Colonoscopy is high yield in spinal cord injury

Abstract

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.

Colonoscopy after spinal cord injury: a case–control study

“…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.…”

“…The occurrence of rectal bleeding in the majority should preclude the use of faecal occult blood test as a screening test. 3 Computed tomographic colonography still requires bowel preparation, is inaccurate for lesions o1 cm 11 and has not adequately been assessed in this population. Flexible sigmoidoscopy is arguably inadequate given high rates of proximal tumours.…”

“…Similar to that described elsewhere, 3 the quality of bowel preparation was dichotomised to allow comparison as either 'satisfactory' to encompass the descriptors, 'good', 'adequate' and 'satisfactory' or 'unsatisfactory', to include 'poor', 'inadequate' and 'unsatisfactory'. A complete colonoscopy was indicated by caecal or terminal ileal intubation.…”

“…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.…”

“…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.…”