Is Lower GI Endoscopy Still a Problem?

AIM: To analyze the outcome of colonoscopies performed at a localhospital.METHODS: A retrospective review of all Lower GI endoscopiesperformed at Fauji Foundation Hospital Rawalpindi was conductedfrom November 1993 through December 2011. All aspects wereanalyzed to record the number, quality and appropriateness ofprocedures, completion rate, diagnostic and therapeutic outcome andcomplications reported. The reasons for failure to complete werescrutinized and recorded. The procedures were carried out as suchwithout questioning the appropriateness of indication or otherwise.RESULTS: A total of 1431 patients underwent Lower GI endoscopicexaminations between September 1993 and October 2011. The agerange was from 4 to 93 years (mean 45±18.8). There were morefemale patients. The overall caecal intubation rate was 42%. Theincomplete procedures comprised 800 (60%). The success rate ofbowel preparation was (92.8%). Rectal bleeding constituted theleading indication for colonoscopy (31%). The results were normal in(46.36%) patients. The colonoscopic diagnoses could not be obtainedin 117 (8%) patients owing to poor bowel preparation. Inflammatorybowel disease was the most common diagnosis (13.98%) followedby colorectal cancer (8%). Therapeutic procedures were performedin 93 patients. The most important procedural complication wasperforation in 1 case only. The overall polyp detection rate was 8% inthis study.CONCLUSION: Completion rate was 42%. Rectal bleeding was theleading indication for colonoscopy followed by chronic diarrhea andabdominal pain. Colonoscopy performed for appropriate indicationsyields more significant findings and avoids wastage of resources. Thefactors that can enhance performance at colonoscopy were properbowel cleansing and devoting sufficient time for the examination.There is a need to develop new generation slick instruments toovercome technical difficulties.