Colonoscopy in Elderly Patients with Hemorrhoidal Disease and Average-Risk for Colorectal Cancer, a Qatari Community Hospital Experience

Abstract

Introduction: Hemorrhoids are a frequent and familiar concern of patients in the general practice and surgery settings. Colonoscopy is both diagnostic and therapeutic. In Qatar, There are little data available about coincidental pathology in elderly patients with hemorrhoids. Objective: To assess the outcome of colonoscopy in management patients with hemorrhoidal disease and average-risk for colorectal cancer and its clinical significance. Method: A retrospective study of 200 patients with hemorrhoids with average risk colorectal cancer (anal bleeding and anal symptoms) and subjected to colonoscopic examination at Al Khor hospital’s endoscopy unit during the period from May 2005 till August 2012. Patients below 50 years and high risk patients for colorectal cancer; with the following alarm signs: Positive personal history of colorectal neoplasms or Inflammatory Bowel Disease (IBD), positive first degree family history of colorectal neoplasms, history of altered bowel habits, recent significant weight loss, presence of iron deficiency anemia, and history of previous colonoscopy were excluded. All significant endoscopic co-findings (diverticuli, polyps, cancer, angiodysplasia and varices, or colitis) were recorded. Results: There were 200 patients; 134 male, 66 female; Mean patient age was 56.3 years (range, 50 to 82 years), who met the eligibility criteria. 200 colonoscopies were performed. Evaluation of these patients revealed Polyps in 16 patients (13 benign and 3 malignant), seven malignant lesions(one annular lesion and 6 fungating masses), Ulcerative colitis in 5 patients, no crohn’s disease, diverticular disease in 4 patients, no Vascular malformations, bleeding piles in 3 patients controlled by injection, and 65.5% of patients were free from any additional pathology. Colonoscopy changed the treatment plan in 58 patients (29%). No complications were encountered. Conclusion: Coincidental abnormalities in colon and rectum in elderly patients with hemorrhoids are common. Benign polyps, followed by diverticular diseases, anal fissures then colorectal cancer were the commonest findings. Endoscopic evaluation of elderly patients with hemorrhoids and average risk for colorectal cancer is advocated. Omitting endoscopy in these patients can lead to major doctors’ delay.