Impact of Colonoscopy in the Diagnosis and Management of Diarrhea in Solid Organ Transplant Recipients

Abstract

Background: Diarrhea is common in solid organ transplant recipients with the incidence ranging from 13 to 43%. Colonoscopy with random biopsies is frequently performed in the diagnostic evaluation of the post-transplant population with diarrhea. Aim: To determine the yield of colonoscopy in the diagnosis and management of diarrhea in the solid organ transplant recipient. Methods: From October 1996 to June 2008, 88 patients were identified who had undergone solid organ transplantation and subsequently underwent colonoscopy for an indication of “diarrhea”. Endoscopic findings at time of colonoscopy and any subsequent pathology were reviewed to determine the impact of these studies on the management of the patient's diarrhea. Results: 88 patients (mean age 54 years, 65% male) underwent colonoscopy a mean of 69 months after transplantation (31 kidney, 26 liver, 21 heart, 6 kidney-pancreas, 3 lung, 1 lung-kidney, 1 pancreas). Stool studies including evaluation for clostridium difficile, ova and parasites and stool culture were performed in only 28.1% of patients prior to colonoscopy. Abnormal endoscopic findings were seen in 16/88 (18.2%). Pathology was abnormal in 17/80 (21.3%). In total, only 9/88 (10%) had findings on colonoscopy or pathology that led to a change in management for the diarrhea. Four of 9 patients that had a change in management had findings that could have been diagnosed with flexible sigmoidoscopy. Therefore, overall only 6% (5/88) of all patients had management affected by colonoscopic investigation. There was 1 serious complication (perforation) associated with colonoscopy. No difference in colonoscopy/pathology findings was seen based upon diarrhea duration (acute vs. chronic). Conclusion: The use of colonoscopy with biopsy in the evaluation of post solid organ transplant recipients with diarrhea rarely shows pathologic disease and is unlikely to change patient management in the vast majority of cases. In the absence of other indications, colonoscopy should be reserved for continued diarrhea after negative stool studies and sigmoidoscopy.