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Screening colonoscopy in liver transplant candidates: risks and findings
Author(s) -
Weismüller Tobias J.,
Bleich Florian,
Negm Ahmed A.,
Schneider Andrea,
Lankisch Tim O.,
Manns Michael P.,
Strassburg Christian P.,
Wedemeyer Jochen
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12083
Subject(s) - medicine , colonoscopy , diverticulosis , gastroenterology , liver transplantation , endoscopy , varices , cirrhosis , liver disease , transplantation , surgery , colorectal cancer , cancer
Abstract The indication for mandatory screening colonoscopies in liver transplant candidates is controversial. Since the introduction of MELD ‐based allocation, patients with advanced liver disease and often severe comorbidities are prioritized for liver transplantation ( LT ). This study evaluated safety and outcome of colonoscopy in this high‐risk patient group. During a two‐yr period, we performed 243 colonoscopies in potential LT candidates. Endoscopic findings were registered in a standardized form, and correlations with biochemical or clinical parameters were analyzed using M ann– W hitney U ‐test and chi‐square test. Only 57 patients (23.5%) had an endoscopically normal colon. Main findings were polyps (45.7%), hypertensive colopathy (24.3%), diverticulosis (21%), rectal varices (19.8%), and hemorrhoids (13.6%). In 21% of all patients, the removed polyps were diagnosed as adenomas. The prevalence of neoplastic polyps increased significantly with age: 13.6% (patients <50 yr) vs. 25% (patients ≥50 yr) (p = 0.03). Advanced neoplasia was found only in patients older than 40 yr. No major complications were observed; post‐interventional hemorrhage was observed in 1.7% and controlled by clipping or injection therapy. In conclusion, lower gastrointestinal endoscopy is safe and effective in LT candidates. Due to the age dependency of neoplastic polyps, a screening colonoscopy should be performed in LT candidates older than 40 yr or with symptoms or additional risk factors.