Use of Colonoscopy in identifying Malignant and Non-malignant Anorectal Conditions prior to Surgery

Nitin Kumar Patel^1*, Saranshi Shrivastava² and Parth Patel³

^*Correspondence: Nitin Kumar Patel, Department of Surgical Gastroenterology, RD Gardi Medical College, Ujjain, Madhya Pradesh,, India, Email:

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Introduction

Colonoscopy is a commonly used diagnostic and therapeutic procedure for colon disorders [1]. When performed correctly, it is generally a safe, precise, and well-tolerated procedure [2]. Colonoscopy is a mandated preoperative procedure to evaluate the colon in case of pathological conditions of anorectal and beyond.

Colonoscopy is usually done for adults with largebowel symptoms, iron deficiency, anaemia, abnormal radiographic results, positive results on colorectal cancer (CRC) screening tests, post-polypectomy and post-cancer resection surveillance, and diagnosis and surveillance in inflammatory bowel disease [1,3,4]. Reports suggest that regular screening by colonoscopy could prevent most deaths due to colon cancer by early detection and removal of cancerous and precancerous polyps. A nationwide study involving the observations of colonoscopies of patients with polyps suggested that periodic colonoscopy could prevent 76% to 90% of colon cancers [5]. Colonoscopy can be performed in two ways – actual and virtual. The virtual colonoscopy is performed for diagnostic purposes only when actual colonoscopy is not feasible due to age or associated comorbidities [6]. Diagnosis of anorectal diseases such as haemorrhoids, anal warts, anal fissures or fistulas is performed using a proctoscope [7]. However, colonoscopy is the gold standard diagnostic for inflammatory bowel disease (IBD) and Colon carcinomas [8]. It is also important for anorectal conditions that are likely to be skipped in diagnosis beyond the reach of a proctoscope [9]. This is because visualizing the mucosa of the entire large intestine and distal terminal ileum is usually possible during colonoscopy. In some instances, preoperative cytological and histopathological confirmation helps the surgeon decide the type of surgical procedure to be performed [10]. Colonoscopy is also used to confirm such diagnoses by cytology, histopathology, and other imaging modalities like X-ray, ultrasonography, MRI, and CT scans. Further, polyps can even be removed during colonoscopy, thereby reducing the risk of colon cancer, wherein advanced techniques are used for improved efficacy [11]. Hence, colonoscopy is considered an emerging technique to diagnose and treat many medical and surgical diseases, both benign and malignant. In this background, this study aims to understand the importance of colonoscopy in all lower gastrointestinal pathology for medical or surgical treatment. The primary objective of this study is to identify lesions that are missed in routine per rectal and proctoscopy examination and to confirm the findings of ultrasonography and anorectal symptoms. We have included colonoscopies of 96 patients to diagnose various anorectal conditions that would have been missed otherwise.

Methods

Study setting

This study was conducted in R. D. Gardi Medical College and associated hospitals from December 2019 to April 2021.

Study sample

The observations of adult patients scheduled to undergo various surgical procedures with any anaesthesia (general, local or regional) during regular hospital hours were included. Based on the prevalence of ulcerative colitis, 46% as reported, the sample size was calculated to be 96 with a 95% Confidence level.

Inclusion criteria

Patients aged from 16 to 78 years admitted to the hospital for various surgical procedures; presenting with symptoms such as bleeding per rectum, constipation, diarrhoea, haemorrhoids, Ano fistula, irritable bowel syndrome, abdominal pain and any other abnormal anorectal symptoms.

Exclusion criteria

Patients aged below 15 years or those allergic to local anaesthetic; with acute coronary artery disease, acute congestive heart failure or acute valvular heart disease; with a history of epilepsy and other CNS catastrophe like hemiplegia, paraplegia, Transient Ischemic Attack; those with coagulopathy, acute obstruction, acute fulminant colitis or acute anal fissure with extreme spasm of sphincter.

Data collection

All observations made on the study participants were entered in a predesigned proforma. The demographic data like age, sex, weight, height, and socioeconomic status were recorded. The patients included in the study were examined a day before the surgery to determine baseline values of vital parameters and to rule out any coexisting systemic disease. All the patients included in the study underwent routine preoperative biochemical investigations like the estimation of haemoglobin concentration, complete blood count, urine analysis, serum creatinine, random blood glucose, electrocardiogram, and Chest X-ray. They were instructed to remain nil by mouth after midnight, and bowel preparation with polyethene glycol with electrolytes (PEGWASH) was done 12 hours before the colonoscopy procedure. Colonoscopy under anaesthesia was performed, and the findings were noted under proforma.

Outcome

Diagnosis of different anorectal symptoms was made.

Statistical method

All statistical analysis was done using SPSS VERSION 23. A chi-square test was used to analyze any significant association between the measures and the outcome.

Ethical statement

This study was approved by the institutional ethics committee and research guidance committee. All participants were informed of the voluntary nature of their participation in the study. Informed consent was obtained from all participants included in the study.