Ansari Zaid, Ahmad Akram, Khan Osama Sharjeel, Reddi Vuha, Castro Fernando
Department of Gastroenterology Cleveland Clinic Weston Florida USA.
Department of Cardiology Cleveland Clinic Weston Florida USA.
JGH Open. 2024 Dec 30;9(1):e70090. doi: 10.1002/jgh3.70090. eCollection 2025 Jan.
Patients undergoing evaluation for a heart transplant are frequently on inotropic medications or mechanical circulatory support (MCS) devices, which places them at a higher risk for anesthesia-related complications. These patients often require colonoscopies for bleeding or screening purposes, but there are limited data on the safety and outcomes of colonoscopy in this setting.
This is a retrospective, two-center study between the years 2015 and 2021 of patients with heart failure who subsequently underwent a heart transplant. To be included in the study, patients were required to be on advanced heart failure therapies at the time of colonoscopy. Advanced heart failure therapies were defined as requiring inotropes (milrinone or dobutamine), vasopressors (norepinephrine or vasopressin), or MCS such as an impella, left ventricular assist device (LVAD), intra-aortic balloon pump (IABP), or extra-corporeal membrane oxygenation (ECMO). Indications for colonoscopy, adequacy of bowel preparation, and complications were reported.
A total of 92 patients were included in the study. The most common indication was colon cancer screening (67%), and the remainder were performed due to gastrointestinal bleeding. An inadequate bowel preparation was reported on 20% of patients, but the cecum was reached in all of them. There was no association between the inadequacy of bowel preparation and the presence of MCS (20% vs. 17%, value 0.67). In colonoscopies performed for screening, 8% (5/62) of patients were found to have an advanced adenoma. In colonoscopies performed for bleeding, 17% (5/30) had a source that required therapeutic intervention and use of hemostatic clips was the preferred modality. Only four patients had a complication of bleeding requiring clips after polypectomy during the index procedure, with no anesthesia-related adverse events (such as hypotension, arrhythmias, or cardiac arrest) or addition of inotropes, vasopressors, or MCS.
Colonoscopy in patients on advanced heart failure therapies is acceptable with not only a low rate of complications but also a high rate of inadequate bowel preparation.
接受心脏移植评估的患者经常使用正性肌力药物或机械循环支持（MCS）设备，这使他们面临更高的麻醉相关并发症风险。这些患者常因出血或筛查目的需要进行结肠镜检查，但关于这种情况下结肠镜检查的安全性和结果的数据有限。
这是一项2015年至2021年间在两个中心进行的回顾性研究，研究对象为随后接受心脏移植的心力衰竭患者。要纳入该研究，患者在结肠镜检查时需接受晚期心力衰竭治疗。晚期心力衰竭治疗定义为需要使用正性肌力药物（米力农或多巴酚丁胺）、血管升压药（去甲肾上腺素或血管加压素）或MCS，如Impella、左心室辅助装置（LVAD）、主动脉内球囊泵（IABP）或体外膜肺氧合（ECMO）。报告了结肠镜检查的适应证、肠道准备的充分性和并发症情况。
共有92例患者纳入该研究。最常见的适应证是结肠癌筛查（67%），其余是因胃肠道出血进行检查。20%的患者报告肠道准备不充分，但所有患者均到达了盲肠。肠道准备不充分与MCS的存在之间无关联（20%对17%，P值0.67）。在因筛查进行的结肠镜检查中，8%（5/62）的患者发现有高级别腺瘤。在因出血进行的结肠镜检查中，17%（5/30）有需要治疗干预的出血源，使用止血夹是首选方式。在首次手术期间，只有4例患者在息肉切除术后出现需要夹闭的出血并发症，没有麻醉相关不良事件（如低血压、心律失常或心脏骤停），也没有增加正性肌力药物、血管升压药或MCS的使用。
对于接受晚期心力衰竭治疗的患者，结肠镜检查是可以接受的，不仅并发症发生率低，而且肠道准备不充分的发生率高。
