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Endoscopy Through Colostomy: a Population-Based Study
Nicole E. Wieghard*, Vassiliki L. Tsikitis
General Surgery, Oregon Health and Science University, Portland, OR
Background:
Endoscopic evaluation of the colon is a critical tool for screening and surveillance for colorectal diseases. Little is known about the use of colonoscopy in patients with colostomies, nearly all of whom have antecedent colon disease.
Objective:
The objective of this study is to describe the indications and outcomes for colonoscopy through colostomies.
Methods:
Retrospective review of colonoscopies through colostomies was performed from 2000 - 2013. Data were obtained from the National Endoscopic Database of Clinical Outcomes Research Initiative, and included procedures from 86 contributing GI practices. Main outcomes measures were primary indication, quality of bowel prep, procedure duration, polyp detection rate and procedural complications. Colonoscopies through the anus for the same time period were used as a reference group.
Results:
A total of 3,801 colonoscopies were performed through colostomies (stoma group) and 1,496,614 colonoscopies were performed through the anus (no-stoma group). Patients in the stoma group were more likely to be older (mean 64 vs 60, p <0.0001) and male (60% vs 52%, p <0.0001) than the no-stoma group.
Surveillance was the most common indication in the stoma group (49% vs 17%, p < 0.0001), whereas screening was the most common for the no-stoma group (26% vs 6%, p <0.0001). Abdominal pain, changes in bowel habits, and bleeding were more common indications for the no-stoma group (33.5% vs 29.4%, p <0.0001). IBD evaluation/surveillance was infrequent as an indication but higher in stoma group (6.2% vs 2.2%, p < 0.0001).
Bowel prep quality was excellent or good in 59.5% of procedures in the stoma group and 69.1% in no-stoma group (p < 0.0001). Cecal intubation rate was lower in the stoma group (93.3% vs 96%, p < 0.0001). Procedure duration in minutes was similar among the cohorts (22.2 in stoma, 22.8 in no-stoma, p = 0.03). Polyp detection rates were higher in the no-stoma group (42.6% vs 31%, p <0.0001).
Complication rates were low (0.63% in stoma vs 1.12% no-stoma, p = 0.004). There were no differences in complications requiring intervention (0.16% stoma group vs 0.26% no-stoma, p = 0.2).
Conclusion:
Patients with colostomies represent a high risk group as they are often undergoing colonoscopies for colorectal cancer surveillance. There is a need for improved quality control of colonoscopies in this patient group, as cecal intubation rates, adequate bowel preps, and polyp detection rates are all significantly lower than patients without colostomies and lower than current quality assurance goals.
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