The Role of Colonoscopy Without Intestinal Preparation in an Emergency Context

Aims When talking about emergency colonoscopy, the guidelines are assertive in stating that colonoscopy without preparation has no place in the evaluation of patients with suspected lower gastrointestinal bleeding (LGB). The objective of the present work is to verify whether, despite these recommendations, the performance of emergency colonoscopy, without any preparation, has any type of positive impact.

Methods A retrospective analysis of 77 patients (male-53.2 %; mean age-69.6 ± 17 years) admitted consecutively to the Emergency Department (ED) by LGB and who underwent colonoscopy without prior intestinal preparation was performed.

Results Despite the lack of preparation, it was possible to perform total colonoscopy in 7 patients (9.1 %), left colonoscopy in 44 (57.1 %) and rectosigmoidoscopy in 26 (33.8 %). In 61 % of the patients, a definitive diagnosis was established in this initial approach, with only 3 (6.4 %) having undergone total colonoscopy after anterograde preparation, confirming the established diagnosis.

Biopsies were performed in 28.6 % of the individuals, allowing the establishment of a histological diagnosis. Additionally, in 10 patients (13 %) an active hemorrhagic focus was identified, with endoscopic hemostasis being performed. None of these 10 patients required additional procedures during hospitalization.

Even in the 30 patients in whom it was not possible to establish a diagnosis at the initial colonoscopy, 14 did not present major changes in the mucosa or presence of blood that justified the clinical complaints. Therefore, they were safely discharged without any being readmitted in the following 28 days. In the end, only 16 patients (20.8 %) had the initial colonoscopy inconclusive and consequently, the need to repeat it after anterograde preparation. Even in those cases, no diagnosis was reached in 26.7 %.

Conclusions Colonoscopy without preparation in an urgent context is not a useless attitude, allowing adequate guidance in 4/5 of the patients, with benefits in terms of costs and time.

Citation: Correia C, Almeida N, Souto P etal. eP287 THE ROLE OF COLONOSCOPY WITHOUT INTESTINAL PREPARATION IN AN EMERGENCY CONTEXT. Endoscopy 2021; 53: S192.

Publication History

Article published online:
19 March 2021