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Appropriateness and diagnostic yield of colonoscopy in the management of patients with ulcerative colitis: A prospective study in an open access endoscopy service

Authors

  • Gianpiero Manes MD,

    Corresponding author
    1. Department of Clinical Science, Chair and Department of Gastroenterology, L. Sacco University Hospital, Milano, Italy
    • Divisione e Cattedra di Gastroenterologia, Ospedale Universitario L. Sacco, Via G.B. Grassi 74, 20157 Milano, Italy
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  • Venerina Imbesi MD,

    1. Department of Clinical Science, Chair and Department of Gastroenterology, L. Sacco University Hospital, Milano, Italy
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  • Sandro Ardizzone MD,

    1. Department of Clinical Science, Chair and Department of Gastroenterology, L. Sacco University Hospital, Milano, Italy
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  • Andrea Cassinotti MD,

    1. Department of Clinical Science, Chair and Department of Gastroenterology, L. Sacco University Hospital, Milano, Italy
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  • Matteo Bosani MD,

    1. Department of Clinical Science, Chair and Department of Gastroenterology, L. Sacco University Hospital, Milano, Italy
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  • Alessandro Massari MD,

    1. Department of Clinical Science, Chair and Department of Gastroenterology, L. Sacco University Hospital, Milano, Italy
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  • Gabriele Bianchi Porro PhD

    1. Department of Clinical Science, Chair and Department of Gastroenterology, L. Sacco University Hospital, Milano, Italy
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Abstract

Background: Colonoscopy is frequently performed in ulcerative colitis (UC), but its benefit in the management of the disease is a matter of debate. The objective was to determine the clinical impact of colonoscopy in UC.

Methods: Consecutive patients with UC undergoing colonoscopy were studied. The design and main outcome measurement was appropriateness of indications, evaluated according to guidelines. Endoscopic findings altering the management of the patients were registered. The endoscopist's management decisions based on patient's clinical picture were compared with those selected after endoscopy. Need for further investigations was recorded. Endpoints for colonoscopy-improving management were prospectively defined: change in medical therapy, need for adjuctive procedures, identification or exclusion of cancer, adenomatous polyps, or other conditions with clinical impact. The setting was an open access endoscopy service in a tertiary care center.

Results: In all, 507 patients (268 male, 239 female, mean age 42 years) were included. Colonoscopy was indicated in 60.8% of cases. In 46% of patients endoscopy revealed a significant lesion; this rate was higher for indicated (67.2) than for not indicated procedures (13.5%, P < 0.0001). The endoscopist's decision was altered by the endoscopic finding in 7.6% of cases and was not different between appropriate and inappropriate procedures.

Conclusions: Endoscopy is a potent tool in the management of UC if correctly used. However, in the majority of cases a correct therapeutic decision may be established simply on the basis of the clinical picture. Relevant endoscopic findings have a relatively low impact on the medical treatment, but may have a very important value in the prognostic assessment of the disease.

(Inflamm Bowel Dis 2008)

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