Does a primary symptom of constipation warrant a colonoscopy for suspected colorectal cancer?
Abstract
Objective: We aim to evaluate the diagnostic accuracy of
colonoscopy in picking up colorectal cancer in patients
with a primary symptom of constipation. As colonoscopies
are dependent on bowel preparation, we also aimed
to look at the rates of adequate bowel preparation and
appropriate sedation
Methodology: This was a retrospective study conducted
at Queens Hospital Burton between January and June
2018. A total of 102 patients over the age of 18 years were
included in this study. Using an online clinical manager
database, patient notes and clinic letters, data was collected
of patients with documented chronic constipation or
altered bowel habits as their main symptom. Picolax was
used for bowel preparation with Moviprep preferred in
patients with renal impairment. Colonoscopy had been
carried out by consultant surgeons, consultant gastroenterologists,
specialist registrars or specialist endoscopy
nurse practitioners
Results: A total of 102 colonoscopies were performed
with 41 performed in males and 61 in females. 67 patients
(65.68%) had a normal colonoscopy result, 35 patients
had a mix of diseases with only one having rectal malignancy.
Adequate views were obtained in 76% of patients
with 24% giving inadequate views. Adequate bowel prep
was defined by endoscopists report on views obtained.
Conclusion: We conclude that constipation as a primary
symptom is not in itself an indication for referral for colonoscopy
for suspected cancer. The quality of bowel prep
is also an important factor that needs to addressed as per
guidance. In patients presenting with chronic constipation,
we must first try to categorise them according to the
Rome 3 criteria and bear in mind the ‘red flag’ symptoms
during the history and examination process
