Patients’ comorbidities reduce the clinical value of emergency colonoscopy: results of a retrospective cohort study
Background and study aims Urgent endoscopy is often used to diagnose and sometimes treat acute upper gastrointestinal syndromes (hemorrhage, toxic ingestion, and occlusion). However, its suitability concerning the management of lower gastrointestinal conditions in emergency circumstances is controve...
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Format: | Article |
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Georg Thieme Verlag KG
2017-11-01
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Series: | Endoscopy International Open |
Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-118001 |
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doaj-4587ab9b3deb4d8890118f1bcebdf6de |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Cristiano Cremone Anouk Esch Charlotte Gagniere Alessandro Fugazza Faria Mesli Michael Levy Aurelien Amiot Alexis Laurent Yann LeBaleur Francois Hemery Nicolas De’Angelis Francesco Brunetti Iradj Sobhani |
spellingShingle |
Cristiano Cremone Anouk Esch Charlotte Gagniere Alessandro Fugazza Faria Mesli Michael Levy Aurelien Amiot Alexis Laurent Yann LeBaleur Francois Hemery Nicolas De’Angelis Francesco Brunetti Iradj Sobhani Patients’ comorbidities reduce the clinical value of emergency colonoscopy: results of a retrospective cohort study Endoscopy International Open |
author_facet |
Cristiano Cremone Anouk Esch Charlotte Gagniere Alessandro Fugazza Faria Mesli Michael Levy Aurelien Amiot Alexis Laurent Yann LeBaleur Francois Hemery Nicolas De’Angelis Francesco Brunetti Iradj Sobhani |
author_sort |
Cristiano Cremone |
title |
Patients’ comorbidities reduce the clinical value of emergency colonoscopy: results of a retrospective cohort study |
title_short |
Patients’ comorbidities reduce the clinical value of emergency colonoscopy: results of a retrospective cohort study |
title_full |
Patients’ comorbidities reduce the clinical value of emergency colonoscopy: results of a retrospective cohort study |
title_fullStr |
Patients’ comorbidities reduce the clinical value of emergency colonoscopy: results of a retrospective cohort study |
title_full_unstemmed |
Patients’ comorbidities reduce the clinical value of emergency colonoscopy: results of a retrospective cohort study |
title_sort |
patients’ comorbidities reduce the clinical value of emergency colonoscopy: results of a retrospective cohort study |
publisher |
Georg Thieme Verlag KG |
series |
Endoscopy International Open |
issn |
2364-3722 2196-9736 |
publishDate |
2017-11-01 |
description |
Background and study aims Urgent endoscopy is often used to diagnose and sometimes treat acute upper gastrointestinal syndromes (hemorrhage, toxic ingestion, and occlusion). However, its suitability concerning the management of lower gastrointestinal conditions in emergency circumstances is controversial.
Patients and methods We studied the role of emergency colonoscopy in diagnosis and treatment of all consecutive patients presenting with acute lower gastrointestinal symptoms referred to our hospital on an emergency basis. All patients were first managed by physicians from the emergency room and/or the intensive care unit (ICU); the treatments included fluid resuscitation, blood transfusion, and antibiotic or cardiotonic as needed. Bowel cleansing was performed to purge the colon of clots, stool, and blood when clinically possible; alternatively, a bowel enema was used. Patients only underwent a computed tomography (CT) scan prior to the colonoscopy in clinically relevant situations. Colonoscopy was performed within 6 – 36 hours after hospitalization or the beginning of the clinical symptoms (hemorrhage, sepsis, colon distension) or occlusion, as assessed by abdominal CT scan.
Results From 2010 to 2015, 603 patients underwent urgent colonoscopy; among them, 214 (36 %) presented with lower GI bleeding, while 264 (44 %) had symptoms suggestive of intestinal ischemia; almost half (49 %, n = 295) of the patients were hospitalized in the ICU. Patients received therapies, such as clips (15 %), epinephrine injections (5 %), bipolar coagulation (7 %), or devolvulation (3 %) using colonoscopy or antibiotic therapy when needed. No perforation was observed after colonoscopy and only three cases of hemorrhage recurrence were documented as complications after the procedure. Overall, 192 patients died within 1 month after colonoscopy due to four independent risk situations, as follows: septic shock, heart transplantation, multiorgan failure, and ischemic colitis. Only 67 (35 %) underwent urgent intestinal surgery when ischemic colitis was identified, and this did not have a significant effect on the mortality rate.
Conclusions Urgent bedside colonoscopy is feasible and safe for routine use. The highest advantage was observed in patients with red blood hemorrhage, diarrhea, and colon distension when symptoms were not associated with multiorgane failure, heart transplantation, or septic shock. As revealed by colonoscopy and pathological features, ischemic colitis is associated with a bad prognosis, and patients experience a higher rate of early mortality regardless of whether they undergo urgent colon surgery. |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-118001 |
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doaj-4587ab9b3deb4d8890118f1bcebdf6de2020-11-25T03:12:32ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362017-11-010511E1119E112710.1055/s-0043-118001Patients’ comorbidities reduce the clinical value of emergency colonoscopy: results of a retrospective cohort studyCristiano Cremone0Anouk Esch1Charlotte Gagniere2Alessandro Fugazza3Faria Mesli4Michael Levy5Aurelien Amiot6Alexis Laurent7Yann LeBaleur8Francois Hemery9Nicolas De’Angelis10Francesco Brunetti11Iradj Sobhani12EC2M3: Department of Academic Research (EA7375) Université Paris Est Créteil (UPEC) – Val de Marne, FranceDepartment of Liver and Gastroenterology, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceDepartment of Liver and Gastroenterology, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceDepartment of Liver and Gastroenterology, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceDepartment of Liver and Gastroenterology, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceDepartment of Liver and Gastroenterology, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceDepartment of Liver and Gastroenterology, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceDepartment of Liver and GI surgery, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceDepartment of Liver and Gastroenterology, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceDepartment of Bio Informatic, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceDepartment of Liver and GI surgery, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceDepartment of Liver and GI surgery, Hôpital Henri Mondor – Assistance Pulique Hôpitaux de Paris (APHP), Paris, FranceEC2M3: Department of Academic Research (EA7375) Université Paris Est Créteil (UPEC) – Val de Marne, FranceBackground and study aims Urgent endoscopy is often used to diagnose and sometimes treat acute upper gastrointestinal syndromes (hemorrhage, toxic ingestion, and occlusion). However, its suitability concerning the management of lower gastrointestinal conditions in emergency circumstances is controversial. Patients and methods We studied the role of emergency colonoscopy in diagnosis and treatment of all consecutive patients presenting with acute lower gastrointestinal symptoms referred to our hospital on an emergency basis. All patients were first managed by physicians from the emergency room and/or the intensive care unit (ICU); the treatments included fluid resuscitation, blood transfusion, and antibiotic or cardiotonic as needed. Bowel cleansing was performed to purge the colon of clots, stool, and blood when clinically possible; alternatively, a bowel enema was used. Patients only underwent a computed tomography (CT) scan prior to the colonoscopy in clinically relevant situations. Colonoscopy was performed within 6 – 36 hours after hospitalization or the beginning of the clinical symptoms (hemorrhage, sepsis, colon distension) or occlusion, as assessed by abdominal CT scan. Results From 2010 to 2015, 603 patients underwent urgent colonoscopy; among them, 214 (36 %) presented with lower GI bleeding, while 264 (44 %) had symptoms suggestive of intestinal ischemia; almost half (49 %, n = 295) of the patients were hospitalized in the ICU. Patients received therapies, such as clips (15 %), epinephrine injections (5 %), bipolar coagulation (7 %), or devolvulation (3 %) using colonoscopy or antibiotic therapy when needed. No perforation was observed after colonoscopy and only three cases of hemorrhage recurrence were documented as complications after the procedure. Overall, 192 patients died within 1 month after colonoscopy due to four independent risk situations, as follows: septic shock, heart transplantation, multiorgan failure, and ischemic colitis. Only 67 (35 %) underwent urgent intestinal surgery when ischemic colitis was identified, and this did not have a significant effect on the mortality rate. Conclusions Urgent bedside colonoscopy is feasible and safe for routine use. The highest advantage was observed in patients with red blood hemorrhage, diarrhea, and colon distension when symptoms were not associated with multiorgane failure, heart transplantation, or septic shock. As revealed by colonoscopy and pathological features, ischemic colitis is associated with a bad prognosis, and patients experience a higher rate of early mortality regardless of whether they undergo urgent colon surgery.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-118001 |