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Endoscopy I
PMO-197 Endoscopic findings in collagenous colitis; not always microscopic
  1. A Smirnidis1,
  2. K C Trimble1,
  3. A Lessells2,
  4. A Koulaouzidis1
  1. 1Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Pathology Department, Western General Hospital, Edinburgh, UK

Abstract

Introduction CC is classically associated with normal or unremarkable colonoscopy. In the last few years, reports have been published revealing findings that are thought to be characteristic or even pathognomonic of CC, such as alteration of the vascular mucosal pattern, mucosal nodularity and a sequence of mucosal changes from defects/lacerations to cicatricial lesions. The aim of this study was to evaluate the frequency and type of endoscopic findings in patients diagnosed with CC in our centre.

Methods Setting: Tertiary hospital, outpatients. Design: Retrospective study. The database of Pathology Department was searched for patients who have been diagnosed with CC between May 2008 and August 2011. Endoscopy reports and endoscopic images were retrieved and reviewed.

Results 155 patients were diagnosed with CC in the study period. The indications for colonoscopy were altered bowel habit (acute or chronic diarrhoea) in 126/133; 33 patients reported associated weight loss. The reports from 123 patients (96F/27M; median age 68.7 yrs, range 37–91 yrs) were eventually retrieved and further reviewed. The colonoscopies had been carried out by consultant (medical/surgeons): 47%, nurse endoscopist: 20%, associate specialist: 13% and fellow or registrar: 10%. Of the above cohort, 67 (54.4%) patients had no endoscopic findings and 44 (35.7%) had irrelevant to CC findings such as diverticulosis, polyps or telangiectasias. Twelve (n=12; 9.75%) had findings previously described as consistent with CC. In particular: 7 (5.7%) had mucosal erythema or oedema (patchy, mild granularity or congestion), 4 (3.25%) had lacerations (cat-scratch mucosa or bigger mucosal breaks) and 1 of them had a few mucosal scars. The sigmoid and the descending colon were the main colonic parts affected (in 7/12 cases) and the rest were found in the caecum-ascending colon area (4/12) while there was only one patient in which the entire large bowel was affected.

Conclusion A significant minority of patients with CC (almost 10%) presented endoscopic findings indicative of CC. Furthermore, 4% had findings that are considered pathognomonic for CC. Although still the subject of isolated cases reports, the endoscopic appearances of CC are becoming more familiar among the endoscopic community.

Competing interests None declared.

Reference 1. Distinct colonoscopy findings of microscopic colitis: Not so microscopic after all? World J Gastroenterol 2011;17:4157–65.

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