Endoscopic intervention for ischemic colitis: Safety and recommendations

Introduction: Ischemic colitis is the most common ischemic disorder of the GI tract. Although endoscopy may be a preferred diagnostic modality, colonoscopy is approached with caution for fear of perforation. Aim: To assess the safety and outcome of endoscopic intervention in patients with ischemic colitis. Methods: All cases of ischemic colitis in our Bleeding Team data base from 1988-1995 were reviewed for extent of endoscopy, endoscopic diagnosis, underlying conditions, pathology, complications and outcome. Results: Ischemic colitis was diagnosed in 67 pts (29F, 38M; mean age 71±11, range 40-91 yrs). Predisposing conditions were abdominal aortic aneurysm repair in 21/67 (31%) and atherosclerotic disease in 43/67 (64%). 84 endoscopies were performed [colonoscopies (63%), sigmoidoscopies (37%)]. Biopsies confirmed ischemic colitis in 85% and showed acute colitis in an additional 12.5%. The in-hospital mortality was 7/67 pts (10%) and related to underlying diseases. Endoscopic data: 53 colonoscopies were performed in 44 pts (20F, 24M; mean age 71±11, range 40-91). The right colon was examined in 34/53 (64%), the transverse colon in 14/53 (27%) and the left colon in 5/53 (9%). Proximal ischemic colitis beyond the reach of a sigmoidoscope was present in 16/44 (36%) of patients undergoing colonoscopy. Ischemic colitis involved the left colon in 19/21 (90%) pts with abdominal aortic aneurysm repair, with 2/21 (10%) having ischemia beyond reach of a flexible sigmoidoscope. 31 sigmoidoscopies were performed in 23 pts (9F,14M; mean age 70±10, range 41-83). The mean extent of endoscopy was 39±15 cm (range 15-60), limited by poor preparation, angulation or pain. Colonoscopy was discontinued because of severity of disease in 9%, luminal narrowing in 4% and poor preparation in 11%. There were no endoscopic complications or related mortality. Conclusions: 1. Endoscopic intervention in patients with ischemic colitis is safe. 2. Sigmoidoscopy appears to be sufficient in patients with abdominal aortic aneurysm repair. 3. In patients with other predisposing conditions colonoscopy is preferable to sigmoidoscopy due to high incidence of proximal ischemia. 4. Biopsies of the affected area should be encouraged to support the diagnosis. 5. Although the in hospital mortality is high (10%) this is related to the severity of the underlying conditions.