Colonoscopy in patients with liver cirrhosis : success and safety issues

Background : Patients with liver cirrhosis undergo screening colonoscopy before liver transplantation. Screening colonoscopy is subject to specific quality criteria, among which caecal intubation rate. Several factors associated with failed caecal intubation have been identified. Aims : We investigated whether liver cirrhosis influenced success and safety of screening colonoscopy. Methods : Caecal intubation and complication rate of 93 candidates for liver transplantation due to liver cirrhosis were compared with the control rates of our endoscopy unit. Several patient and colonoscopy variables were taken into account. Results : In patients with liver cirrhosis caecal intubation rate was only 83%, whereas in the control group it was 94% (P < 0.0001). The presence of high volume ascites tends to compromise a successful colonoscopy. Serious complication rate was 0,4% in controls without colonoscopy-related mortality. In the cirrhotic population two severe complications were encountered (2,2%, P < 0.05) and one patient died due to colonic perforation and sepsis (mortality 1.1%). Conclusions : Caecal intubation rate is significantly lower in patients with liver cirrhosis undergoing screening colonoscopy, possibly related to the presence of ascites. Complication and mortality rate of screening colonoscopy is significantly higher in patients being screened for liver transplantation