Prevalence of Ischemic Colitis in Asymptomatic Patients Undergoing Colonoscopy

Abstract

The purpose of this analysis was to determine the prevalence of “suspected” ischemic colitis (IC) in asymptomatic patients undergoing routine screening colonoscopy. This is the first analysis of IC in a large asymptomatic cohort. Methods: The CORI consortium includes more than 70 diverse practices which use a computerized endoscopic report generator, and transmit report data electronically to a central data repository. We surveyed colonoscopy procedures performed from 1/1/00 to 12/31/03 in adults (age 20 years); 74% come from private practice, and 26% from academic and VA settings. Patients receiving asymptomatic screening or colonoscopy for positive FOBT without other symptoms were included. The diagnosis of suspected ischemic colitis was based on the impression of the endoscopist. The description of endoscopic findings and pathology was reviewed in each case to determine if findings were consistent with a diagnosis of IC. Endoscopic findings were considered to be consistent with IC if there was segmental colon involvement with inflammation, submucosal hemorrhage, edema or ulceration, in the absence of any other reason. Pathology consistent with IC included acute inflammation, submucosal hemorrhage and edema. Results: During the study period, 347,672 unique patients were reported to have colonoscopy for any indication. 560 (0.16%) had suspected ischemic colitis based on the endoscopic report. Among 100,173 patients who did not have reported GI symptoms, 21 (0.02%) had suspected ischemic colitis. All patients were greater than 50 years old, and most were 60 years or older (71.4%). Endoscopic descriptions included focal areas of erythema or inflammation located most commonly in the splenic flexure (7) or sigmoid colon (7). In 6 cases, there was erythema noted only in the region of diverticulosis. Pathology was available in 17 of 21 cases (81%). Pathology revealed findings consistent with ischemia in 8, focal acute colitis in 5, and normal histology in 4. In conclusion, the finding of suspected IC is an uncommon finding at colonoscopy in asymptomatic individuals, but does occur rarely (0.02%). In most cases, the endoscopic findings and pathology were consistent with IC. Future studies should determine rates of IC in symptomatic patients receiving colonoscopy and ascertain risk factors for IC in patients receiving colonoscopy. The purpose of this analysis was to determine the prevalence of “suspected” ischemic colitis (IC) in asymptomatic patients undergoing routine screening colonoscopy. This is the first analysis of IC in a large asymptomatic cohort. Methods: The CORI consortium includes more than 70 diverse practices which use a computerized endoscopic report generator, and transmit report data electronically to a central data repository. We surveyed colonoscopy procedures performed from 1/1/00 to 12/31/03 in adults (age 20 years); 74% come from private practice, and 26% from academic and VA settings. Patients receiving asymptomatic screening or colonoscopy for positive FOBT without other symptoms were included. The diagnosis of suspected ischemic colitis was based on the impression of the endoscopist. The description of endoscopic findings and pathology was reviewed in each case to determine if findings were consistent with a diagnosis of IC. Endoscopic findings were considered to be consistent with IC if there was segmental colon involvement with inflammation, submucosal hemorrhage, edema or ulceration, in the absence of any other reason. Pathology consistent with IC included acute inflammation, submucosal hemorrhage and edema. Results: During the study period, 347,672 unique patients were reported to have colonoscopy for any indication. 560 (0.16%) had suspected ischemic colitis based on the endoscopic report. Among 100,173 patients who did not have reported GI symptoms, 21 (0.02%) had suspected ischemic colitis. All patients were greater than 50 years old, and most were 60 years or older (71.4%). Endoscopic descriptions included focal areas of erythema or inflammation located most commonly in the splenic flexure (7) or sigmoid colon (7). In 6 cases, there was erythema noted only in the region of diverticulosis. Pathology was available in 17 of 21 cases (81%). Pathology revealed findings consistent with ischemia in 8, focal acute colitis in 5, and normal histology in 4. In conclusion, the finding of suspected IC is an uncommon finding at colonoscopy in asymptomatic individuals, but does occur rarely (0.02%). In most cases, the endoscopic findings and pathology were consistent with IC. Future studies should determine rates of IC in symptomatic patients receiving colonoscopy and ascertain risk factors for IC in patients receiving colonoscopy.