Published: 2019-08-28

Colonoscopy: an inquiry into indications, findings and their correlation at a tertiary care hospital

Raghuveer M. N., Harshavardhan Shetty, Madhusudhan K.


Background: Though colonoscopy is widely performed, the statistical data regarding its indications, findings, and the diagnostic yield are not widely documented especially in developing countries. This study is an attempt to determine such data in a group of patients who underwent colonoscopy at our hospital.

Methods: This was a hospital‑based retrospective study carried out at the Department of General Surgery, MMC&RI, Mysore. The subjects were a total of 286 patients who underwent colonoscopies in the year 2017. The relevant data from colonoscopy register were recorded and tabulated.

Results: The major indications in our study group were bleeding per rectum (25%), unexplained diarrhoea or dysentery (16%), pain abdomen (15%) and suspected malignancy (13%). Other indications included suspected inflammatory bowel disease (IBD), subacute intestinal obstruction, anaemia, mass per abdomen and suspected irritable bowel syndrome (IBS). More than one third (35%) had normal colonoscopic studies. The most common pathology found was malignancy (24%) followed by the spectrum of proctocolitis (20%). The indications which produced high diagnostic yields included suspected carcinoma (97%), bleeding per rectum (82%) and suspected IBD (80%). Significant number of patients with per rectal bleeding was diagnosed with malignancy (21%). The indications which produced low yields included subacute intestinal obstruction (31%), anaemia (45%), non-specific pain abdomen (50%) and suspected irritable bowel syndrome (18%).

Conclusions: Colonoscopy is highly rewarding among patients who are being evaluated for suspected malignancies, lower gastrointestinal bleeding and suspected IBD. As such, certain indications produce a higher diagnostic yield than others, suggesting that a stricter patient selection criterion may be employed for performing colonoscopy especially in resource poor settings. 


Colonoscopy, Bleeding per rectum, Carcinoma colon, Diagnostic yield

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Häfner M. Conventional colonoscopy: Technique, indications, limits. Eur J Radiol. 2007;61(3):409-14.

Berkowitz I, Kaplan M. Indications for colonoscopy. An analysis based on indications and diagnostic yield. S Afr Med J. 1993;83(4):245-8.

Olokoba AB, Obateru OA, Bojuwoye MO, Olatoke SA, Bolarinwa OA, Olokoba LB. Indications and findings at colonoscopy in Ilorin, Nigeria. Niger Med J. 2013;54(2):111–4.

Morini S, Hassan C, Meucci G, Toldi A, Zullo A, Minoli G. Diagnostic yield of open access colonoscopy according to appropriateness. Gastrointest Endosc. 2001;54:175-9.

Kassa E. Colonoscopy in the investigation of colonic disease. East Afr Med J. 1996;73:741-5.

Rex DK. Colonoscopy: A review of its yield for cancers and adenomas by indication. Am J Gastroenterol. 1995;90:353-65.

Al-Shamali MA, Kalaoui M, Hasan F, Khajah A, Siddiqe I, Al-Nakeeb B. Colonoscopy: Evaluating Indications and Diagnostic Yield. Ann Saudi Med. 2001;21(5-6):304-7.

Sahu SK, Husain M, Sachan PK. Clinical spectrum and diagnostic yield of lower gastrointestinal endoscopy at a tertiary centre. Internet J Surg. 2009;18.

Siddique I, Mohan K, Hasan F, Memon A, Patty I, Al-Nakib B. Appropriateness of indication and diagnostic yield of colonoscopy: First report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy. World J Gastroenterol. 2005;11:7007-13.

Rex DK. Colonoscopy: A review of its yield for cancers and adenomas by indication. Am J Gastroenterol. 1995;90:353-65.

Leis VM, Hughes ML, Williams CB, Neumaster TD, Ludwig DJ, Fontenelle LJ. Risk Factors predictive of positive findings at colonoscopy. Curr Surg. 2001;58(2):227-9.

Marshall JB, Singh R, Diaz-Arias AA. Chronic, unexplained diarrhea: are biopsies necessary if colonoscopy is normal? Am J Gastroenterol. 1995;90:372-6.

Patel Y, Pettigrew NM, Grahame GR, Bernstein CN. The diagnostic yield of lower endoscopy plus biopsy in nonbloody diarrhea. Gastrointest Endosc. 1997;46:338-43.

Lee JH, Rhee PL, Kim JJ, Koh KC, Paik SW, Han JH, et al. The role of mucosal biopsy in the diagnosis of chronic diarrhea: value of multiple biopsies when colonoscopic finding is normal or nonspecific. Korean J Intern Med. 1997;12:182-7.

Balaguer F, Llach J, Castells A, Bordas JM, Ppellisé M, Rodríguez-Moranta F, et al. The European panel on the appropriateness of gastrointestinal endoscopy guidelines colonoscopy in an open-access endoscopy unit: a prospective study. Aliment Pharmacol Ther. 2005;21:609-13.

Vader JP, Pache I, Froehlich F, Burnand B, Schneider C, Dubois RW, et al. Overuse and underuse of colonoscopy in a European primary care setting. Gastrointest Endosc. 2000;52:593-9.

de Bosset V, Froehlich F, Rey JP, Thorens J, Schneider C, Wietlisbach V, et al. Do explicit appropriateness criteria enhance the diagnostic yield of colonoscopy? Endoscopy. 2002;34:360-8.