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The value of flexible sigmoidoscopy for patients
with bright red rectal bleeding
HK Choi, WL Law, KW ChU
Department of Surgery, The University of Hong Kong, Queen Mary Hospital,
Pokfulam, Hong Kong
OBJECTIVE. To review the diagnostic yield of flexible
sigmoidoscopy in patients presenting with bright red rectal bleeding.
DESIGN. Retrospective study.
SETTING. University teaching hospital, Hong Kong.
SUBJECTS AND METHODS. Patients who underwent flexible
sigmoidoscopy between January 1995 and April 1996 for investigation
of bright red rectal bleeding were recruited. The extent of the
endoscopic examination, complications, and endoscopic findings were
recorded.
RESULTS. A total of 1052 patients were included
in the study. The mean length of endoscopic examination was 55 cm.
There were no complications attributed to the procedure. Thirteen
(1.2%) patients aged from 41 to 87 years were found to have malignant
tumours that were not palpable on digital examination. All the tumours
were moderately differentiated adenocarcinoma. Two patients had
synchronous liver metastasis at presentation. Adenomatous polyps
were detected in 81 (7.7%) patients, of whom 76 were older than
40 years. The majority of polyps were tubular adenomas associated
with mild or moderate dysplasia. Other endoscopic findings included
hyperplastic and juvenile polyps, proctocolitis, diverticulosis,
irradiation colitis, ischaemic colitis, rectal ulcers, and infective
colitis. The overall diagnostic yield was 21.1%. No mucosal lesion
was detected by flexible sigmoidoscopy in 78.9% of patients in whom
the rectal bleeding was due to either haemorrhoids or anal fissure.
CONCLUSIONS. Cancer was detected in 1.2% and adenomatous
polyps in 7.7% of patients with bright red rectal bleeding using
flexible sigmoidoscopy. All cancers and 94% of adenomatous polyps
were detected in patients older than 40 years. Flexible sigmoidoscopy
appears to be a valuable initial investigation for bright red rectal
bleeding in patients older than 40 years.
Hong Kong Med J 2003;9:171-4
Key words: Colorectal neoplasms; Sigmoidoscopy
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