DIAGNOSTIC YIELD OF COLORECTAL NEOPLASIA WITH COLONOSCOPY FOR ABDOMINAL-PAIN, CHANGE IN BOWEL HABITS, AND RECTAL BLEEDING

Objectives: To assess the clinical yield of colonoscoping in patients who present with rectal bleeding, persistent abdominal pain, or change in bowel habits in the absence of bleeding. Design: A prospective stu dy of colonoscopy patients. Setting. Three colonoscopy practices in Ne w York City between April 1986 and November 1989. Patients: Eight hund red sixty-one patients with rectal bleeding, 113 patients with abdomin al pain, 154 with change in bowel habits, and 44 patients with both ab dominal pain and bowel change. Main results: Of 861 patients with rect al bleeding, 293 (33.6%) had colonic neoplasia (8.6% cancer and 25% ad enomatous polyps). In patients who had colonoscopy because of abdomina l pain (n = 113), change in bowel habits (n = 154), or both abdominal pain and bowel change (n = 44), respectively 25 (22.1%), 42 (27.3%), a nd 10 (22.7%) had colonic neoplasms. If one looks at significant neopl asia (cancer or adenomas > 1 cm), then the findings in rectal bleeders were 14.5%, whereas the abdominal pain, change in bowel habits, and b oth groups had 7.1%, 7.1%, and 13.6%, respectively. Patients with rect al bleeding were more likely to have multiple adenomas than those with nonbleeding symptoms (p < 0.05). Conclusions: Patients with persisten t nonbleeding GI symptoms, including abdominal pain and change in bowe l habits, have almost as high a yield of colorectal neoplasia as those with rectal bleeding.