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The yield of colonoscopy in patients attending a tertiary hospital in Cape Town, South Africa
Background: Colonoscopy is widely used for diagnosis, therapeutic intervention of conditions of the lower gastrointestinal tract and colorectal cancer screening. Given its widespread use and complications, colonoscopy should be performed for appropriate indications. The aim of this study was to dete...
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| Format: | Thesis |
| Language: | English |
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Department of Medicine
2022
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| _version_ | 1867613165603258368 |
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| access_status_str | Open Access |
| author | Elhenghari, Emad |
| author2 | Setshedi, Mashiko |
| author_browse | Elhenghari, Emad Setshedi, Mashiko |
| author_facet | Setshedi, Mashiko Elhenghari, Emad |
| author_sort | Elhenghari, Emad |
| collection | Thesis |
| description | Background: Colonoscopy is widely used for diagnosis, therapeutic intervention of conditions of the lower gastrointestinal tract and colorectal cancer screening. Given its widespread use and complications, colonoscopy should be performed for appropriate indications. The aim of this study was to determine the yield and appropriateness of colonoscopy at a tertiary hospital. Methods: Demographic, clinical and endoscopic data was retrieved from a prospective endoscopy database from 01 Jan 2014 to 31 December 2019. The variables collected were patient details (age, sex), clinical indication, symptoms, urgency of colonoscopy, sedation used, quality of bowel preparation, and findings. Results: The total number of patients was 4033 with median age of 56 (IQR 18-85), of whom 59.6% were female. Colonoscopy was performed for appropriate indications in 98% of cases (according to EPAGE II criteria). Older patients were more likely to be investigated for anaemia (OR=0.55, CI 0.43-0.70, p=0.000), and surveillance postpolypectomy (OR=0.57, CI 0.37-0.85, p=0.005), while patients under 50 had a colonoscopy for an IBD flare (OR=1.98, CI 1.49-2.6, p=0.000), or surveillance for HNPCC (OR=3.0, CI 2.1-4.3, p=0.000). Rectal bleeding was the commonest symptom (16.5%). Patients younger than 50 were more likely to present with abdominal pain (OR=1.3, CI 1.07-1.6, p=0.006), and diarrhoea (OR=1.8, CI 1.5-2.3, p=0.000), whilst those older than 50 were more likely to present with alteration of bowel habit (OR=0.63, CI 0.43-0.9, p=0.012), and loss of weight (OR=0.45, CI 0.33-0.60, p=0.000). Polyps were the commonest finding (15.4%); the prevalence of colorectal cancer and diverticular disease was 3.6% and 6.5% respectively. Patients younger than 50 were more likely to have inflammation (OR=2.6, CI 2.18-3.15, p=0.000), whilst those older than 50 were more likely to have diverticulae (OR=0.08, CI 0.05-0.14, p=0.000), polyps (OR=0.43, CI 0.35- 0.53, p=0.000) or a tumour (OR=0.47, CI 0.29-0.72, p=0.000). Although 69% of the bowel preparation was reported as good or adequate, there was no difference in the detection of lesions when compared to poor bowel preparation. The adjusted caecal intubation rate was 95.1%. Conclusion: Colonoscopy was performed in a relatively young cohort, predominantly for symptoms not screening. The study provides some epidemiologic data on common lower gastrointestinal conditions in a referral center, but also highlights some inefficiencies in the system. Furthermore, this study serves as an audit on the clinical service, a baseline from which improvements can be made. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/35722 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:31:48.735Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/35722 The yield of colonoscopy in patients attending a tertiary hospital in Cape Town, South Africa Elhenghari, Emad Setshedi, Mashiko Thomson, Sandie Medicine Background: Colonoscopy is widely used for diagnosis, therapeutic intervention of conditions of the lower gastrointestinal tract and colorectal cancer screening. Given its widespread use and complications, colonoscopy should be performed for appropriate indications. The aim of this study was to determine the yield and appropriateness of colonoscopy at a tertiary hospital. Methods: Demographic, clinical and endoscopic data was retrieved from a prospective endoscopy database from 01 Jan 2014 to 31 December 2019. The variables collected were patient details (age, sex), clinical indication, symptoms, urgency of colonoscopy, sedation used, quality of bowel preparation, and findings. Results: The total number of patients was 4033 with median age of 56 (IQR 18-85), of whom 59.6% were female. Colonoscopy was performed for appropriate indications in 98% of cases (according to EPAGE II criteria). Older patients were more likely to be investigated for anaemia (OR=0.55, CI 0.43-0.70, p=0.000), and surveillance postpolypectomy (OR=0.57, CI 0.37-0.85, p=0.005), while patients under 50 had a colonoscopy for an IBD flare (OR=1.98, CI 1.49-2.6, p=0.000), or surveillance for HNPCC (OR=3.0, CI 2.1-4.3, p=0.000). Rectal bleeding was the commonest symptom (16.5%). Patients younger than 50 were more likely to present with abdominal pain (OR=1.3, CI 1.07-1.6, p=0.006), and diarrhoea (OR=1.8, CI 1.5-2.3, p=0.000), whilst those older than 50 were more likely to present with alteration of bowel habit (OR=0.63, CI 0.43-0.9, p=0.012), and loss of weight (OR=0.45, CI 0.33-0.60, p=0.000). Polyps were the commonest finding (15.4%); the prevalence of colorectal cancer and diverticular disease was 3.6% and 6.5% respectively. Patients younger than 50 were more likely to have inflammation (OR=2.6, CI 2.18-3.15, p=0.000), whilst those older than 50 were more likely to have diverticulae (OR=0.08, CI 0.05-0.14, p=0.000), polyps (OR=0.43, CI 0.35- 0.53, p=0.000) or a tumour (OR=0.47, CI 0.29-0.72, p=0.000). Although 69% of the bowel preparation was reported as good or adequate, there was no difference in the detection of lesions when compared to poor bowel preparation. The adjusted caecal intubation rate was 95.1%. Conclusion: Colonoscopy was performed in a relatively young cohort, predominantly for symptoms not screening. The study provides some epidemiologic data on common lower gastrointestinal conditions in a referral center, but also highlights some inefficiencies in the system. Furthermore, this study serves as an audit on the clinical service, a baseline from which improvements can be made. 2022-02-18T06:43:35Z 2022-02-18T06:43:35Z 2021 2022-02-10T14:34:14Z Master Thesis Masters MSc http://hdl.handle.net/11427/35722 eng application/pdf Department of Medicine Faculty of Health Sciences |
| spellingShingle | Medicine Elhenghari, Emad The yield of colonoscopy in patients attending a tertiary hospital in Cape Town, South Africa |
| thesis_degree_str | Master's |
| title | The yield of colonoscopy in patients attending a tertiary hospital in Cape Town, South Africa |
| title_full | The yield of colonoscopy in patients attending a tertiary hospital in Cape Town, South Africa |
| title_fullStr | The yield of colonoscopy in patients attending a tertiary hospital in Cape Town, South Africa |
| title_full_unstemmed | The yield of colonoscopy in patients attending a tertiary hospital in Cape Town, South Africa |
| title_short | The yield of colonoscopy in patients attending a tertiary hospital in Cape Town, South Africa |
| title_sort | yield of colonoscopy in patients attending a tertiary hospital in cape town south africa |
| topic | Medicine |
| url | http://hdl.handle.net/11427/35722 |
| work_keys_str_mv | AT elhenghariemad theyieldofcolonoscopyinpatientsattendingatertiaryhospitalincapetownsouthafrica AT elhenghariemad yieldofcolonoscopyinpatientsattendingatertiaryhospitalincapetownsouthafrica |