The diagnostic yield of lower endoscopy plus biopsy in nonbloody diarrhea

doi:10.1016/S0016-5107(97)70122-6

Gastrointestinal Endoscopy

Volume 46, Issue 4, October 1997, Pages 338-343

https://doi.org/10.1016/S0016-5107(97)70122-6 Get rights and content

Abstract

Background: Patients presenting with diarrhea frequently undergo lower endoscopy plus biopsy as part of their diagnostic evaluation. The diagnostic yield of this approach has not been systematically evaluated. Methods: To evaluate the diagnostic yield of endoscopy and biopsy in the investigation of nonbloody diarrhea, we performed a retrospective analysis using the endoscopy unit database of a tertiary care university hospital over a 3-year period. The database was searched for cases in which colonoscopy was performed for the single indication of diarrhea. The endoscopic findings and initial biopsy reports were extracted from a chart review, and each clinician was interviewed for the patient's current clinical diagnosis. The clinical diagnoses were compared with the endoscopy and biopsy results to determine whether the tests had contributed to making the clinical diagnoses. Results: Three hundred six patients were identified. One hundred one were excluded for standardized predefined exclusion criteria, leaving 205 evaluable patients, of whom 77 had flexible sigmoidoscopy and 128 had colonoscopy. Eighteen percent had specific clinical diagnoses facilitated by endoscopy and/or biopsy. Endoscopy and biopsy results were normal in 74% of cases. In 8% of the cases either the endoscopy or biopsy findings were inconsistent with the final clinical diagnoses. Conclusions: Endoscopy and biopsy are important diagnostic tools in the evaluation of patients with nonbloody diarrhea, leading to a specific diagnosis in nearly one fifth of cases.(Gastrointest Endosc 1997;46:43)

Section snippets

Materials and Methods

This was a retrospective study of patients undergoing lower endoscopy for diarrhea at an 800 bed university-affiliated tertiary care hospital, the main teaching hospital for the province of Manitoba. The endoscopy unit is used by six gastroenterologists and five gastrointestinal surgeons who primarily have referral-based consultant practices. A coded endoscopy sheet for each patient undergoing lower endoscopy was filled out by the physician performing the procedure. The endoscopy sheet

Results

There were 1893 colonoscopies and 1207 sigmoidoscopies performed in 2524 patients between June 1992 and June 1995. During this time period a total of 306 patients had either sigmoidoscopy or colonoscopy for the evaluation of diarrhea. One hundred one patients were excluded from analysis for the following reasons: 38 patients had no biopsies taken at the time of endoscopy, 27 patients were previously diagnosed as having inflammatory bowel disease, 1 patient had a liver transplant, 8 patients had

Discussion

The diagnostic yield of endoscopy plus biopsy is 18% in patients evaluated for nonbloody diarrhea, confirming the diagnostic utility of these tests. Prior to this study, there were no data on the yield of endoscopy and biopsy of the colon in the evaluation of patients with diarrhea. Without a clear understanding of its diagnostic usefulness, endoscopy has become a routine test in the evaluation of diarrhea. We excluded patients with prior gastrointestinal diseases, HIV-1 infection, abdominal

Acknowledgements

The authors thank Dr. Wilfred Weinstein for his thoughtful review of this manuscript, Mark Torchia, BSc for assistance with the database, and the participating clinicians who provided clinical followup on their patients: Drs. G. Assuras, G. Duffy, D. Gillespie, G. Illiffe, A. Khan, J. Lipschitz, B. Rosser, and E. Walli.

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^☆: From the Departments of Medicine and Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.

^☆☆: Reprint requests: Charles N. Bernstein, MD, Gastroenterology, GB-443 Health Sciences Centre, 820 Sherbrook St., Winnipeg, Manitoba, Canada R3A-1R9.

^★: 37/1/83523

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The diagnostic yield of lower endoscopy plus biopsy in nonbloody diarrhea☆,☆☆,★

Abstract

Section snippets

Materials and Methods

Results

Discussion

Acknowledgements

Hum Pathol

Hum Pathol

Gastroenterology

Am J Med

Diarrhea

Approach to the patient with diarrhea

Self-limited nature of chronic idiopathic diarrhea

N Engl J Med

Evaluation of patients with chronic diarrhea

N Engl J Med

Diagnostic approach to the patient with chronic diarrheal disorder

Dis Mon

Diagnostic yield of routine ileoscopy