By Alexandria Bachert MPH
Noninvasive testing modalities could benefit high-risk patients
Patients with inflammatory bowel disease (IBD) had more complications requiring hospitalization or emergency department (ED) care after colonoscopy than patients without IBD, according to researchers here.
In an analysis of 2014 all-payer administrative claims data, the 7-day all-cause unplanned visit rate was 1.6 higher for patients with Crohn’s disease (RR 1.55, 95% CI 1.40-1.72, P<0.0001) and 1.3 times higher for those with ulcerative colitis (RR 1.31, 95% CI 1.19-1.45, P<0.0001) compared with patients without IBD, reported Peiqi Wang, MD, of Johns Hopkins University in Baltimore, and colleagues.
The strongest risk factors for an unplanned visit within 7 days of colonoscopy were hospitalization (OR 4.55, 95% CI 3.38-6.11) or endoscopic procedure (OR 2.38, 95% CI 1.50-3.79) within 30 days prior to the colonoscopy, according to their poster session at the Advances in Inflammatory Bowel Diseases meeting.
“The implication is that most of the time people just think that colonoscopy doesn’t do any harm … that it helps you to diagnose or understand the disease. But in some circumstances, there could be better timing,” Wang told MedPage Today. “We’re not saying that colonoscopy shouldn’t be done, but choosing the timing is important.”
Wang’s group examined 2014 all-payer administrative claims data from California, Florida, New York, Georgia, Nebraska, and Vermont to identify colonoscopy procedures performed in ambulatory surgery centers for IBD and non-IBD patients. They found data on 36,175 patients with IBD, defined as those with Crohn’s disease (N=15,273) or ulcerative colitis (N=20,902), and 1,340,501 patients without IBD.
The researchers tracked patients’ ED visits and unplanned hospital admissions within 7 and 30 days after their colonoscopy. Using the diagnosis codes of those unplanned visits, they compared the complication rates due to any cause, perforation, sepsis, any infection, and Clostridium difficileinfection between IBD and non-IBD patients.
Patients with Crohn’s disease were more likely than non-IBD patients to require unplanned care for perforation within 7 days (RR 3.64, 95% CI 2.05-6.49, P<0.0001), sepsis (RR 2.59, 95% CI 1.34-5.02, P=0.004), and any infection (RR 2.32, 95% CI 1.75-3.08, P<0.0001) compared with patients without IBD. Ulcerative colitis had similar rates of perforation and sepsis but higher rates of any infection (RR 1.87, 95% CI 1.43-2.45, P<0.0001) compared with non-IBD patients.
Younger (ages 10-39) or older (ages ≥80s) age, having an EGD concomitantly with the colonoscopy, and having one or more co-morbidities were all linked to an increased odds of all-cause unplanned visits.
The researchers reported a seven-fold and 13-fold increase in C. diff infection rate after colonoscopy for patients with Crohn’s disease and ulcerative colitis compared with non-IBD patients: “We strikingly found that Crohn’s disease and ulcerative colitis patients had higher rates of any complication after colonoscopy but importantly they had higher rates of C. diff compared with non-IBD and this is after excluding people with preexisting C. diff,” Wang told MedPage Today. This suggests that C. diff might be related to the colonoscopy procedure, she explained.
Wang concluded that substituting colonoscopy with noninvasive testing modalities could potentially benefit high-risk patients with IBD. “If a patient was admitted 2 weeks ago and then comes back showing complication symptoms, then it could probably be considered to give them a fecal calprotectin test first combined with CPR, ESR, a lot of things.”