Dr Cappell and colleagues from Philadelphia in America undertook a study in order to analyze the risks vs. the benefits of colonoscopy soon after myocardial infarction.
The researchers studied a total of 100 consecutive patients undergoing colonoscopy within 30 days after myocardial infarction at 2 large tertiary cardiac referral hospitals.
The research team compared the study group with 100 control patients with neither myocardial infarction nor unstable angina during the preceding 6 months who underwent colonoscopy.
The researchers matched patients with controls for age, colonoscopy indication, and colonoscopist.
The indications for colonoscopy were bleeding per rectum (37 patients), fecal occult blood (36 patients, hematocrit < 30% in 25), iron deficiency anemia (11 patients, hematocrit < 25% in 9), and other (16 patients).
Colonoscopy was performed at a mean of 15.5 days after myocardial infarction.
2 patients underwent colonoscopic colonic decompression.
The research team noted that colonoscopy was diagnostic in 47% of the study patients vs. 41% of the control patients.
|23 patients had a major therapeutic benefit consequent to colonoscopy|
In addition, the investigators found that the relative rate of ischemic colitis was significantly higher in study vs. control patients.
Other diagnoses in study patients were the following: colon cancer (8), bleeding internal hemorrhoids (5), pseudomembranous colitis (5), high-risk adenomatous polyp (large or villous histopathology) (4), and other (10).
Urgent colonoscopy was diagnostic in 63% of cases.
The researchers found that 23 patients had a major therapeutic benefit consequent to colonoscopy, including colon cancer surgery in 5.
Study patients were found to be significantly sicker than control patients and suffered significantly more colonoscopic complications compared with control patients.
The team noted minor complications without clinical sequelae in 8 study patients (asymptomatic hypotension or bradycardia).
The researchers recorded 1 major complication in this group that was probably not procedure related.
Dr Cappell concluded, "Colonoscopy in patients with a recent myocardial infarction is associated with a higher rate of minor, transient, and primarily cardiovascular complications compared with control patients".
"Colonoscopy is relatively infrequently associated with major complications."
"Colonoscopy is beneficial and indicated after myocardial infarction, despite a higher risk, in certain circumstances".
"The relative frequency of ischemic colitis was relatively high in study patients."