Pullens Hendrikus J M, Joosten Marieke, Siersema Peter D, Brink Menno A
Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort;Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort,The Netherlands.
J Gastrointestin Liver Dis. 2014 Jun;23(2):153-9. doi: 10.15403/jgld.2014.1121.232.1hjmp.
BACKGROUND & AIMS: General practitioners (GPs) in the Netherlands have open access to flexible sigmoidoscopy (FS) for patients with lower gastrointestinal symptoms, but not to colonoscopy. This study was performed to investigate the yield of FS in GP-referred patients, to evaluate the proportion of patients in whom additional colonoscopy was performed and to investigate whether there was a subgroup of patients referred for symptoms with a low risk of detecting significant findings.
All patients undergoing FS in 2008 and 2009 who were referred by GPs were analyzed. Indications for additional colonoscopy were the presence of polyps and/or colorectal cancer (CRC), polyp screening or surveillance, incomplete FS or other reasons.
In total, 916 patients underwent FS. A cause for the symptoms was found in 44.2% of patients. In patients aged 50 years or older, additional colonoscopy was more frequently performed than in younger patients (27.5% vs. 9.6%, OR=3.6 [95% CI 2.4-5.4]), mainly due to a higher prevalence of adenomatous polyps (29.9% vs. 10.5%, OR=3.6 [95% CI 2.4-5.4]) and CRC (7.5% vs. 1.3%, OR=6.2 [95% CI 2.2-17.5]) during FS. In 7.8% patients undergoing FS for abdominal pain as the presenting symptom, a probable cause for the symptoms was found, mainly diverticular disease.
Due to the high prevalence of polyps and CRC in symptomatic patients aged 50 years or older undergoing FS, an additional colonoscopy is performed frequently. In patients referred with abdominal pain, FS is unlikely to reveal a relevant cause for the symptoms.
在荷兰，全科医生（GP）可为有下消化道症状的患者进行乙状结肠镜检查（FS），但无法进行结肠镜检查。本研究旨在调查全科医生转诊患者中FS的诊断率，评估进行额外结肠镜检查的患者比例，并调查是否存在因症状转诊但发现重大病变风险较低的患者亚组。
对2008年和2009年所有由全科医生转诊并接受FS检查的患者进行分析。进行额外结肠镜检查的指征包括息肉和/或结直肠癌（CRC）的存在、息肉筛查或监测、FS不完全或其他原因。
共有916例患者接受了FS检查。44.2%的患者发现了症状的病因。50岁及以上患者比年轻患者更频繁地进行额外结肠镜检查（27.5%对9.6%，OR=3.6[95%CI 2.4-5.4]），主要是因为FS期间腺瘤性息肉（29.9%对10.5%，OR=3.6[95%CI 2.4-5.4]）和CRC（7.5%对1.3%，OR=6.2[95%CI 2.2-17.5]）的患病率较高。在以腹痛为主要症状接受FS检查的患者中，7.8%发现了可能的症状病因，主要是憩室病。
由于50岁及以上有症状患者在接受FS检查时息肉和CRC的患病率较高，因此经常进行额外的结肠镜检查。对于以腹痛转诊的患者，FS不太可能揭示症状的相关病因。
