Investigators from San Francisco, California, USA, clarified the yield of lower endoscopy in patients with constipation.
Endoscopic databases from 3 diverse hospitals were searched for procedures with constipation as an indication.
Detection of neoplasia was the main outcome of interest.
Among 19,764 sigmoidoscopies or colonoscopies, constipation was a procedure indication for 563 patients (mean age 61 years, 52% women).
Of the patients, 58% had procedure indications in addition to constipation.
Colorectal cancer was diagnosed in 8 (1.4%), adenomas in 82 (14.6%), and advanced lesions (cancer or adenoma with malignancy, high-grade dysplasia, villous features, or size ≥10 mm) in 24 (4.3%).
| Constipation was a procedure indication in almost 3% of lower endoscopies.
| Gastrointestinal Endoscopy |
In the 358 patients who underwent colonoscopy, cancer was detected in 1.7%, adenomas in 19.6%, and advanced lesions in 5.9%.
The authors discovered that 2 patients with cancer were less than 50 years of age.
In as many as 6 patients with cancer, the tumor may have caused partial obstruction.
Author Craig Pepin, of the University of California, San Francisco, said on behalf of his colleagues, "The range of neoplasia in patients with constipation evaluated with lower endoscopy was comparable with what would be expected in asymptomatic subjects undergoing colorectal cancer screening."
"Although chronic constipation alone may not be an appropriate indication for lower endoscopy, age-appropriate colorectal cancer screening should be pursued when patients with constipation seek medical care," he concluded.