[Endoscopic assessment of large bowel and safety of bowel preparation and sedoanalgesia in patients with advanced liver cirrhosis].
BACKGROUND
In patients with advanced liver cirrhosis endoscopic images of large bowel are still poorly recognized in comparison with upper digestive tract. At present, the colonoscopy is examination routinely performed during qualification to liver transplantation. The purpose of this study was to retrospectively analyze colonoscopic reports and to assess a safety of all procedures realized before and during colonoscopy.


METHODS
The study included 46 patients with liver cirrhosis (males 54.4%, females 45.6%) at age of 18-66 years, hospitalized between 2007-2009 for qualification to liver transplantation. Colonoscopy was done in short general sedation, and standard bowel preparation involved 256 g of polyethylene glycol dissolved in 4 liters of fluid given to the patient one day before colonoscopy.


RESULTS
In 26.1% of patients no pathology was found on colonoscopy. Anal/rectal varices were found in 41.3% of patients, lesions classified as portal colopathy in 13% of patients and sigmoid diverticula in 8.7% of patients. In 17 (37%) of patients colonoscopy disclosed 46 polyps in large bowel (38 polyps in 12 patients were retrieved for histopathological examination). In 4 (8.7%) patients polyps were hyperplastic, in 6 (about 13%) tubular adenomas of low grade dysplasia and in 2 (4.35%) tubulo-villous adenomas of low grade dysplasia. Tubulo-villous adenomas were found only in patients with alcoholic cirrhosis. Colonoscopy did not worsen the general clinical state of any patient, however, as compared with compensated cirrhotics, the patients with ascites and/or peripheral edema showed features of water retention (larger body mass changes -0.50 +1.21 kg vs 0.23 +1.38 kg; p < 0.05). After colonoscopy a significant increase of body temperature by 0.23 +0.30 degrees C; p < 0.001 was noted, while examination had no significant effect on serum creatinine level and white blood cell number.


CONCLUSIONS
Liver cirrhosis may predispose to certain diseases of the large bowel, including portal colopathy and adenomatous polyps. Procedures accomplished before and during colonoscopy seem to be safe for cirrhotic patients, however, in decompensated cirrhosis exists a tendency to further water retention.
Katedra i Klinika Gastroenterologii i Hepatologii, Slaski Uniwersytet Medyczny, Samodzielny Publiczny Centralny Szpital Kliniczny, ul. Medyków 14, 40-752 Katowice. grzegorzboryczka@op.pl
Grzegorz
G
Boryczka
Marek
M
Hartleb
Krzysztof
K
Gutkowski
D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D003106:Colon / Q000098:blood supply; D003108:Colonic Diseases / Q000150:complications* / Q000175:diagnosis*; D003111:Colonic Polyps / Q000150:complications / Q000175:diagnosis; D003113:Colonoscopy / Q000009:adverse effects; D043963:Diverticulosis, Colonic / Q000150:complications / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000098:blood supply; D012189:Retrospective Studies; D014648:Varicose Veins / Q000150:complications / Q000175:diagnosis; D055815:Young Adult