SAFETY AND EFFECTIVENESS OF LEFT SIDE COLONOSCOPY OR SIGMOIDOSCOPY VERSUS TOTAL COLONOSCOPY IN PATIENTS LESS THAN 45 YEARS OLD AGE PRESENTED WITH THE PERIANAL DISEASE AT KURDISTAN CENTER FOR GASTROENTEROLOGY/SULAIMANIYAH
Sarko Jamal Ahmed a and Mohamed Abdulrahman Mohamed b
a Kurdistan Board Candidate (KBMC), Directorate of Health, Ministry of Health, Sulaimani, Kurdistan Region, Iraq.
b Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
Submitted: 27/5/2022; Accepted: 21/10/2022; Published: 21/12/2022
DOI Link: https://doi.org/10.17656/jsmc.10389
Colonoscopy and flexible sigmoidoscopy are recommended tools for diagnosing colorectal diseases, but their relative effectiveness needs to be clarified. Direct comparisons of colonoscopy and sigmoidoscopy in the same population would help inform patients, providers, and policymakers about patients presented with perianal features and colorectal cancer (CRC) screening options.
To evaluate the ability of each of these two modalities (colonoscopy and sigmoidoscopy) to reach the diagnosis in patients presenting with features suggestive of perianal disease and to determine factors that predict safely performing left-sided colonoscopy in patients less than forty-five years old given with features suggestive of perianal disease.
Materials and Methods
This prospective cross-sectional study will be conducted between the 1st of January 2021 and the 1st of January 2022 in the department of KCGH (Kurdistan center for gastrointestinal and Hepatology) / Teaching- Hospital, Sulaymaniyah City, Iraq. One thousand patients presented with features (bright red bleeding per-rectum, blood on toilet tissue, pain and itching in anal region, anal soiling) of perianal disease were subjected to sigmoidoscopy and extended to full colonoscopy. The patients are divided into two groups, each group of 500 patients. The first group (basic group) includes patients younger than 45 years and the second group (comparison group) includes patients aged equally and more than 45 years.
The mean age of the primary group is about 33 years. All patients underwent sigmoidoscopy and extended to total colonoscopy with terminal ileal intubation; in the basic group, we have 48 (4.8%) patients with left side polyps (10 large and 38 small polyps) and 16 (1.6%) right side polyps (2 large and 14 small polyps), in this group, we have only 6 (0.6%) patients with left side colonic mass and no cases of right side colonic mass, while in comparison group we have 115 (11.5%) cases with left side colonic polyp (27 large and 88 small polyps) and about 86 (8.6%) cases of right side colonic polyp, regarding detecting mass in this group we have 20 (2.0%) cases of left side colonic mass and 6 (0.6%) cases of right side colonic mass..
Colonoscopy and sigmoidoscopy are important tools for investigating patients presenting with perianal features. While both are sensitive to detecting pathology in the left side of the colon, our study concluded that although colonoscopy is the ideal procedure for detecting lesions in the whole colon (proximal & distal to splenic flexure), limited colonoscopy up to splenic flexure can be safely carried out in patients less than 45 years old presented with perianal diseases.
Perianal disease, Sigmoidoscopy, Colonoscopy.
Atkin WS, Edwards R, Kralj-Hans I, Wooldrage K, Hart AR, Northover JMA, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomized controlled trial. Lancet 2010; 375:1624–1633.
Beejay U, Marcon NE. Endoscopic treatment of lower gastrointestinal bleeding. Curr Opin Gastroenterol 2002; 18:87–93.
Church JM. Analysis of the colonoscopic findings in patients with rectal bleeding according to the pattern of their presenting symptoms. Dis Colon Rectum 1991; 34:391–5.
Church JM. Colonoscopy for the diagnosis and treatment of colorectal bleeding. Semin Colon Rectal Surg 1992; 3:42–8.
Holme O, Loberg M, Kalager M. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality. JAMA. 2014; 312:606–615.
Holme O, Loberg M, Kalager M. Long-term effectiveness of sigmoidoscopy screening on colorectal cancer incidence and mortality in women and men. Ann Intern Med. 2018; 168:775–782.
Levin TR, Conell C, Shapiro JA, Chazan SG, Nadel MR, Selby JV. Complications of screening flexible sigmoidoscopy. Gastroenterology. 2002; 123:1786–1792.
Schoen RE, Pinsky PF, Weissfeld JL, Yokochi LA, Church T, Laiyemo AO. et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med. 2012; 366:2345–2357.
Segnan N, Armaroli P, Bonelli L, Risio M, Sciallero S, Zappa M., et al. the SCORE Working Group Once-only sigmoidoscopy in colorectal cancer screening. J Natl Cancer Inst. 2011; 103:1310–1322.
Laura Seeff, Faruque Ahmed, Jessica B, Steven S, Colorectal cancer incidence and incidence of colorectal cancer in the US. American Cancer society. 2009; 130: 65–57.
Bretthauer M, Grotmol T. Hoff G, Skovlund E. J Natl Cancer Inst. sigmoidoscopy in colorectal cancer screening. Natl Cancer Inst. 2003. 100:1089-90.
Selby J, Friedman G, Quesenberry CP, Weiss N. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992; 326: 653–57.
Newcomb P, Storer B, Morimoto L, Templeton A, Potter J. Long-term efficacy of sigmoidoscopy in reducing colorectal cancer incidence. J Natl Cancer Inst. 2003; 95: 622–25.
Baxter NN, Goldwasser MA, Paszat LF, Rabeneck L, Saskin R, Urbach DR, Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009; 150:1–8.
Allen JD, Barlow WE, Steinwachs D. National Institutes of Health state-of-the-science conference statement: enhancing use and quality of colorectal cancer screening. Ann Intern Med 2010; 152: 663 –7.
Nikpour S, Ali Asgari A. Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer. World J Gastroenterol. 2008; 14(42): 6536-6540.
Amanda J. Cross, Kate Wooldrage, Emma C. Robbins, Kevin Pack, Jeremy P. Brown, William Hamilton, et al. Based on presenting symptoms and signs, a whole-colon investigation vs. flexible sigmoidoscopy for suspected colorectal cancer. British Journal of Cancer 2019: 120:154–164.
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.