Department of Gastroenterology and Hepatology, Hillel Yaffe medical center, Hadera, Israel.
Technion Faculty of Medicine, Haifa, Israel.
J Investig Med. 2023 Dec;71(8):797-803. doi: 10.1177/10815589231193953. Epub 2023 Oct 20.
Data on colonoscopy's diagnostic yield in young adults with lower gastrointestinal symptoms are scarce. We evaluated this yield in young patients by performing an indication-based analysis of outcomes.
We reviewed diagnostic colonoscopies performed in young adults (age <50 years) over 10 years. We created two groups of young adults (18-39 years, n = 4941) and quadragenarians (40-49 years; n = 6605), included a control group of average-risk patients referred for screening colonoscopies during the same period (50-60 years, n = 1453). We evaluated clinical indications for colonoscopies among the young and performed an indication-based analysis of patients' outcomes.
Chronic diarrhea and abdominal pain (42.4 and 36.2%), rectal bleeding (19.8 and 18.4%), and constipation were major indications for colonoscopy performance in quadragenarian and younger patients, respectively. Overall, diverticulosis (8.7 vs 1.3 and 3.9%; p < 0.000) and polyp detection rates (PDR) (19.6 vs 6.1 and 12.1; p < 0.000) were significantly higher in the control group, while inflammatory bowel disease (10.9 and 3.6% vs 0.1%; p < 0.000) was more prevalent in both young patients' groups. Indication-based analysis revealed that rectal bleeding was linked with increased PDR and significantly and independently associated with colorectal cancer (CRC) development (odds ratio = 10.160. p < 0.001 and 95% confidence interval = 6.201-16.647), even in the younger patients. In contrast, performing a colonoscopy for the evaluation of constipation was associated with the lowest yield.
We outlined the expected diagnostic yields of colonoscopy performed in young patients for multiple indications, showing that rectal bleeding was consistently associated with CRC and polyp detection.
关于年轻患者下消化道症状行结肠镜检查的诊断率数据较少。我们通过对结果进行基于指征的分析来评估年轻患者的这种诊断率。
我们回顾了 10 年内进行的年轻成年人（年龄 <50 岁）的诊断性结肠镜检查。我们创建了两组年轻成年人（18-39 岁，n=4941）和 40-49 岁的四旬期成年人（n=6605），并纳入了同期行筛查性结肠镜检查的平均风险患者的对照组（50-60 岁，n=1453）。我们评估了年轻患者行结肠镜检查的临床指征，并进行了基于指征的患者结局分析。
慢性腹泻和腹痛（42.4%和 36.2%）、直肠出血（19.8%和 18.4%）和便秘分别是四旬期和年轻患者行结肠镜检查的主要指征。总体而言，憩室病（8.7%比 1.3%和 3.9%；p<0.000）和息肉检出率（PDR）（19.6%比 6.1%和 12.1%；p<0.000）在对照组中显著更高，而炎症性肠病（10.9%和 3.6%比 0.1%；p<0.000）在两个年轻患者组中更为普遍。基于指征的分析显示，直肠出血与 PDR 增加显著相关，且与结直肠癌（CRC）的发生独立相关（比值比=10.160，p<0.001，95%置信区间=6.201-16.647），甚至在年轻患者中也是如此。相比之下，因评估便秘而行结肠镜检查的诊断率最低。
我们概述了针对多种指征为年轻患者行结肠镜检查的预期诊断率，结果显示直肠出血始终与 CRC 和息肉检出相关。
