of neoplasia was the main outcome of interest. Results: Among 19,764 sigmoidoscopies or colonoscopies, constipation was a procedure indication for 563 patients (mean age 61 [16] years, 52% women); 58% had procedure indications in addition to constipation. Colorectal cancer was diagnosed in 8 (1.4%), adenomas in 82 (14.6%), and advanced lesions (cancer or adenoma with malignancy, high-grade dysplasia, villous features, or size ≥10 mm) in 24 (4.3%). In the 358 patients who underwent colonoscopy, cancer was detected in 1.7%, adenomas in 19.6%, and advanced lesions in 5.9%. Two patients with cancer were less than 50 years of age. In as many as 6 patients with cancer, the tumor may have caused partial obstruction. Conclusions: The range of neoplasia in patients with constipation evaluated with lower endoscopy was comparable with what would be expected in asymptomatic subjects undergoing colorectal cancer screening. Although chronic constipation alone may not be an appropriate indication for lower endoscopy, age-appropriate colorectal cancer screening should be pursued when patients with constipation seek medical care. (Gastrointest Endosc 2002;56:325-32.)

Section snippets

Endoscopic databases and study population

The study was approved by the UCSF Committee on Human Research. The 3 sites included were the Moffitt-Long Hospital (MLH), a university tertiary care medical center that also serves as a community hospital for many patients; San Francisco General Hospital (SFGH), a public county hospital; and the San Francisco Veterans Administration Medical Center (SFVAMC). At each site, electronic endoscopic reports were available for different time periods: at MLH, all endoscopic reports from June 1997 to

Study population

During the study periods, a total of 19,764 lower endoscopies were performed at the 3 sites. Of these, 566 (2.9%) included constipation as an indication for the procedure, representing 563 unique patients. The demographic and procedure-related data for these patients are summarized in Table 1. In total, the mean age of patients was 60.6 (15.9) years, 52% were women, 42% had CONSTIP and 58% CONSTIP+, and the procedure performed was SIG in 36% and COL in 64% of cases.

Age was not different between

Discussion

In this analysis of data from the endoscopic databases of a university hospital, public county hospital, and VA medical center in the UCSF system, 563 patients were identified who underwent SIG or COL with constipation as an indication. The overall yield of lower endoscopy for detecting advanced lesions was 4.3%. In those patients who underwent full colonoscopy, the frequency of advanced lesions was 5.9%. All 8 patients in whom a diagnosis of CRC was made had other procedure indications in

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A Case-Based Approach to Constipation in Primary Care
2021, Medical Clinics of North America
Citation Excerpt :
A meta-analysis demonstrated no increase in colorectal cancer in patients with chronic constipation.16 The diagnostic yield of colonoscopy in chronic constipation is low and comparable to the asymptomatic general population.17 Because she is at average risk, the patient is offered age-appropriate colorectal cancer screening with colonoscopy or FIT.
Clinical practice guidelines for the management of constipation in adults. Part 2: Diagnosis and treatment
2017, Gastroenterologia y Hepatologia
El estreñimiento es un trastorno muy frecuente que afecta negativamente el bienestar y la calidad de vida de las personas. Para el correcto manejo y tratamiento eficiente y seguro de los pacientes, las guías de práctica clínica basadas en la evidencia son un elemento esencial.
El objetivo de esta guía es proporcionar a los profesionales sanitarios encargados de la asistencia a pacientes con estreñimiento crónico una herramienta que les permita tomar las mejores decisiones sobre la prevención, el diagnóstico y el tratamiento del estreñimiento.
La metodología utilizada en la elaboración de esta guía de práctica clínica se describe en la Parte 1. En este artículo expondremos las recomendaciones en el manejo, tanto diagnóstico como terapéutico del estreñimiento.
Constipation is a very common disorder that adversely affects well-being and quality of life. Evidence-based clinical practice guidelines are an essential element for proper patient management and safe, effective treatment.
The aim of these guidelines is to provide health care professionals who care for patients with chronic constipation with a tool that allows them to make the best decisions about the prevention, diagnosis and treatment of constipation.
The methodology used to draw up these guidelines is described in the Part 1. In this article we will discuss the recommendations for the diagnostic and therapeutic management of constipation.
Clinical practice guidelines: Irritable bowel syndrome with constipation and functional constipation in adults: Concept, diagnosis, and healthcare continuity. (Part 1 of 2)
2017, Atencion Primaria
En esta Guía de práctica clínica analizamos el manejo diagnóstico y terapéutico de pacientes adultos con estreñimiento y molestias abdominales, bajo el espectro del síndrome del intestino irritable y el estreñimiento funcional. Tienen una importante repercusión personal, sanitaria y social, afectando a la calidad de vida de los pacientes que las padecen. En el síndrome del intestino irritable con predomino del estreñimiento, este es la alteración deposicional predominante junto con dolor abdominal recurrente, hinchazón y distensión abdominal frecuente. El estreñimiento se caracteriza por la dificultad o la escasa frecuencia en las deposiciones, acompañado por esfuerzo excesivo durante la defecación o sensación de evacuación incompleta. La mayoría no tienen una causa orgánica subyacente, considerándose un trastorno funcional intestinal. Poseen muchas similitudes clínicas y fisiopatológicas, con respuesta similar del estreñimiento a fármacos comunes. La diferencia fundamental es la presencia o ausencia de dolor, pero no de un modo evaluable como «todo o nada». La gravedad depende tantro de la intensidad de los síntomas intestinales como de otros factores: asociación de síntomas gastrointestinales y extraintestinales, grado de afectación, formas de percepción y comportamiento. Los criterios de Roma diagnostican los trastornos funcionales intestinales. Esta Guía está adaptada a los criterios de Roma IV (mayo de 2016) y analiza, en esta primera parte, los criterios de alarma, las pruebas diagnósticas y los criterios de derivación entre Atención Primaria y Aparato Digestivo. En una segunda parte, se revisarán las alternativas terapéuticas disponibles (ejercicio, dieta, tratamientos farmacológicos, neuroestimulación de raíces sacras o cirugía), efectuando recomendaciones prácticas para cada una de ellas.
In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; “all or nothing”. The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them.
Clinical practice guidelines: Irritable bowel syndrome with constipation and functional constipation in adults: Concept, diagnosis, and healthcare continuity. (Part 1 of 2)
2017, Semergen
En esta Guía de práctica clínica analizamos el manejo diagnóstico y terapéutico de pacientes adultos con estreñimiento y molestias abdominales, bajo el espectro del síndrome del intestino irritable y el estreñimiento funcional. Tienen una importante repercusión personal, sanitaria y social, afectando a la calidad de vida de los pacientes que las padecen. En el síndrome del intestino irritable con predomino del estreñimiento, este es la alteración deposicional predominante junto con dolor abdominal recurrente, hinchazón y distensión abdominal frecuente. El estreñimiento se caracteriza por la dificultad o la escasa frecuencia en las deposiciones, acompañado por esfuerzo excesivo durante la defecación o sensación de evacuación incompleta. La mayoría no tienen una causa orgánica subyacente, considerándose un trastorno funcional intestinal. Poseen muchas similitudes clínicas y fisiopatológicas, con respuesta similar del estreñimiento a fármacos comunes. La diferencia fundamental es la presencia o ausencia de dolor, pero no de un modo evaluable como «todo o nada». La gravedad depende tantro de la intensidad de los síntomas intestinales como de otros factores: asociación de síntomas gastrointestinales y extraintestinales, grado de afectación, formas de percepción y comportamiento. Los criterios de Roma diagnostican los trastornos funcionales intestinales. Esta Guía está adaptada a los criterios de Roma IV (mayo de 2016) y analiza, en esta primera parte, los criterios de alarma, las pruebas diagnósticas y los criterios de derivación entre Atención Primaria y Aparato Digestivo. En una segunda parte, se revisarán las alternativas terapéuticas disponibles (ejercicio, dieta, tratamientos farmacológicos, neuroestimulación de raíces sacras o cirugía), efectuando recomendaciones prácticas para cada una de ellas.
In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; “all or nothing”. The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them.
The role of endoscopy in the management of constipation
2014, Gastrointestinal Endoscopy
Citation Excerpt :
The yield of colonoscopy in isolated constipation is low and comparable to that of asymptomatic patients undergoing colonoscopy for colorectal cancer screening. In one study of 563 sigmoidoscopies or colonoscopies done for the evaluation of constipation, colorectal cancer was found in 8 (1.4%), adenomas in 82 (14.6%), and advanced lesions (cancer or adenoma with malignancy, high-grade dysplasia, villous features, or size >10 mm) in 24 (4.3%).17 Another study that evaluated the yield of colonoscopy performed for the sole indication of constipation found that the prevalence of colorectal neoplasia was lower in patients with constipation than in those undergoing colonoscopy for routine colorectal cancer screening.18
American gastroenterological association technical review on constipation
2013, Gastroenterology
Citation Excerpt :
Testing should also be considered in patients with an abrupt change in bowel habits without an obvious cause, recognizing the limitations of defining an abrupt change. Because the prevalence of colonic neoplastic lesions at colonoscopy is comparable in patients with versus without chronic constipation, routine colonoscopy is not warranted for most patients with constipation.83 Patients are usually referred for specialty consultation because their symptoms have not responded to fiber supplements and/or over-the-counter laxatives.

View all citing articles on Scopus

^☆: Reprint requests: Uri Ladabaum, MD, MS, Division of Gastroenterology, S-357, Box 0538, University of California, 513 Parnassus Ave., San Francisco, CA 94143-0538.

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Original ArticlesThe yield of lower endoscopy in patients with constipation: Survey of a university hospital, a public county hospital, and a Veterans Administration medical center☆

Abstract

Section snippets

Endoscopic databases and study population

Study population

Discussion

Gastrointest Endosc

Gastroenterology

Gastrointest Endosc

Gastroenterology

Gastrointest Endosc

Am J Gastroenterol

Gastrointest Endosc

Gastroenterology

Gastroenterology

Gastroenterology

Approach to the patient with constipation

Appropriate use of gastrointestinal endoscopy. Manchester (MA): American Society for Gastrointestinal Endoscopy

Gastrointest Endosc

Diagnostic yield of colorectal neoplasia with colonoscopy for abdominal pain, change in bowel habits, and rectal bleeding

Am J Gastroenterol

Indications for colonoscopy. An analysis based on indications and diagnostic yield

S Afr Med J

Original Articles
The yield of lower endoscopy in patients with constipation: Survey of a university hospital, a public county hospital, and a Veterans Administration medical center☆