Duration, efficacy and safety of colonoscopy in patients with compensated and decompensated cirrhosis

Objectives In patients with decompensated liver cirrhosis, colonoscopy is primarily performed for evaluation of abdominal complaints, in preparation for liver transplantation listing, and for diagnosis and therapy of gastrointestinal bleeding. This retrospective study aimed to clarify whether duration, efficacy and safety of colonoscopy differ in patients with decompensated cirrhosis.

Methods Among patients with cirrhosis, 360 inpatient colonoscopies with the OPS-code 1-650 were retrospectively analyzed. Post-procedural complications (PPC) including post-procedural bleeding (PPB) were defined as the clinical endpoint. Duration and safety of the procedures were calculated using univariate regression analysis. Results In total, 335 patients with a mean MELD score of 17 ±8 points and CLIF-AD score of 50 ±11 were included. Child-Pugh stadium C was present in 143 (40 %) cases and uncontrolled ascites in 107 (29 %) cases, respectively. Complete colonoscopy including inspection of the coecum was performed in 320 (89 %) examinations. Mean procedure time was 26 ±15 min for complete colonoscopies. PPC were observed in 52/320 (16 %) cases, and PPB in 43/320 (13 %) cases, respectively. Of patients with PPB, 30/43 (70 %) had undergone polypectomy, of which 21 (49 %) had been assessed as difficult. Uncontrolled ascites, hepatic encephalopathy, number of polypectomies, difficult or multi-step polypectomy, MELD score and CLIF-AD score were independent predictors of PPC (p< 0.05).

Conclusion Patients with decompensated cirrhosis are at increased risk for bleeding upon colonoscopy, particularly if undergoing polypectomy. Further studies are warranted to evaluate timing and adequate safety measures for polypectomy in this vulnerable cohort.

Publication History

Article published online:
07 September 2021