| Abstract: | Purpose Bedside colonoscopy for the critically ill patient in Intensive Care Units (ICU) confronts the endoscopist with a new set of challenges and aims. This study examines the value and benefits that colonoscopy offers to critically ill patients with acute lower gastrointestinal disease. Methodology ICU patients who received bedside colonoscopy were identified from the colonoscopy database and the indications, co morbidities, depth of intubation, progression to surgery and death were recorded. Results 39 patients underwent one or more bedside ICU colonoscopies to investigate ischemic colitis (11, confirmed in 8, 3 operated), colonic distension (10, all decompressed, 2 operated), lower gastrointestinal hemorrhage (13, cause found in 3, 2 operated), and diarrhea (4 patients). 14 patients died. Overall, 18 patients were diagnosed with ischemic colitis; 7 were operated and 6 died. Colonoscopy reached the cecum in 16 patients, the hepatic flexure in 25 and the splenic flexure in 36. Prep was poor in 15 patients and stool prevented completion in 13. In 30% of patients colonoscopy was not pursued to the cecum because decompression was achieved without it, or because ischemic colitis was already diagnosed Colonoscopic techniques specific to ICU included prevention of a loop outside the patient and “slide‐through” with copious irrigation. Conclusion Bedside ICU colonoscopies are able to make an accurate diagnosis. Reaching the cecum is often not the aim of the study, nor is the diagnosis of small adenomas. In many cases a serious colorectal disease can be diagnosed or excluded, helping in the management of these severely ill patients. |
