Abstract
Purpose: The aim of this study was to determine the diagnostic value of colonoscopy in patients with nonspecific abdominal pain
Patients and Methods: A prospective observational study was performed at the department of general surgery between March 2006 and March 2009. All patients with abdominal pain (n: 2.604) were evaluated carefully. After a detailed anamnesis, physical examination, laboratory and radiological evaluation, the patients with nonspecific abdominal pain were invited for a colonoscopic examination.
Results: Colon cancer was detected in three of the patients aged 59, 63 and 68 years old. Other nine had pedunculated polyps with dysplasia in three of them. Neither had pedicle invasion. Millimetric hyperplastic polyps were detected in 16 other patients. A hundred and ninety eight patients had colonic diverticula. Seventeen of the 25 patients with polyps and 127 of the patients with diverticula were over age 50 years.
Conclusion: The value of colonoscopic examination is still controversial in patients with nonspecific abdominal pain. Although the detection rate of malignant and pre-malignant lesions are low, the high detection rate of diverticula and the low complication rate due to the procedure are in favour of colonoscopic examination in these patients.
Keywords:
Nonspecific abdominal pain, colonoscopy, abdominal pain
References
1Gallenger EJ. Gastrointestinal emergency: acute abdominal pain. In: Tintinalli JE, Kelen GD, Stapczynski JS, editors. Emergency medicine: a comprehensive study guide.5th ed. New York: McGraw- Hill Companies Inc; 2000. p. 356- 356.
2Özgüç H, Çakın N, Duman U. Akut non spesifik karın ağrısı bulunan olguların bir yıllık prognozları, semptom ve bulgularının tanısal doğruluğu. Ulus Travma Acil Cerrahi Derg 2008;14:118-124.
3de Dombal FT. The OMGE acute abdominal pain survey. Progress report, 1986. Scand J Gastroenterol Suppl 1988;144:35 -42.
4Wolff WI, Shinya H. Colonofiberoscopy. JAMA 1971;217:1509–1512.
5Walsh JME, Terdiman JP. Colorectal cancer screening – scientific review. JAMA 2003;289:1228-1296. [DOI:10.1001/ jama.289.10.1288]
6Brenner H, Hoffmeister M, Brenner G, Altenhofen L, Haug U. Expected reduction of colorectal cancer incidence within 8 years after introduction of the German screening colonoscopies. Eur J Cancer 2009;45:2027-2033.
7Lieberman DA, de Garmo PL, Fleischer DE, et al. Colonic neoplasia in patients with nonspecific GI symptoms. Gastrointest Endosc 2000;51:647–651.
8Siddique I, Mohan K, Hasan F, et al. Appropriateness of indication and diagnostic yield of colonoscopy: first report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy. World J Gastroenterol 2005;11:7007–7013.
9Raheja SK, McDonald PJ, Taylor I. Nonspecific abdominal pain: an expensive mystery. J R Soc Med 1990;3:10.
10Decadt B, Sussman L, Lewis MP et al. Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain. Br J Surg 1999;86:1383-1386.
11Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc 2001;53:620- 627. [DOI:10.1067/mge.2001.114422]
12Waye JD, Kahn O, Auerbach ME. Complications of colonoscopy and flexible sigmoidoscopy. Gastrointest Endosc Clin N Am 1996;6:343-377.
13Manukyan MN, Severge U, Kapaklı MS et al. Genel cerrahi asistanlarının endoskopi eğitimi: bir üniversite hastanesi sonuçları. Ulusal Cerrahi Dergisi 2009; 25:101-104.
14Appropriate use of gastrointestinal endoscopy: a consensus statement from the American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 2000;52:831–837.
15Tamura K, Ishguro S, Munakata A. Annual changes in colorectal carcinoma incidence in Japan. Analysis of survey data on incidence in Aomori prefecture. Cancer 1996;78:1187-1194.
16Köhler L, Sauerland S, Neugebauer E; The Scientific Committee of the European Association for Endoscopic Surgery. Diagnosis and treatment of diverticular disease: results of a consensus development conference. Surg Endosc 1999;13:430–436.
17Pines J, Uscher Pines L, Hall A, Hunter J, Srinivasan R, Ghaemmaghami C. The interrater variation of ED abdominal examination findings in patients with acute abdominal pain. Am J Emerg Med 2005;23:483-487.
