Colonoscopic lesions in veterans with spinal cord injury

Rabadi, Meheroz H.; Vincent, Andrea S.

doi:10.1682/jrrd.2011.03.0036

Cited by 6 publications

(8 citation statements)

References 17 publications

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“…19 Our neoplasm detection rates (68% for adenomas and 4% for adenocarcinoma) support other investigators' claims that CRC rates in persons with SCI&D approach that of the general population. 19,20 Despite the challenges regarding adequate bowel preparation (which improved significantly over time in our sample), colonoscopy did not appear to pose a clinically significant higher risk of complications in this population and is potentially life-saving by detecting CRC. However, an old clinical adage is to not perform a test if you are not going to act on the results.…”

Section: Discussionmentioning

confidence: 78%

“…One striking finding of our sample was the high rate of inadequate bowel preparation in this population, which has been observed by other researchers when compared with healthy patients. [8][9][10][11][12][13][14]20 In the non-SCI&D population, colonoscopy is usually performed as an outpatient procedure; the patient self-administers the bowel prep the night before and usually goes home the same day as the procedure. However, in order to accommodate an intensified and longer bowel prep regimen 7 and to assist with pressure ulcer prevention, many patients with SCI&D are admitted prior to the procedure or receive colonoscopy during an unrelated admission, as evidenced by our long median length of stay.…”

Section: Discussionmentioning

confidence: 99%

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Colonoscopy is high yield in spinal cord injury

Hayman

Guihan

Fisher

et al. 2013

The Journal of Spinal Cord Medicine

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Objectives/background: Colorectal cancer (CRC) can be prevented by routine colonoscopy. CRC screening in special populations, e.g. spinal cord injury and disorders, presents unique barriers and, potentially, a higher risk of complications. We were concerned about potentially higher risks of complications and sought to determine the safety of colonoscopy. Methods: Retrospective observational design using medical record review for 311 patients who underwent 368 colonoscopies from two large VA SCI centers from 1997-2008. Patient demographics and peri-procedural characteristics, including indication, bowel prep quality, and pathological findings are presented. Descriptive statistics are presented. Results: The population was predominantly male and Caucasian, and 199 (64%) had high-level injuries (T6 or above). Median age at colonoscopy was 61 years (interquartile range 53-69). Just <1/2 of the colonoscopies were diagnostic, usually for evidence of rectal bleeding. Although a majority of colonoscopies were reported as poorly prepped, the proportion that were adequately prepped increased over time (from 3.7 to 61.3%, P = <0.0001). Of the 146 polyps removed, 101 (69%) were adenomas or carcinomas. Ten subjects had 11 complications, none of which required surgical intervention. Conclusions: Although providing quality colonoscopic care in this population is labor intensive, the data suggests that it appears safe and therapeutically beneficial. The results indicate that the risk of screening is outweighed by the likelihood of finding polyps. Recognition of the benefit of colonoscopy in this population may have improved bowel prep and reporting over time. Spinal cord injury providers should continue to offer screening or diagnostic colonoscopy to their patients when indicated, while being aware of the special challenges that they face.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Colonoscopy is high yield in spinal cord injury

Hayman

Guihan

Fisher

et al. 2013

The Journal of Spinal Cord Medicine

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“…2 In Australia, the general population has a 1 in 21 lifetime incidence of colorectal cancer 11 and while an early study suggested an increased risk of CRC in SCI, 12 our study supports the more recent notion of an equivalent cancer risk. [3][4][5] SCI patients have increased obesity and physical inactivity as CRC risk factors, 13 a tendency for a more advanced stage of malignancy at diagnosis 6 and an increased risk of complications in the treatment of established cancer, 14 thus further emphasising the need for screening and investigation of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Two small comparative series had not previously demonstrated a difference between groups. 4,5 Haemorrhoids are much more common in SCI and the most frequent explanation for peri-rectal bleeding. Their occurrence is likely the consequence of altered anorectal tone permitting prolapse and/or the repeated trauma of digital stimulation to achieve evacuation.…”

Section: Discussionmentioning

confidence: 99%

“…1 Despite improvements in acute mortality, there is still a decreased life expectancy now most frequently attributed to cancer. 2 Colorectal cancer (CRC) screening in this group has received little attention despite reports of an at least equivalent cancer risk [3][4][5] and presentation with more advanced disease. 6 Detection of occult neoplastic disease is difficult due to higher rates of gastrointestinal complaints 6,7 and the high frequency of PR bleeding should exclude SCI patients from faecal occult blood testing.…”

Section: Introductionmentioning

confidence: 99%

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Colonoscopy after spinal cord injury: a case–control study

2014

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Design: An age-and gender-matched case-control study. Objective: To compare colonoscopy after spinal cord injury (SCI) with the general population in terms of indications, bowel preparation, technical success and disease detection. Setting: Victoria, Australia. Methods: Consecutive SCI colonoscopies between January 1998 and February 2013 were compared with a randomly selected ageand gender-matched control group. Injury level, indication for procedure and demographics were collected. Outcome measures included quality of bowel preparation, completion rates, procedural duration and benign and malignant disease detection. Results: A total of 440 colonoscopies were assessed, comprising 148 SCI patients and 292 age-and gender-matched controls. Both the groups were of similar age (54.7 years vs 54.5 years, P = 0.906) and comprised predominantly males (87.1% vs 86.3%, P = 0.919). SCI colonoscopies were more often performed to investigate abnormalities (85.1% vs 58.2%, Po0.001) than for screening or surveillance (18.2% vs 40.8%, Po0.001). Unsatisfactory bowel preparation was recorded more often in the SCI group (36.0% vs 13.0%, Po0.001) and completion rates were lower (75.7% vs 93.1%, Po0.001). Overall disease detection was lower in the SCI group (45.3% vs 59.6%, Po0.006). The polyp detection rate was lower for SCI (11.4% vs 25.3%, P = 0.001). The rate of diagnosis of malignancy was equivalent (2.7% vs 3.0%, P = 0.904). Conclusion: SCI patients have the same risk of malignancy as the general population and are less likely to undergo screening colonoscopy. Colonoscopy is then limited by poor bowel preparation and lower completion rates with a subsequent lower polyp detection rate. INTRODUCTIONThere is both an increasing prevalence and increasing average age of SCI patients. 1 Despite improvements in acute mortality, there is still a decreased life expectancy now most frequently attributed to cancer. 2 Colorectal cancer (CRC) screening in this group has received little attention despite reports of an at least equivalent cancer risk 3-5 and presentation with more advanced disease. 6 Detection of occult neoplastic disease is difficult due to higher rates of gastrointestinal complaints 6,7 and the high frequency of PR bleeding should exclude SCI patients from faecal occult blood testing. 3 Colonoscopy is challenging with difficulties in bowel preparation and low intubation rates despite multiday bowel preparation, 3,8,9 and studies assessing yield and safety of colonoscopy after SCI 3,8 have been limited by a small sample size or lack of a control group. We seek to highlight the difficulties with colonoscopy after SCI using a noninjured control group but to emphasise its importance by demonstrating the rates of benign and malignant diseases.

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