Short Term Outcome of Patients with Hematochezia and Normal Initial Colonoscopic Findings: Do They Really Need Further Screening?

Background: In a significant number of the patients with hematochezia, colonoscopy turns out to be normal and therefore is unable to determine the cause of bleeding. This study investigates outcomes and possible necessity for further work up in cases of hematochezia with normal colonoscopy. Methods: Ninety-seven patients with normal colonoscopy were followed for at least one year from the time of colonoscopy by regular visits and phone calls. Mortality and recurrent bleeding were recorded as primary end points. Those with recurrent or continued hematochezia were invited for a new visit and further work up. Results: Among the ninety seven patients, nine cases (9.3%) were lost at follow ups, 10 experienced rebleeding (10.3 %), and the remaining 78 (80.4 %) were apparently healthy and had no further complaints. There were two mortalities during the follow up, one due to gastric cancer and the other due to cerebrovascular accident. Conclusion: It is unusual for the cases of hematochezia with a normal initial colonoscopy to have recurrent bleeding as a result of a significant missed lesion in the colon.