Safety, feasibility, and tolerability of ileocolonoscopy in inflammatory bowel disease

 

 Buy Article Permissions and Reprints

Background and study aims: Ileocolonoscopy including biopsies is the first-line investigation in the diagnosis, management, and monitoring of inflammatory bowel disease (IBD). However, data on its safety, feasibility, and tolerability, especially in patients with extensive or severe inflammation, are rare. The aim of this study was to assess prospectively the risks of ileocolonoscopy in relation to various disease patterns and to compare possible burdens of the procedure in the endoscopist’s and the patient’s perception.

Patients and methods: We prospectively analyzed a total of 558 consecutive patients, 482 with a confirmed diagnosis of IBD and 76 with suspected IBD. Data were recorded regarding the indication for ileocolonoscopy, sedation, procedure time, completion rate, feasibility of the procedure, patient tolerance, and procedure-related and postprocedure complications. Endoscopic data included the region involved, the nature of the involvement, activity of the disease, and number of biopsies.

Results: In 558 endoscopic procedures performed by 14 gastroenterologists no procedure-related deaths occurred. Major complications, defined as bleeding (n = 1) or perforation (n = 3), occurred in 4/558 patients (0.7 %). Minor complications, which included intense flatulence, tachycardia, allergic reaction to a sedation drug, and autonomic symptoms such as nausea, vomiting, and intense perspiration, occurred in 22/558 patients (3.9 %). There was no relationship between the complication rate and the activity of the disease. Mean procedure time was 21.0 minutes and the completion rate, defined by intubation of the terminal ileum, was 94.6 %. We documented a high tolerability independent of the severity of the disease.

Conclusions: Ileocolonoscopy is a safe and feasible procedure in patients with IBD and is well tolerated by patients when carried out by well-trained endoscopists.

References

• 1 Hoffmann J C, Zeitz M, Bischoff S C. et al . Diagnosis and therapy of ulcerative colitis: results of an evidence based consensus conference by the German Society of Digestive and Metabolic Diseases and the Competence Network on Inflammatory Bowel Disease.  Z Gastroenterol. 2004;  42 979-983
  Article in Thieme ConnectPubMedGoogle Scholar
• 2 Stange E F, Schreiber S, Fölsch U R. et al . Diagnostics and treatment of Crohn’s disease: results of an evidence based consensus conference by the German Society for Digestive and Metabolic Diseases.  Z Gastroenterol. 2003;  41 19-20
  Article in Thieme ConnectPubMedGoogle Scholar
• 3 Rachmilewitz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis; a randomized study trial.  BMJ. 1989;  298 82-86
  PubMedGoogle Scholar
• 4 Liebermann D A, Smith F W. Screening for colon malignancy with colonoscopy.  Am J Gastroenterol. 1991;  86 946-951
  PubMedGoogle Scholar
• 5 DiSario J A, Foutch P G, Mai H D. et al . Prevalence and malignant potential of colorectal polyps in asymptomatic, average-risk men.  Am J Gastroenterol. 1991;  86 941-945
  PubMedGoogle Scholar
• 6 Johnson D A, Gurney M, Volpe R J. et al . A prospective study of prevalence of colonic neoplasms in asymptomatic patients with an age-related risk.  Am J Gastroenterol. 1990;  85 969-974
  PubMedGoogle Scholar
• 7 Rex D K, Lehmann G A, Ulbright T M. et al . Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history.  Am J Gastroenterol. 1993;  88 825-831
  PubMedGoogle Scholar
• 8 Rogge J D, Elmore M F, Mahoney S J. et al . Low-cost, office-based, screening colonoscopy.  Am J Gastroenterol. 1994;  89 1775-1780
  PubMedGoogle Scholar
• 9 Nelson D B, McQuaid K R, Bond J H. et al . Procedural success and complications of large-scale screening colonoscopy.  Gastrointest Endosc. 2002;  55 307-314
  CrossrefPubMedGoogle Scholar
• 10 Sieg A, Theilmeier A. Results of coloscopy screening in 2005: an Internet-based documentation.  Dtsch Med Wochenschr. 2006;  131 379-383
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Heldwein W, Dollhopf M, Rösch T. et al . The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies.  Endoscopy. 2005;  37 1116-1122
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Macrae F A, Tan K G, Williams C B. et al . Toward safer colonoscopy: a report on the complications of 5000 diagnostic and therapeutic colonoscopies.  Gut. 1983;  24 376-383
  CrossrefPubMedGoogle Scholar
• 13 Basson M D, Etter L, Panzini L A. et al . Rates of colonoscopic perforation in current practice [letter].  Gastroenterology. 1998;  114 1115
  PubMedGoogle Scholar
• 14 Eckardt V F, Kanzler G, Schmitt T. et al . Complications and adverse effects of colonoscopy with selective sedation [letter].  Gastrointest Endosc. 1999;  49 560-565
  PubMedGoogle Scholar
• 15 Zubarik R, Fleischer D E, Mastropietro C. et al . Prospective analysis of complications 30 days after outpatient colonoscopy.  Gastrointest Endosc. 1999;  50 322-328
  CrossrefPubMedGoogle Scholar
• 16 Anderson M L, Pasha T M, Leighton J A. et al . Endoscopic perforation of the colon: lessons from a 10-year study.  Am J Gastroenterol. 2000;  95 3418-3422
  CrossrefPubMedGoogle Scholar
• 17 Anderson J C, Gonzalez J D, Messina C R. et al . Factors that predict incomplete colonoscopy: thinner is not always better.  Am J Gastroenterol. 2000;  95 2784-2787
  CrossrefPubMedGoogle Scholar
• 18 Waye J D, Lewis B S, Yessayan S. et al . Colonoscopy: a prospective report of complications.  J Clin Gastroenterol. 1992;  15 347-351
  CrossrefPubMedGoogle Scholar
• 19 Nivatvongs S. Complications in colonoscopic polypectomy: an experience with 1555 polypectomies.  Dis Colon Rectum. 1986;  29 825-831
  CrossrefPubMedGoogle Scholar
• 20 Rosen L, Bub D S, Reed J F. et al . Hemorrhage following colonoscopic polypectomy.  Dis Colon Rectum. 1993;  36 1126-1131
  CrossrefPubMedGoogle Scholar
• 21 Gibbs D H, Opelka F G, Beck D E. et al . Postpolypectomy colonic hemorrhage.  Dis Colon Rectum. 1996;  39 806-810
  CrossrefPubMedGoogle Scholar
• 22 Waye J D, Kahn O, Auerbach M E. et al . Complications of colonoscopy and flexible sigmoidoscopy.  Gastrointest Endosc Clin North Am. 1996;  6 343-377
  PubMedGoogle Scholar
• 23 Hall C, Dorricott N J, Donovan I A. et al . Colon perforation during colonoscopy: surgical versus conservative management.  Br J Surg. 1991;  78 542-544
  CrossrefPubMedGoogle Scholar
• 24 Reiertsen O, Skjoto J, Jacobsen C D. et al . Complications of fiberoptic gastrointestinal endoscopy: five years’ experience in a central hospital.  Endoscopy. 1987;  19 1-6
  Article in Thieme ConnectPubMedGoogle Scholar
• 25 Di Prima R E, Barkin J S, Blinder M. et al . Age as a risk factor in colonoscopy: fact versus fiction.  Am J Gastroenterol. 1988;  83 123-125
  PubMedGoogle Scholar
• 26 Alemayehu G, Järnerot G. Colonoscopy during an attack of severe ulcerative colitis is a safe procedure and of great value in clinical decision making.  Am J Gastroenterol. 1991;  86 187-190
  PubMedGoogle Scholar
• 27 Carbonnel F, Lavergne A, Lemann M. et al . Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity.  Dig Dis Sci. 1994;  39 1550-1557
  PubMedGoogle Scholar
• 28 Koobatian G J, Choi P M. Safety of surveillance colonoscopy in long-standing ulcerative colitis.  Am J Gastroenterol. 1994;  89 1472-1475
  PubMedGoogle Scholar
• 29 Rubin P H, Friedman S, Harpaz N. et al . Colonoscopic polypectomy in chronic colitis: conservative management after endoscopic resection of dysplastic polyps.  Gastroenterology. 1999;  117 1295-1300
  CrossrefPubMedGoogle Scholar
• 30 Hardman K A, Manjunath S, Trash D B. Safety of colonoscopy.  J R Coll Physicians Lond. 1995;  29 398-400
  PubMedGoogle Scholar
• 31 Chutkan R K, Scherl E, Waye J D. Colonoscopy in inflammatory bowel disease.  Gastroinest Endosc Clin North Am. 2002;  12 463-483
  CrossrefPubMedGoogle Scholar
• 32 Fefferman D S, Farrell R J. Endoscopy in inflammatory bowel disease: indications, surveillance and use in clinical practice.  Clin Gastroenterol Hepatol. 2005;  3 11-24
  CrossrefPubMedGoogle Scholar
• 33 Modigliani R. Endoscopic management of inflammatory bowel disease.  Am J Gastroenterol. 1994;  89 53-65
  PubMedGoogle Scholar
• 34 Hommes D W, van Deventer S J. Endoscopy in inflammatory bowel disease.  Gastroenterology. 2004;  126 1561-1573
  CrossrefPubMedGoogle Scholar
• 35 Lee S D, Cohen R D. Endoscopy in inflammatory bowel disease.  Gastroenterol Clin North Am. 2002;  31 119-132
  CrossrefPubMedGoogle Scholar
• 36 Pera A, Bellando P, Caldera D. et al . Colonoscopy in inflammatory bowel disease.  Gastroenterology. 1987;  92 181-185
  PubMedGoogle Scholar
• 37 Leighton J A, Shen B, Baron T H. et al . ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease.  Gastrointest Endosc. 2006;  63 558-565
  CrossrefPubMedGoogle Scholar
• 38 Daperno M, Sostegni R, Lavagna A. et al . The role of endoscopy in inflammatory bowel disease.  Eur Rev Med Pharmacol Sci. 2004;  8 209-214
  PubMedGoogle Scholar
• 39 Allez M, Lemann M, Bonnet J. et al . Long term outcome of patients with active Crohn’s disease exhibiting extensive and deep ulcerations at colonoscopy.  Am J Gastroenterol. 2002;  97 947-953
  PubMedGoogle Scholar
• 40 Geboes K, Ectors N, D’Haens G. et al . Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of inflammatory bowel disease ?.  Am J Gastroenterol. 1998;  93 201-206
  PubMedGoogle Scholar
• 41 Chutkan R K, Wayne J D. Endoscopy in inflammatory bowel disease. In: Kirshner JB (ed). Inflammatory bowel disease. 5th edn. Baltimore; Williams & Wilkins 2000: 453-477
  Google Scholar
• 42 Lewis B S. Ileoscopy should be part of standard colonoscopy: a comparison of radiographic and endoscopic evaluation of the ileum.  J Clin Gastroenterol. 2000;  31 103-104
  CrossrefPubMedGoogle Scholar
• 43 Church J M. Complete colonoscopy: how often? And if not, why not?.  Am J Gastroenterol. 1994;  89 556-560
  PubMedGoogle Scholar
• 44 Cirocco W C. Factors that predict incomplete colonoscopy.  Dis Colon Rectum. 1995;  38 964-968
  CrossrefPubMedGoogle Scholar
• 45 Marshall J B, Barthel J S. The frequency of total colonoscopy and terminal ileal intubation in the 1990s.  Gastrointest Endosc. 1993;  39 518-520
  PubMedGoogle Scholar
• 46 Waye J D, Bashkoff E. Total colonoscopy: is it always possible?.  Gastrointest Endosc. 1991;  37 152-154
  CrossrefPubMedGoogle Scholar
• 47 Kim W H, Cho Y J, Park J Y. et al . Factors affecting insertion time and patient discomfort during colonoscopy.  Gastrointest Endosc. 2000;  52 600-605
  CrossrefPubMedGoogle Scholar
• 48 Ristikankare M, Hartikainen J, Heikkinen M. et al . The effects of gender and age on the colonoscopic examination.  J Clin Gastroenterol. 2001;  32 69-75
  CrossrefPubMedGoogle Scholar
• 49 Bowles C J, Leicester R, Romaya C. et al . A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?.  Gut. 2004;  53 277-283
  CrossrefPubMedGoogle Scholar
• 50 Rex D K, Chen S C, Overhiser A J. Colonoscopy technique in consecutive patients referred for prior incomplete colonoscopy.  Clin Gastroenterol Hepatol. 2007;  5 879-883
  CrossrefPubMedGoogle Scholar
• 51 Hull T, Church J M. Colonoscopy: how difficult, how painful?.  Surg Endosc. 1994;  8 784-787
  CrossrefPubMedGoogle Scholar
• 52 Froehlich F, Thorens J, Schwizer W. et al . Sedation and analgesia for colonoscopy: patient tolerance, pain, and cardiorespiratory parameters.  Gastrointest Endosc. 1997;  45 1-9
  CrossrefPubMedGoogle Scholar
• 53 Macken E, Gevers A M, Hendrickx A. et al . Midazolam versus diazepam in lipid emulsion as conscious sedation for colonoscopy with or without reversal of sedation with flumazenil.  Gastrointest Endosc. 1998;  47 57-61
  CrossrefPubMedGoogle Scholar
• 54 Schmitt C M, Schutz S M, Lee J G. et al . Patient comfort during conscious sedation: discrimination from patient satisfaction [abstract].  Gastrointest Endosc. 1994;  40 46
  PubMedGoogle Scholar
• 55 Saunders B P, Fukumatoto M, Halligan S. et al . Why is colonoscopy more difficult in women?.  Gastrointest Endosc. 1996;  43 124-126
  PubMedGoogle Scholar
• 56 Schutz S M, Lee J G, Schmitt C M. et al . Clues to patient dissatisfaction with conscious sedation for colonoscopy.  Am J Gastroenterol. 1994;  89 1476-1479
  PubMedGoogle Scholar
• 57 Sadahiro S, Ohmura T, Yamada Y. et al . Analysis of length and surface area of each segment of the large intestine according to age, sex, and physique.  Surg Radiol Anat. 1992;  14 251-257
  CrossrefPubMedGoogle Scholar
• 58 Conn M, Allen M L, De Martino P. et al . Factors affecting duration of colonoscopy [abstract].  Gastrointest Endosc. 1993;  39 294
  PubMedGoogle Scholar
• 59 Mahajan R J, Johnson J C, Marshall J B. Predictors of patient cooperation during gastrointestinal endoscopy.  J Clin Gastroenterol. 1997;  24 220-223
  CrossrefPubMedGoogle Scholar
• 60 Eckardt V F, Kanzler G, Willems D. et al . Colonoscopy without premedication versus barium enema: a comparison of patient discomfort.  Gastrointest Endosc. 1996;  44 177-180
  PubMedGoogle Scholar

G. Terheggen, MD 

Department of Internal Medicine
Evangelisches Krankenhaus Kalk

Buchforststraße 2
51103 Köln
Germany

Email: gterheggen@web.de