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.
