The role of colonoscopy in evaluating hematochezia: a population-based study in a large consortium of endoscopy practices

Background: Data on the role of colonoscopy in hematochezia are almost exclusively derived from clinical experience in tertiary care practice. Objective: To characterize the patient population who received colonoscopy for hematochezia in a consortium of diverse gastroenterology practices. Design: Retrospective analysis. Setting: Clinical Outcomes Research Initiative Database, 2002 to 2008. Patients: Adults undergoing colonoscopy for the indication of hematochezia. Main Outcome Measurements: Demographics, comorbidity, practice setting, adverse events, and colonoscopy procedure characteristics and findings. Age-stratified analyses and analyses of inpatient-versus outpatient-performed colonoscopies were also performed. Results: A total of 966,536 colonoscopies were performed during the study period, 76,186 (7.9%) were performed for evaluation of hematochezia. The majority of patients were white non-Hispanic men younger than 60 years old who underwent colonoscopy at a community practice site (79.1%) and had a low-risk American Society of Anesthesiologists (ASA) score (81.5%), in whom colonoscopy reached the cecum (94.8%), and serious adverse events were rare. Colonoscopy findings were hemorrhoids (64.4%), diverticulosis (38.6%), and polyp or multiple polyps (38.8%). From the overall cohort, 38.3% were 60 years of age and older. The older age cohort had significantly more white non-Hispanic females, high-risk ASA scores, incomplete colonoscopies, and unplanned events. Colonoscopy findings demonstrated significantly higher rates of diverticulosis, polyp or multiple polyps, mucosal abnormality/colitis, tumor, and solitary ulcer (P < .0001). There were 3941 (5.2%) who underwent inpatient-performed colonoscopy. One third of this cohort (32.6%) was defined as having a high ASA score. Limitations: Retrospective database review. Conclusions: These results describe patient populations and characterize colonoscopy findings in individuals presenting with hematochezia primarily in a community practice setting. (Gastrointest Endosc 2013;77:410-8.)