Severe acute ischemic colitis: What is the place of endoscopy in the management strategy?

Background and study aims Ischemic colitis (IC) is potentially lethal. Clinical and biology information and results of computed tomography (CT) scan and/or colonoscopy are used to assess its severity. However, decision-making about therapy remains a challenge. Patients and methods This wa...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Diane Lorenzo, Marc Barthet, Mélanie Serrero, Laura Beyer, Stéphane Berdah, David Birnbaum, Véronique Vitton, Jean Michel Gonzalez
Formato:	article
Lenguaje:	EN
Publicado:	Georg Thieme Verlag KG 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/1d50a584f7834a2f8c8beb70744363ad
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:1d50a584f7834a2f8c8beb70744363ad
record_format	dspace
spelling	oai:doaj.org-article:1d50a584f7834a2f8c8beb70744363ad2021-11-13T00:00:31ZSevere acute ischemic colitis: What is the place of endoscopy in the management strategy?2364-37222196-973610.1055/a-1561-2259https://doaj.org/article/1d50a584f7834a2f8c8beb70744363ad2021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/a-1561-2259https://doaj.org/toc/2364-3722https://doaj.org/toc/2196-9736Background and study aims Ischemic colitis (IC) is potentially lethal. Clinical and biology information and results of computed tomography (CT) scan and/or colonoscopy are used to assess its severity. However, decision-making about therapy remains a challenge. Patients and methods This was a retrospective, single-center study between 2006 and 2015. Patients with severe IC who underwent endoscopic evaluation were included. The aims were to determine outcomes depending on endoscopic findings and assess the role of endoscopy in the management. Results A total of 71 patients were included (men = 48 (68%), mean age = 71 ± 13 years). There was hemodynamic instability in 29 patients (41 %) and severity signs on CT scan in 18 (38 %). Twenty-nine patients (41 %) underwent surgery and 24 (34 %) died. The endoscopic grades were: 15 grade 1 (21 %), 32 grade 2 (45 %), and 24 grade 3 (34%). Regarding patients with grade 3 IC, 55 % had hemodynamic instability, 58 % had severity signs on CT scan, 68 % underwent surgery, and 55 % died. The decision to perform surgery was based on hemodynamic status in 62 % of cases, CT scan data in 14 %, endoscopic findings in 10 %, and other in 14 %. Colectomy was more frequent in patients with grade 3 IC (P < 0.05). A mismatch between mucosal aspect (necrosis) and serous (normal) was observed in 13 patients (46 %). Risk factors for colectomy in univariate analysis were aortic aneurysm surgery, hemodynamic instability, no colic enhancement on CT scan, and endoscopic grade 3. Risk factors for mortality in multivariate analysis were hemodynamic instability, colectomy, and Charlson score > 5 (P < 0.05). Conclusions This study suggests a low impact of endoscopy on surgical decision making. Hemodynamic instability was the first indication for colectomy. A discrepancy between endoscopic mucosal (necrosis) and surgical serous (normal) aspects was frequently noted.Diane LorenzoMarc BarthetMélanie SerreroLaura BeyerStéphane BerdahDavid BirnbaumVéronique VittonJean Michel GonzalezGeorg Thieme Verlag KGarticleDiseases of the digestive system. GastroenterologyRC799-869ENEndoscopy International Open, Vol 9, Iss 11, Pp E1770-E1777 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 Diane Lorenzo Marc Barthet Mélanie Serrero Laura Beyer Stéphane Berdah David Birnbaum Véronique Vitton Jean Michel Gonzalez Severe acute ischemic colitis: What is the place of endoscopy in the management strategy?
description	Background and study aims Ischemic colitis (IC) is potentially lethal. Clinical and biology information and results of computed tomography (CT) scan and/or colonoscopy are used to assess its severity. However, decision-making about therapy remains a challenge. Patients and methods This was a retrospective, single-center study between 2006 and 2015. Patients with severe IC who underwent endoscopic evaluation were included. The aims were to determine outcomes depending on endoscopic findings and assess the role of endoscopy in the management. Results A total of 71 patients were included (men = 48 (68%), mean age = 71 ± 13 years). There was hemodynamic instability in 29 patients (41 %) and severity signs on CT scan in 18 (38 %). Twenty-nine patients (41 %) underwent surgery and 24 (34 %) died. The endoscopic grades were: 15 grade 1 (21 %), 32 grade 2 (45 %), and 24 grade 3 (34%). Regarding patients with grade 3 IC, 55 % had hemodynamic instability, 58 % had severity signs on CT scan, 68 % underwent surgery, and 55 % died. The decision to perform surgery was based on hemodynamic status in 62 % of cases, CT scan data in 14 %, endoscopic findings in 10 %, and other in 14 %. Colectomy was more frequent in patients with grade 3 IC (P < 0.05). A mismatch between mucosal aspect (necrosis) and serous (normal) was observed in 13 patients (46 %). Risk factors for colectomy in univariate analysis were aortic aneurysm surgery, hemodynamic instability, no colic enhancement on CT scan, and endoscopic grade 3. Risk factors for mortality in multivariate analysis were hemodynamic instability, colectomy, and Charlson score > 5 (P < 0.05). Conclusions This study suggests a low impact of endoscopy on surgical decision making. Hemodynamic instability was the first indication for colectomy. A discrepancy between endoscopic mucosal (necrosis) and surgical serous (normal) aspects was frequently noted.
format	article
author	Diane Lorenzo Marc Barthet Mélanie Serrero Laura Beyer Stéphane Berdah David Birnbaum Véronique Vitton Jean Michel Gonzalez
author_facet	Diane Lorenzo Marc Barthet Mélanie Serrero Laura Beyer Stéphane Berdah David Birnbaum Véronique Vitton Jean Michel Gonzalez
author_sort	Diane Lorenzo
title	Severe acute ischemic colitis: What is the place of endoscopy in the management strategy?
title_short	Severe acute ischemic colitis: What is the place of endoscopy in the management strategy?
title_full	Severe acute ischemic colitis: What is the place of endoscopy in the management strategy?
title_fullStr	Severe acute ischemic colitis: What is the place of endoscopy in the management strategy?
title_full_unstemmed	Severe acute ischemic colitis: What is the place of endoscopy in the management strategy?
title_sort	severe acute ischemic colitis: what is the place of endoscopy in the management strategy?
publisher	Georg Thieme Verlag KG
publishDate	2021
url	https://doaj.org/article/1d50a584f7834a2f8c8beb70744363ad
work_keys_str_mv	AT dianelorenzo severeacuteischemiccolitiswhatistheplaceofendoscopyinthemanagementstrategy AT marcbarthet severeacuteischemiccolitiswhatistheplaceofendoscopyinthemanagementstrategy AT melanieserrero severeacuteischemiccolitiswhatistheplaceofendoscopyinthemanagementstrategy AT laurabeyer severeacuteischemiccolitiswhatistheplaceofendoscopyinthemanagementstrategy AT stephaneberdah severeacuteischemiccolitiswhatistheplaceofendoscopyinthemanagementstrategy AT davidbirnbaum severeacuteischemiccolitiswhatistheplaceofendoscopyinthemanagementstrategy AT veroniquevitton severeacuteischemiccolitiswhatistheplaceofendoscopyinthemanagementstrategy AT jeanmichelgonzalez severeacuteischemiccolitiswhatistheplaceofendoscopyinthemanagementstrategy
_version_	1718430300870017024

Severe acute ischemic colitis: What is the place of endoscopy in the management strategy?

Ejemplares similares