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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 9(11): E1770-E1777
DOI: 10.1055/a-1561-2259
Original article

Severe acute ischemic colitis: What is the place of endoscopy in the management strategy?

Diane Lorenzo
1   Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
,
Marc Barthet
1   Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
,
Mélanie Serrero
1   Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
,
Laura Beyer
2   Department of Visceral Surgery, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
,
Stéphane Berdah
2   Department of Visceral Surgery, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
,
David Birnbaum
2   Department of Visceral Surgery, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
,
Véronique Vitton
1   Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
,
Jean Michel Gonzalez
1   Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
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Abstract

Background and study aims Ischemic colitis (IC) is potentially lethal. Clinical and biology information and results of computed tomography (CT) scan and/or colonoscopy are used to assess its severity. However, decision-making about therapy remains a challenge.

Patients and methods This was a retrospective, single-center study between 2006 and 2015. Patients with severe IC who underwent endoscopic evaluation were included. The aims were to determine outcomes depending on endoscopic findings and assess the role of endoscopy in the management.

Results A total of 71 patients were included (men = 48 (68%), mean age = 71 ± 13 years). There was hemodynamic instability in 29 patients (41 %) and severity signs on CT scan in 18 (38 %). Twenty-nine patients (41 %) underwent surgery and 24 (34 %) died. The endoscopic grades were: 15 grade 1 (21 %), 32 grade 2 (45 %), and 24 grade 3 (34%). Regarding patients with grade 3 IC, 55 % had hemodynamic instability, 58 % had severity signs on CT scan, 68 % underwent surgery, and 55 % died. The decision to perform surgery was based on hemodynamic status in 62 % of cases, CT scan data in 14 %, endoscopic findings in 10 %, and other in 14 %. Colectomy was more frequent in patients with grade 3 IC (P < 0.05). A mismatch between mucosal aspect (necrosis) and serous (normal) was observed in 13 patients (46 %). Risk factors for colectomy in univariate analysis were aortic aneurysm surgery, hemodynamic instability, no colic enhancement on CT scan, and endoscopic grade 3. Risk factors for mortality in multivariate analysis were hemodynamic instability, colectomy, and Charlson score > 5 (P < 0.05).

Conclusions This study suggests a low impact of endoscopy on surgical decision making. Hemodynamic instability was the first indication for colectomy. A discrepancy between endoscopic mucosal (necrosis) and surgical serous (normal) aspects was frequently noted.



Publication History

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Brandt LJ, Feuerstadt P, Longstreth GF. et al. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol 2015; 110: 18-44 ; quiz 45
    CrossrefPubMedGoogle Scholar
  • 2 Brandt LJ, Boley SJ. Colonic ischemia. Surg Clin North Am 1992; 72: 203-229
    CrossrefPubMedGoogle Scholar
  • 3 Higgins PDR, Davis KJ, Laine L. Systematic review: the epidemiology of ischaemic colitis. Aliment Pharmacol Ther 2004; 19: 729-738
    CrossrefPubMedGoogle Scholar
  • 4 Yadav S, Dave M, Edakkanambeth VarayilJ. et al. A population-based study of incidence, risk factors, clinical spectrum, and outcomes of IC. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2015; 13: 731-738 .e1–6; quiz e41
    PubMedGoogle Scholar
  • 5 Hervé S, Beaugerie L, Bouhnik Y. et al. Irritable bowel syndrome is more frequent in patients hospitalized for ischaemic colitis: results of a case-control study. Neurogastroenterol Motil 2009; 21: 1170-e102
    CrossrefPubMedGoogle Scholar
  • 6 Champagne BJ, Darling RC, Daneshmand M. et al. Outcome of aggressive surveillance colonoscopy in ruptured abdominal aortic aneurysm. J Vasc Surg 2004; 39: 792-796
    CrossrefPubMedGoogle Scholar
  • 7 Champagne BJ, Lee EC, Valerian B. et al. Incidence of colonic ischemia after repair of ruptured abdominal aortic aneurysm with endograft. J Am Coll Surg 2007; 204: 597-602
    CrossrefPubMedGoogle Scholar
  • 8 Becquemin J-P, Majewski M, Fermani N. et al. Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair. J Vasc Surg 2008; 47: 258-263 ; discussion 263
    CrossrefPubMedGoogle Scholar
  • 9 Walker AM, Bohn RL, Cali C. et al. Risk factors for colon ischemia. Am J Gastroenterol 2004; 99: 1333-1337
    CrossrefPubMedGoogle Scholar
  • 10 Longstreth GF, Yao JF. Diseases and drugs that increase risk of acute large bowel ischemia. Clin Gastroenterol Hepatol 2010; 8: 49-54
    CrossrefPubMedGoogle Scholar
  • 11 Savoye G, Ben Soussan E, Hochain P. et al. [How and how far to investigate IC?].. Gastroenterol Clin Biol 2002; 26: B12-23
    PubMedGoogle Scholar
  • 12 Nguyen TQ, Lewis JH. Sumatriptan-associated IC: case report and review of the literature and FAERS. Drug Saf 2014; 37: 109-121
    CrossrefPubMedGoogle Scholar
  • 13 Castleberry AW, Turley RS, Hanna JM. et al. A 10-year longitudinal analysis of surgical management for acute IC. J Gastrointest Surg 2013; 17: 784-792
    CrossrefPubMedGoogle Scholar
  • 14 Reissfelder C, Sweiti H, Antolovic D. et al. IC: who will survive?. Surgery 2011; 149: 585-592
    CrossrefPubMedGoogle Scholar
  • 15 Favier C, Bonneau HP, Tran Minh V. et al. [Endoscopic diagnosis of regressive IC. Endoscopic, histologic and arteriographic correlations]. Nouv Presse Médicale 1976; 5: 77-79
    PubMedGoogle Scholar
  • 16 Moszkowicz D, Mariani A, Trésallet C. et al. IC: the ABCs of diagnosis and surgical management. J Visc Surg 2013; 150: 19-28
    CrossrefPubMedGoogle Scholar
  • 17 Corcos O, Nuzzo A. Gastro-intestinal vascular emergencies. Best Pract Res Clin Gastroenterol 2013; 27: 709-725
    CrossrefPubMedGoogle Scholar
  • 18 Charlson M, Szatrowski TP, Peterson J. et al. Validation of a combined comorbidity index. J Clin Epidemiol 1994; 47: 1245-1251
    CrossrefPubMedGoogle Scholar
  • 19 Huguier M, Barrier A, Boelle PY. et al. Ischemic colitis. Am J Surg 2006; 192: 679-684
    CrossrefPubMedGoogle Scholar
  • 20 Washington C, Carmichael JC. Management of IC. Clin Colon Rectal Surg 2012; 25: 228-235
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Church J, Kao J. Bedside colonoscopy in intensive care units: indications, techniques, and outcomes. Surg Endosc 2014; 28: 2679-2682
    CrossrefPubMedGoogle Scholar
  • 22 Longo WE, Ward D, Vernava AM. et al. Outcome of patients with total colonic ischemia. Dis Colon Rectum 1997; 40: 1448-1454
    CrossrefPubMedGoogle Scholar
  • 23 Petit A, Guédon C, Duhamel C. et al. [“Ambulatory” IC. Clinical course and etiologic features in 88 cases]. Gastroentérologie Clin Biol 1990; 14: 739-743
    PubMedGoogle Scholar
  • 24 Leone M, Bechis C, Baumstarck K. et al. Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intensive Care Med 2015; 41: 667-676
    CrossrefPubMedGoogle Scholar
  • 25 Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology 2010; 256: 93-101
    CrossrefPubMedGoogle Scholar
  • 26 Milone M, Di Minno MND, Musella M. et al. Computed tomography findings of pneumatosis and portomesenteric venous gas in acute bowel ischemia. World J Gastroenterol 2013; 19: 6579-6584
    CrossrefPubMedGoogle Scholar
  • 27 Scharff JR, Longo WE, Vartanian SM. et al. IC: spectrum of disease and outcome. Surgery 2003; 134: 624-629 ; discussion 629–630
    CrossrefPubMedGoogle Scholar
  • 28 Paterno F, McGillicuddy EA, Schuster KM. et al. IC: risk factors for eventual surgery. Am J Surg 2010; 200: 646-650
    CrossrefPubMedGoogle Scholar
  • 29 Biondo S, Parés D, Martí Ragué J. et al. Emergency operations for nondiverticular perforation of the left colon. Am J Surg 2002; 183: 256-260
    CrossrefPubMedGoogle Scholar
  • 30 O’Neill S, Elder K, Harrison SJ. et al. Predictors of severity in ischaemic colitis. Int J Colorectal Dis 2012; 27: 187-191
    CrossrefPubMedGoogle Scholar
  • 31 Senekowitsch C, Assadian A, Assadian O. et al. Replanting the inferior mesentery artery during infrarenal aortic aneurysm repair: influence on postoperative colon ischemia. J Vasc Surg 2006; 43: 689-694
    CrossrefPubMedGoogle Scholar