Diagnostic Yield for Endoscopy in Patients with Altered Bowel Habits

Background Alterations in bowel habits is one of leading complaints among patients seen in the gastroenterology office The increased volume of patient with complaints of chronic diarrhea constipation or altered bowel habits continues to raise the question of the appropriateness and role for endoscopy as part of the diagnostic workup regarding these increasingly prevalent complaints There is currently no clear evidence as to when endoscopy should be performed in evaluation of altered bowel habits Many of the causative pathological processes resulting in altered bowel habits would not be detected on endoscopy or pathology and therefore the suspected diagnostic yield would be low We suspect that the risk and cost associated with endoscopy relative to the low diagnostic yield should cause clinicians to focus efforts on other diagnostic measures prior to recommending or performing endoscopy for chronic diarrhea chronic constipation or altered bowel habits Objectives The goal of this study is to confirm suspicion that the diagnostic yield for anatomic and histological etiologies on endoscopy in patients with altered bowel habits in a diverse community based hospital setting is significantly low This should prompt patients to have further work up and evaluation through other means Therefore endoscopy without other indications should not be part of the routine or initial work up and selectively applied to patients only after negative initial workups have been performed Methods We performed a retrospective study of patients with complaints of ABH defined as altered bowel habits for greater than weeks chronic diarrhea for greater than weeks or chronic constipation greater than weeks from January through October at South Oakland Gastroenterology Associates SOGA in Farmington Hills Michigan who underwent open access endoscopy some patients had been referred and were seen for the first time by the gastroenterologist on the day of their procedure Data was analyzed from patients and we determined their diagnostic yield based off the anatomic and histological findings that were felt could adequately explain the patient rsquo s symptoms after performing endoscopy Results A total of patients were originally identified but were removed from further analysis due to poor preparations The remaining patient were identified included for full analysis were evaluated for complaint of diarrhea for constipation and for altered bowel habits patients underwent colonoscopy alone evaluation underwent combined EGD and colonoscopy evaluation underwent EGD alone evaluation There were patients with abnormal histology and of total patient population patients that had histological diagnosis IBD Ischemic colitis microscopic colitis infectious colitis cancer or celiac disease that provided a clear diagnosis to explain the patient rsquo s complaints A much higher yield involving the anatomical findings of polyps inflammatory changes mucosal injury mass or stricture was noted in of the patients However it should be noted that many of the anatomical diagnosis did not clearly explain the patient rsquo s complaint Of the anatomically significant findings were polyps with being adenomatous When including only the anatomical finding that were suggestive of being responsible for the patients symptoms only including polyps suspicious for diarrhea inflammatory changes and one recorded stricture were included The diagnostic yield of endoscopy for clearly identifying diagnosis responsible or suggestive for chronic altered bowel habits chronic diarrhea or chronic constipation was very low for the patients in our small community based study The data recorded demonstrated for histological confirmed diagnosis and anatomically suggestive diagnosis that would explain the patient rsquo s complaints Conclusion This study showed that endoscopy is unlikely to uncover a diagnosis to explain altered bowel habits in the general population Given the low diagnostic yield of endoscopic evaluation for altered bowel habits we believe that an initial noninvasive workup is reasonable to identify a likely diagnosis prior to any endoscopic evaluation In patients that have confirmed diagnosis by histology we did note that a significant percentage of these patients had normal endoscopic exams This should encourage that when evaluating patients with altered bowel habits biopsies should be taken even if gross appearance is normal