Introduction Whereas colonoscopy is usually regarded as an outpatient procedure the practice of inpatient colonoscopy has nowadays become routine.1 Apart from the classical indication of acute lower gastrointestinal bleeding, inpatient colonoscopy has some other clear advantages including expedited assessment and relieving waiting list pressures.
Methods We conducted a retrospective cohort study looking at inpatient adult colonoscopies performed at Sheffield Teaching Hospitals over a 1 year period (Oct 2014 and Sep 2015). Inpatient colonoscopies were split as either emergency (EMI) or elective procedures (ELI), the latter usually required for anticoagulation bridging or for inpatient bowel prep. The ELI group served as a control for EMI procedures.
Results 316 inpatient colonoscopies were performed over this time period (43.7% EMI,56.3% ELI). Table 1 compares patient characteristics and endoscopy outcomes between EMI and ELI procedures. Compliance to bowel prep and prep adequacy was suboptimal in both, but particularly poor in the EMI group. This is also reflected by the fact that more EMI patients went on to have an alternative investigation. Caecal intubation was also lower in the EMI group and well below accepted national standards. Polyp detection was similar in both groups.
Overall 34.8% of EMI procedures were deemed diagnostic. Referral indications in order of yield were rectal bleeding (52%), abnormal radiology (44%) and change in bowel habit (38%) with abdominal pain (30%) and anaemia (15%) being the least helpful indications. The commonest pathologies identified during EMI colonoscopy were colitis (15.2%), malignancy (4.3%), vascular lesions (4.3%) and large polyps (3.6%).
Length of stay from time of procedure varied widely within the EMI group with a mean of 19 days and 11.7% of patients had passed away at 3 months post procedure, none of these being procedure related deaths.
Conclusion Emergency inpatient colonoscopy is clearly a useful tool with a relatively high diagnostic yield. A significant proportion of procedures are however being deemed inadequate and therefore submitting frail inpatients to unnecessary stress. The relative lengthy hospital stays and mortality rates indicate that some of these procedures might be futile and not always beneficial. We believe that apart from more consideration being given to the patients’ general wellbeing and medical state, this service should be limited to a few strict indications like rectal bleeding and suspected IBD.
Reference 1. Enns R, Krygier D. The inpatient colonoscopy: A difficult endeavourendeavor. Canadian Journal of Gastroenterology 2008;22(11):900–902
Disclosure of Interest None Declared