Colonoscopy to evaluate abdominal pain in clinical practice: How often is significant neoplasia found?

David Lieberman, D. E. Fleischer, G. M. Eisen, P. DeGarmo, Mark Helfand

Research output: Contribution to journalArticle

Abstract

Colonoscopy is often performed to evaluate patients with abdominal pain, bloating, constipation or diarrhea to rule out significant neoplasia. The purpose of this study was to utilize a national physician network to determine 1) how often colonoscopy is performed to evaluate vague abdominal symptoms (abd-sx); 2) the rate of significant colon neoplasia in such patients and 3) to compare the rates of significant neoplasia to rates in patients undergoing colonoscopy because of a positive fecal occult blood test (FOBT). Methods: A computerized endoscopic report generator was used at 18 sites by 99 physicians from April, 1997 until November 1997. Endoscopy data was sent electronically to a central databank for analysis. A cohort with only vague abd-sx and no other reason for colonoscopy was compared to a cohort undergoing colonoscopy to evaluate a positive FOBT. Significant neoplasia was defined as colonic polyps or masses ≥ 1cm. Results: 5073 colonoscopy reports were received during the study period. 388 patients (43% male) had colonoscopy to evaluate vague abd-sx (8%). 659 patients (52% male) had colonoscopy to evaluate (1) FOBT, accounting for 13% of procedures. Rates of significant neoplasia are shown in the table: Indication for Colonoscopy n Mean age (±SD) Polyp > 9mm Suspected Tumor TOTAL Vague Abd-sx 388 59 (±17) 37 12 49 (12.6%) (+) FOBT 659 65 (±13)*107 36 143 (22%)*p <0.001 Patients with vague abd-sx had a significantly lower rate of serious neoplasia compared to patients with a (+) FOBT in clinical practice settings. Patients with vague abd-sx were younger, which may contribute to the lower rate of neoplasia. Conclusion: 8% of colonoscopy procedures were performed to evaluate vague abd-sx. The yield of serious neoplasia is similar to results in asymptomatic subjects. Further study is needed to determine which patients with vague abd-sx are most likely to benefit from a complete colon evaluation. This study highlights how a national endoscopic database can be used to evaluate endoscopic outcomes.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume47
Issue number4
StatePublished - 1998
Externally publishedYes

Fingerprint

Colonoscopy
Abdominal Pain
Occult Blood
Hematologic Tests
Neoplasms
Colon
Databases
Colonic Polyps
Physicians
Constipation
Polyps
Endoscopy
Diarrhea

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Colonoscopy to evaluate abdominal pain in clinical practice : How often is significant neoplasia found? / Lieberman, David; Fleischer, D. E.; Eisen, G. M.; DeGarmo, P.; Helfand, Mark.

In: Gastrointestinal Endoscopy, Vol. 47, No. 4, 1998.

Research output: Contribution to journalArticle

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abstract = "Colonoscopy is often performed to evaluate patients with abdominal pain, bloating, constipation or diarrhea to rule out significant neoplasia. The purpose of this study was to utilize a national physician network to determine 1) how often colonoscopy is performed to evaluate vague abdominal symptoms (abd-sx); 2) the rate of significant colon neoplasia in such patients and 3) to compare the rates of significant neoplasia to rates in patients undergoing colonoscopy because of a positive fecal occult blood test (FOBT). Methods: A computerized endoscopic report generator was used at 18 sites by 99 physicians from April, 1997 until November 1997. Endoscopy data was sent electronically to a central databank for analysis. A cohort with only vague abd-sx and no other reason for colonoscopy was compared to a cohort undergoing colonoscopy to evaluate a positive FOBT. Significant neoplasia was defined as colonic polyps or masses ≥ 1cm. Results: 5073 colonoscopy reports were received during the study period. 388 patients (43{\%} male) had colonoscopy to evaluate vague abd-sx (8{\%}). 659 patients (52{\%} male) had colonoscopy to evaluate (1) FOBT, accounting for 13{\%} of procedures. Rates of significant neoplasia are shown in the table: Indication for Colonoscopy n Mean age (±SD) Polyp > 9mm Suspected Tumor TOTAL Vague Abd-sx 388 59 (±17) 37 12 49 (12.6{\%}) (+) FOBT 659 65 (±13)*107 36 143 (22{\%})*p <0.001 Patients with vague abd-sx had a significantly lower rate of serious neoplasia compared to patients with a (+) FOBT in clinical practice settings. Patients with vague abd-sx were younger, which may contribute to the lower rate of neoplasia. Conclusion: 8{\%} of colonoscopy procedures were performed to evaluate vague abd-sx. The yield of serious neoplasia is similar to results in asymptomatic subjects. Further study is needed to determine which patients with vague abd-sx are most likely to benefit from a complete colon evaluation. This study highlights how a national endoscopic database can be used to evaluate endoscopic outcomes.",
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