The yield and safety of screening colonoscopy in patients evaluated for liver transplantation

Abstract

Colorectal cancer screening with colonoscopy is commonly used in candidate patients for liver transplantation. We initiated this study to define the risk‐benefit ratio of performing screening colonoscopy in this population.

A retrospective observational study of all consecutive patients undergoing colonoscopy during pre‐liver transplantation screening between 2004‐2017 was conducted. Endoscopic and pathological findings and clinical events potentially related to the colonoscopy in the 30 days after the procedure were registered and compared with a 30 days in‐patient control time frame.

A total of 858 colonoscopies were performed in 808 patients (65% male; median age 55 years (IQR 47‐62); median MELD score 15 (IQR 11‐18)).

Colorectal cancer was found in 2 patients (0.2%) and advanced adenomas in 44 patients (5.4%). The only independent risk factor for an advanced neoplasm was age (OR 1.072 per year; 95%CI 1.031‐1.115; p<0.001).

During the 30 days post‐procedure period 178 clinical events occurred in 128 patients compared to 101 clinical events in 72 patients in the control time frames (p<0.001). After colonoscopy, there was a significant increased risk for renal failure (p=0.001) and gastro‐intestinal bleeding (p=0.023). Presence of ascites and MELD score were identified as independent risk factors for acute renal failure and gastro‐intestinal bleeding. During the study observation period 53.5% of the screened population actually underwent liver transplantation.

Conclusion

Colorectal cancer screening in pre‐liver transplantation patients is associated with a relatively low prevalence of colorectal cancer, and an increased risk of post‐colonoscopy complications such as acute renal failure and gastrointestinal bleeding, especially in patients with advanced liver disease. Since the risk‐benefit ratio of standard performance of a screening colonoscopy in this population appears questionable, alternative screening strategies should be considered.

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