Centro Hospitalar Universitário de São João Porto, Porto, Portugal
Introduction: Few data are available on the prevalence of preneoplastic and neoplastic colonic lesions in patients with liver cirrhosis. In addition, intestinal dysmotility related to cirrhosis might impair bowel preparation more than those without chronic liver disease. The aim of this study was to analyze the adenoma detection rate and to assess the quality of colonoscopy bowel cleansing in patients with liver cirrhosis.
Methods: We conducted a retrospective monocentric study in a cohort of cirrhotic patients who underwent colonoscopy between January 2012 and May 2022. The prevalence of colonic lesions, the adequacy of bowel preparation and the patient´s characteristics were assessed.
Results: A total of 125 patients were included, most of them male (80.8%), with a median age of 61 years old (IQR 55-68). The main etiologies of cirrhosis were alcoholic (60.8%), hepatitis C virus infection (12.8%) and metabolic associated fatty liver disease (8.8%). Seventy-one (56.8%) patients were Child-Pugh class A. A total of 173 colonoscopies were performed. The main reasons for performing the procedure were colorectal cancer screening (48.0%), anemia (26.0%) and gastrointestinal bleeding (11.6%). The cecal intubation rate was 87.9%. Approximately half of the incomplete endoscopies were interrupted because of poor bowel preparation. Indeed, poor bowel preparation was documented in 37% of procedures. Only 26 (15%) patients had a good colon cleansing level. Adenomatous polyps were discovered in 26.6% of procedures (low-grade dysplasia 25.4%, high-grade dysplasia 1.2%). Three individuals had a well-differentiated adenocarcinoma. Rectal varices were found in 26 (15.0%) patients, colonic telangiectasia in 30 (17.3%) and diverticula in 21 (12.1%). No abnormalities were detected in 54 (31.2%) individuals. Neither Child-Pugh grade (p=9.622), gender (p=0.169) or advanced age (p=0.292) affected adenoma detection rates. No significant differences were observed in the findings of adenomas between different chronic liver diseases.
Discussion: Cirrhotic patients have worse bowel preparation scores and cecal intubation rates compared to the general population. Although we did not find a significant difference in polyp detection rates, this result may have been impacted by impaired bowel preparation. Given the importance of colorectal detection, alternative bowel cleansing protocols are needed for cirrhotic patients.
