Young patients with benign anal diseases and rectal bleeding: should a colonoscopy be performed?
Background and aim
There is no consensus whether a colonoscopy should be recommended for patients under 50 years of age who present with both anal bleeding and benign anal diseases. The aim of this study is to evaluate the effectiveness of colonoscopy to detect neoplastic lesions in this specific group of patients.
A prospective study analyzing the results of colonoscopies performed in patients younger than 50 years of age who reported a rectal bleeding and also had a diagnosis of benign anal disease at first clinical visit.
One hundred and eighty-seven consecutive patients were prospectively included in this study. In 35 patients (18.7%), adenomatous polyps were diagnosed. Thirty-seven percent of those lesions (13 cases) were further classified as either advanced adenomas or serrated adenomas. The prevalence of adenomas was 14.6% among patients under the age of 40 and 20% among those between 40 and 50 years of age. Thirty-one percent of the adenomas (11 cases) were located in the right colon, without any other concomitant lesion in the distal colon. In addition, an unsuspected case of sigmoid carcinoma was diagnosed.
The performance of colonoscopy in young patients with benign anal diseases and hematochezia resulted in a high rate of detection of neoplastic lesions. The method might be considered as a valid strategy of investigation in this frequent clinical situation.
KeywordsColorectal cancer Colonoscopy Young patients Gastrointestinal bleeding Colorectal neoplasms
- 2.Chen KC, Chung CS, Hsu WF, Huang TY, Lin CK, Lee TH, Weng MT, Chiu CM, Chang LC, Chiu HM (2018) Identification of risk factors for neoplastic colonic polyps in young adults with bloody stool in comparison with those without symptom. J Gastroenterol Hepatol 33(7):1335–1340. https://doi.org/10.1111/jgh.14070 CrossRefPubMedGoogle Scholar
- 4.Bailey CE, Hu CY, You YN, Bednarski BK, Rodriguez-Bigas MA, Skibber JM et al (2015) Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg 150(1):17–22. https://doi.org/10.1001/jamasurg.2014.1756 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Wang W, Chen W, Lin J, Shen Q, Zhou X, Lin C (2019) Incidence and characteristics of young-onset colorectal cancer in the United States: an analysis of SEER data collected from 1988 to 2013. Clin Res Hepatol Gastroenterol 43:208–215. https://doi.org/10.1016/j.clinre.2018.09.003 CrossRefPubMedGoogle Scholar
- 7.INCA-Instituto Nacional do Câncer-Estimativa 2018-Síntese de Resultados e Comentários [Internet]. [cited 2019 Aug 26]. Available from: http://www1.inca.gov.br/estimativa/2018/sintese-de-resultados-comentarios.asp
- 8.Silva ACB, Vicentini MFB, Mendoza EZ, Fujiki FK, da Fonseca LG et al (2019) Young-age onset colorectal cancer in Brazil: analysis of incidence, clinical features, and outcomes in a tertiary cancer center. Curr Probl Cancer:S0147–0272(18)30204–6. https://doi.org/10.1016/j.currproblcancer.2019.01.009
- 12.Carlo P, Paolo RF, Carmelo B, Salvatore I, Giuseppe A, Giacomo B, Antonio R (2006) Colonoscopic evaluation of hematochezia in low and average risk patients for colorectal cancer: a prospective study. World J Gastroenterol 12:7304–7308. https://doi.org/10.3748/wjg.v12.i45.7304 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Siegel RL, Fedewa SA, Anderson WF, Miller KD, Ma J, Rosenberg PS et al (2017) Colorectal cancer incidence patterns in the United States, 1974–2013. J Natl Cancer Inst 109(8). https://doi.org/10.1093/jnci/djw322
- 23.Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN et al (2010) Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116:544–573. https://doi.org/10.1002/cncr.24760 CrossRefPubMedPubMedCentralGoogle Scholar