Risks and benefits of colonoscopy in pre-liver transplantation screening.
R.C. Oey, L. van Tilburg, N.S. Erler, H.J. Metselaar, H.R. van Buuren, R.A. de Man
Thursday 15 march 2018
16:35 - 16:45h
at Willem Burger Zaal
Categories: Clinical, Session (parallel)
Parallel session: Parallel session 8: Clinical
Objective
To assess the benefits and risks of colonoscopy in a large cohort of patients evaluated for liver transplantation.
Methods
Retrospective study of all consecutive patients undergoing colonoscopy during pre-liver transplantation screening between 2004-2016 with registration of all clinical events during the 30 days after the procedure and during a 30-days control time frame.
Results
The study included 808 patients (65% male; median age 53 years (18-71); median MELD score 15 (6-40)) undergoing 858 colonoscopies. Ascites was present in 41% of the patients at time of colonoscopy (24% diuretic responsive; 17% refractory) and patients did not receive standard periprocedural antibiotic prophylaxis. The cecal intubation success rate was 92.7%. 267 patients had ≥1 polypectomy during colonoscopy. Colorectal cancer was found in 2 patients (0.2%) and advanced adenomas in 44 patients (5.4%). The only independent risk factor for a (pre)malignant lesion was age (RR 1.07 per year; 95%CI 1.03-1.12). Additionally, in 36.4% of patients other colon abnormalities were diagnosed, such as colitis, rectal varices, angiodysplasia, portal enteropathy, and diverticulosis. During the 30 days after the 858 performed colonoscopies, 119 patients had a clinical event (13.9%) compared to 70 patients with an event (8.4%) in the control time frames (p<0.001). After colonoscopy, there was a significant increased risk for renal failure (33 vs 10; p=0.001) and gastro-intestinal bleeding (25 vs 11; p=0.023). Ascites (diuretic responsive ascites RR 1.20; 95%CI 0.36-4.04; refractory ascites RR 5.38; 95%CI 1.94-14.94) and MELD score (RR 1.27 per point; 95%CI 1.18-1.36) were independent risk factors for post-colonoscopy renal failure. Only MELD score (RR 1.13 per point; 95%CI 1.06-1.20) was an independent risk factor for post-colonoscopy gastro-intestinal bleeding.
Conclusions
In this largest reported assessment of risks and benefits of pre-liver transplantation screening with colonoscopy, colorectal cancer was detected in 0.2% of the population. Our results suggest colonoscopy with standard bowel preparation is associated with a small, yet significantly increased risk for renal failure and gastro-intestinal bleeding after the procedure, especially in patients with severely advanced disease. A reconsideration of guidelines regarding the necessity of colonoscopy in unselected patients and the timing of the routine colonoscopy before liver transplantation seems appropriate.
