Langmead, L.; Jones, D.B.; Katelaris, P.H.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA27
Academic Journal
Background: It is an unchallenged axiom that digital rectal examination (DRE) is an essential part of the physical examination of patients with colonic symptoms. However, there is no evidence demonstrating that routine unsedated, unprepared DRE at the initial consultation is useful in patients in whom colonoscopy is indicated. Aims: To assess the value of DRE in patients presenting to gastroenterologists with colonic symptoms. Methods: Consecutive patients presenting to gastroenterologists with colonic symptoms, in whom a colonoscopy was later performed, were studied. Patients with perianal pain or tenesmus and those in whom DRE was done for indications other than routine were excluded. Endoscopic findings were evaluated. Rectal cancers were recorded as distal (within 7 cm of the anal verge and potentially palpable on unsedated DRE) or proximal (beyond 7 cm). Results: In 4834 patients undergoing colonoscopy, 166 cancers were diagnosed, of which 68 (41%) were rectal cancer (23 distal, 45 proximal). Anaemia was a more frequent indication in those with colonic cancers (p < 0.001). A qualitative questionnaire revealed unanimous patient and doctor preference for DRE at the time of colonoscopy rather than unsedated, unprepared DRE. In a presumptive analysis of usefulness, a 75% sensitivity of DRE for distal cancers was assumed. 280 DREs, therefore, wouldbe required to detect one distal cancer in this cohort, with the outcome of this being a possibly reduced waiting time to colonoscopy. Conclusion: Routine DRE was not sensitive for the diagnosis of colorectal cancer. It was unpopular with patients and doctors and would not alter management in more than 0.4% of patients. In those with a positive DRE, the maximum benefit would be to shorten the interval to colonoscopy. In practice, valuable time spent performing DRE may be better spent in the endoscopy suite reducing colonoscopy waiting times.


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