title: Screening colonoscopy in liver transplant candidates: risks and findings.
abstract: The indication for mandatory screening colonoscopies in liver transplant candidates is controversial. Since the introduction of MELD-based allocation, patients with advanced liver disease and often severe comorbidities are prioritized for liver transplantation (LT). This study evaluated safety and outcome of colonoscopy in this high-risk patient group. During a two-yr period, we performed 243 colonoscopies in potential LT candidates. Endoscopic findings were registered in a standardized form, and correlations with biochemical or clinical parameters were analyzed using Mann-Whitney U-test and chi-square test. Only 57 patients (23.5%) had an endoscopically normal colon. Main findings were polyps (45.7%), hypertensive colopathy (24.3%), diverticulosis (21%), rectal varices (19.8%), and hemorrhoids (13.6%). In 21% of all patients, the removed polyps were diagnosed as adenomas. The prevalence of neoplastic polyps increased significantly with age: 13.6% (patients <50 yr) vs. 25% (patients ≥ 50 yr) (p = 0.03). Advanced neoplasia was found only in patients older than 40 yr. No major complications were observed; post-interventional hemorrhage was observed in 1.7% and controlled by clipping or injection therapy. In conclusion, lower gastrointestinal endoscopy is safe and effective in LT candidates. Due to the age dependency of neoplastic polyps, a screening colonoscopy should be performed in LT candidates older than 40 yr or with symptoms or additional risk factors.
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. tobias.weismueller@gmx.de
authors: Tobias J
authors: TJ
authors: Weismüller
authors: Florian
authors: F
authors: Bleich
authors: Ahmed A
authors: AA
authors: Negm
authors: Andrea
authors: A
authors: Schneider
authors: Tim O
authors: TO
authors: Lankisch
authors: Michael P
authors: MP
authors: Manns
authors: Christian P
authors: CP
authors: Strassburg
authors: Jochen
authors: J
authors: Wedemeyer
mesh_terms: D000328:Adult; D000367:Age Factors; D003108:Colonic Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003113:Colonoscopy; D058625:End Stage Liver Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012306:Risk