Clinically relevant findings are common among hospitalized patients who undergo colonoscopy, and the implementation of high-quality parameters such as bowel preparation and adequate colon cleansing will further increase the diagnostic yield of colonoscopy procedures. This is according to research published in Digestive and Liver Disease.
Researchers conducted a prospective, multicenter study of 1302 adult inpatients (mean age, 71±16 years) who underwent colonoscopy for any indication at 12 hospitals across Italy between February 2019 and November 2019. Researchers investigated both the indications and diagnostic yield of colonoscopy in these patients. Clinically relevant findings of colonoscopies included obvious cancers, polyps, signs of active inflammation, and potentially or actively bleeding lesions.
Patients underwent colonoscopy after a median of 5 days spent in the hospital. Indications for colonoscopy were iron deficiency anemia (43.3%), lower gastrointestinal bleeding (25.7%), and positive fecal immunochemical test with or without anemia (9.8%).
The diagnostic yield for relevant findings was 45%; the diagnostic yield for cancer was 8.6%. Approximately 65% of patients used a split-dose/same-day regimen for bowel preparation, and 68.8% of the patient population achieved adequate colon cleansing. Adequate cleansing was associated with a higher diagnostic yield than inadequate colon cleansing (50%; 95% CI, 46.7%-53.3% vs 34%; 95% CI, 29.4%-38.8%; P <.001).
Variables associated with the detection of any clinically relevant finding at colonoscopy included being 70 years old or more (relative risk [RR], 1.32; 95% CI, 1.20-1.46; P <.001), male gender (RR, 1.11; 95% CI, 1.03-1.20; P =.006), evidence of blood loss as an indication for colonoscopy (RR, 1.22; 95% CI, 1.08-1.38; P =.001), and adequate cleansing (RR, 1.62; 95% CI, 1.44-1.82; P <.001).
Additionally, variables associated with detection of cancer at colonoscopy in the multivariable analysis included being 70 years old or more (RR, 2.08; 95% CI, 1.32-3.27; P =.001), split-dose/same-day bowel preparation regimen (RR, 1.59; 95% CI, 1.07-2.36; P =.041), and no previous colonoscopy (RR, 2.69; 95% CI, 1.74-4.16; P <.001).
Study limitations included the lack of standardization of colonoscopies across hospitals as well as the lack of data on patients who underwent emergency colonoscopy and/or outpatient bowel preparation.
“Our study showed a high prevalence of clinically relevant colorectal diseases and cancer among inpatients undergoing colonoscopy,” the researchers concluded. “The clinical relevance of quality parameters for colonoscopy…was stressed for the first time among inpatients and our results indicate that these parameters should be thoroughly pursued also in this setting.”
“Taken altogether, these findings could pose the clinical basis to optimize the management of inpatients scheduled for colonoscopy,” the study authors added.
Frazzoni L, Radaelli F, Spada C, et al. The diagnostic yield of colonoscopy in hospitalized patients. an observational multicenter prospective study. Published online November 10, 2020. Dig Liver Dis. doi: 10.1016/j.dld.2020.10.029