Bedside colonoscopy in intensive care units: indications, techniques, and outcomes.
BACKGROUND
Colonoscopy performed in critically ill patients is poorly documented in the literature. The clinical setting is completely different from routine outpatient colonoscopy with different aims and techniques. We proposed to examine the role of urgent colonoscopy in critically ill patients.


METHODS
This was a retrospective review of patients in a prospectively recorded database. All patients undergoing colonoscopy in an intensive care unit were identified from a colonoscopy database. A chart review yielded indications, diagnoses, co-morbidities, depth of intubation, and outcome. Main outcome measures were indications for colonoscopy, type and dose of sedation, bowel preparation, completion rate, findings, treatment, and complications.


RESULTS
Forty one patients underwent 49 bedside colonoscopies (31 men (79 percent), 10 women, mean age of 68.1 years). The most common indications were to exclude ischemic colitis in 25 (confirmed in 19, operated in 14), decompression of colonic distension in 7 (all decompressed, 0 operated), and diagnosis of lower gastrointestinal hemorrhage in 7 (cause found in 7, 0 operated). All patients had major co-morbidities and 28 were being ventilated at the time of the colonoscopy. A minority of patients received sedation. 14 (36 %) of the patients died. Colonoscopy reached the cecum in 16 patients (41 %), the hepatic flexure in 25 (64 %), and the splenic flexure in 36 (92 %). Prep was poor in 15 patients and stool prevented completion in 13. In 30 % of patients, colonoscopy was not pursued to the cecum.


CONCLUSIONS
Bedside colonoscopy is helpful in the diagnosis and management of acute lower gastrointestinal disease in intensive care patients.
Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Desk A30, 9500 Euclid Ave, Cleveland, OH, 44195, USA, churchj@ccf.org.
James
J
Church
Jeff
J
Kao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum; D003106:Colon; D003113:Colonoscopy / Q000379:methods*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D016896:Treatment Outcome