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Survey Colonoscopy is Safe in Veterans with Spinal Cord Injury or Disorder (SCI&D)

Hayman A, Fischer M, Anaya B, Parachuri R, Bentrem D, Guihan M. Survey Colonoscopy is Safe in Veterans with Spinal Cord Injury or Disorder (SCI&D). Paper presented at: VA Association of Surgeons Annual Meeting; 2011 Apr 11; Irvine, CA.

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Introduction: Colonoscopy is the most effective screening test for colorectal cancer (CRC), but up to 1% of patients experience significant complications. Despite similar CRC incidence rates, persons with SCIandD are less likely to receive colonoscopy, due to practical considerations. Sensory deficits and chronic rectal bleeding in persons with SCIandD may mask CRC symptoms, heightening the importance of regular screening. Therefore, the aims of this study of veterans with SCIandD undergoing colonoscopy were to report: 1) patient and procedure characteristics and 2) the incidence of complications within 30 days of colonoscopy. Methods: VA administrative data identified 107 veterans with SCIandD seen at our medical center who underwent 142 diagnostic or screening colonoscopies from 1998 to 2008. We reviewed subjects' electronic medical records for demographics, length of stay, pre-procedure symptoms, procedure indication and other details, and for post-procedure complications. Results: Median length of stay was 10 days (range: 1 - 779). Forty-four per cent had paraplegia, and 56% had tetraplegia. Median age was 57 (32 -88), and 44% were African-American. Median duration of colonoscopy was 30 minutes (3 - 205). Fifty-six per cent of patients were inadequately bowel prepped. Four patients experienced post-procedure abdominal bloating and one experienced rectal bleeding, but none required medical intervention. Two CRCs and one precancerous lesion were found (3% incidence). Conclusions: Colonoscopy is more difficult in SCIandD patients: neurogenic bowel increases the rate of poor prep. However, colonoscopy does not pose a higher risk of complications, and can be potentially life-saving by detecting CRC. This is especially important as the median life expectancy of veterans with SCIandD approaches that of the general veteran population. These data should encourage SCIandD providers to offer more screening colonoscopies and suggest a need for an extended prep period in these patients.

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