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Research ArticleOriginal Article
Open Access

Outcomes and appropriateness of colonoscopy referrals at King Khalid University Hospital, Saudi Arabia

An opportunity to expand the colonoscopy screening

Shahad M. AlQahtani, Sulaiman A. Alshammari, Reem J. Khidir, Maha F. AlKhunaizi and Osama M. Abdulqader
Saudi Medical Journal November 2023, 44 (11) 1167-1173; DOI: https://doi.org/10.15537/smj.2023.44.11.20230378
Shahad M. AlQahtani
From the Department of Family & Community Medicine (AlQahtani, Alshammari, Abdulqader), College of Medicine, King Saud University, from the Department of Family & Community Medicine (Alshammari), King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Paediatrics (Khidir), University of Khartoum, Khartoum, Sudan, and from the Department of Family Medicine (AlKhunaizi), Xi’an Jiaotong University, Shaanxi, China.
MBBS
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Sulaiman A. Alshammari
From the Department of Family & Community Medicine (AlQahtani, Alshammari, Abdulqader), College of Medicine, King Saud University, from the Department of Family & Community Medicine (Alshammari), King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Paediatrics (Khidir), University of Khartoum, Khartoum, Sudan, and from the Department of Family Medicine (AlKhunaizi), Xi’an Jiaotong University, Shaanxi, China.
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  • ORCID record for Sulaiman A. Alshammari
  • For correspondence: [email protected]
Reem J. Khidir
From the Department of Family & Community Medicine (AlQahtani, Alshammari, Abdulqader), College of Medicine, King Saud University, from the Department of Family & Community Medicine (Alshammari), King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Paediatrics (Khidir), University of Khartoum, Khartoum, Sudan, and from the Department of Family Medicine (AlKhunaizi), Xi’an Jiaotong University, Shaanxi, China.
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Maha F. AlKhunaizi
From the Department of Family & Community Medicine (AlQahtani, Alshammari, Abdulqader), College of Medicine, King Saud University, from the Department of Family & Community Medicine (Alshammari), King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Paediatrics (Khidir), University of Khartoum, Khartoum, Sudan, and from the Department of Family Medicine (AlKhunaizi), Xi’an Jiaotong University, Shaanxi, China.
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Osama M. Abdulqader
From the Department of Family & Community Medicine (AlQahtani, Alshammari, Abdulqader), College of Medicine, King Saud University, from the Department of Family & Community Medicine (Alshammari), King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Paediatrics (Khidir), University of Khartoum, Khartoum, Sudan, and from the Department of Family Medicine (AlKhunaizi), Xi’an Jiaotong University, Shaanxi, China.
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  • Figure 1
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    Figure 1

    - Frequencies of positive colonoscopy result.

Tables

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    Table 1

    - Characteristics of the included patients (N=365).

    Parametersn (%)
    Specialty
    Family Medicine347 (95.1)
    Gastroenterology12 (3.3)
    General Surgery6 (1.6)
    Age, mean±SD56.2±15.7
    Gender
    Male194 (53.2)
    Female171 (46.8)
    Symptoms indicating need for colonoscopy
    Change in bowel habits >6 weeks130 (35.6)
    Abdominal pain111 (30.4)
    Anemia73 (20.1)
    Constipation54 (14.8)
    Weight loss49 (13.5)
    Bloating46 (12.6)
    Rectal bleeding45 (12.3)
    Blood mixed with stool41 (11.2)
    Diarrhea23 (6.3)
    Melena10 (2.7)
    Risk factors for CRC
    Age ≥45 years284 (77.8)
    Family history of colorectal cancer44 (12.1)
    Colorectal cancer or polyps16 (4.4)
    IBD7 (1.9)
    Radiation to the abdomen or pelvic area to treat a prior cancer3 (0.8)
    Confirmed or suspected hereditary colorectal cancer syndrome*0 (0.0)

    Values are presented as numbers and precentages (%). SD: standard deviation, CRC: colorectal cancer, IBD: inflammatory bowel disease

      • View popup
      Table 2

      - Colonoscopy-related data.

      Parametersn (%)
      Appropriateness of CRC screening according to ASGE guideline
      Appropriate314 (86.0)
      Inappropriate51 (14.0)
      Rank of the referring doctor*
      Consultant172 (68.5)
      Associate consultant23 (9.2)
      Assistant consultant27 (10.8)
      Resident21 (8.4)
      Staff physician8 (3.2)
      Colonoscopy carried out after referral (yes)189 (51.8)
      Colonoscopy succeed† (yes)†179 (94.7)
      Colonoscopy failed (yes)†10 (5.3)
      Admitted for colonoscopy (yes)*†3 (1.6)
      Complication after colonoscopy (yes)*†1 (0.6)

      Values are presented as numbers and precentages (%).

      • ↵* The variables have missing records (n=114 for the rank of the referring doctor, n=5 admission for colonoscopy, and n=17 for the complications after colonoscopy).

      • ↵† Descriptive data is based on 189 patients who underwent colonoscopy after referral. CRC: colorectal cancer, ASGE: the American Society for Gastrointestinal Endoscopy

      • View popup
      Table 3

      - Factors associated with the appropriateness of colonoscopy referrals.

      ParametersAppropriateness of referralP-values
       Appropriate (n=314)Inappropriate (n=51) 
      Rank of the referring doctor
      Staff physician6 (75.0)2 (25.0)0.558
      Resident19 (90.5)2 (9.5)
      Assistant consultant21 (77.8)6 (22.2)
      Associate consultant18 (78.3)5 (21.7)
      Consultant146 (84.9)26 (15.1)
      Colonoscopy carried out after referral
      No147 (83.5)29 (16.5)0.183
      Yes167 (88.4)22 (11.6)
      Results of positive colonoscopy
      Neoplasia   
      No251 (83.4)50 (16.6)0.002
      Yes63 (98.4)1 (1.6)
      Non-neoplastic polyps   
      No304 (85.6)51 (14.4)0.369
      Yes10 (100)0 (0.0)
      Diverticular disease   
      No308 (85.8)51 (14.2)>0.999
      Yes6 (100)0 (0.0)
      Inflammatory bowel disease   
      No308 (85.8)51 (14.2)>0.999
      Yes6 (100)0 (0.0)
      Other   
      No308 (85.8)51 (14.2)>0.999
      Yes6 (100)0 (0.0)

      Values are presented as numbers and precentages (%).

        • View popup
        Table 4

        - Factors associated with the significant findings.

        ParametersSignificant findings
         Neoplasia (n=64)IBD only (n=5)P-values
        Gender
        Male30 (46.9)3 (60.0)0.665
        Female34 (53.1)2 (40.0)
        Age
        <457 (10.9)3 (60.0)0.019
        ≥4557 (89.1)2 (40.0)

        Values are presented as numbers and precentages (%). IBD: inflammatory bowel disease

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        Saudi Medical Journal: 44 (11)
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        Vol. 44, Issue 11
        1 Nov 2023
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        Outcomes and appropriateness of colonoscopy referrals at King Khalid University Hospital, Saudi Arabia
        Shahad M. AlQahtani, Sulaiman A. Alshammari, Reem J. Khidir, Maha F. AlKhunaizi, Osama M. Abdulqader
        Saudi Medical Journal Nov 2023, 44 (11) 1167-1173; DOI: 10.15537/smj.2023.44.11.20230378

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        Outcomes and appropriateness of colonoscopy referrals at King Khalid University Hospital, Saudi Arabia
        Shahad M. AlQahtani, Sulaiman A. Alshammari, Reem J. Khidir, Maha F. AlKhunaizi, Osama M. Abdulqader
        Saudi Medical Journal Nov 2023, 44 (11) 1167-1173; DOI: 10.15537/smj.2023.44.11.20230378
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        Keywords

        • colonoscopy
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