Colonoscopy after spinal cord injury: a case-control study

Design: An age-and gender-matched case-control study. Objective: To compare colonoscopy after spinal cord injury (SCI) with the general population in terms of indications, bowel preparation, technical success and disease detection. Setting: Victoria, Australia. Methods: Consecutive SCI colonoscopies between January 1998 and February 2013 were compared with a randomly selected age- and gender-matched control group. Injury level, indication for procedure and demographics were collected. Outcome measures included quality of bowel preparation, completion rates, procedural duration and benign and malignant disease detection. Results: A total of 440 colonoscopies were assessed, comprising 148 SCI patients and 292 age-and gender-matched controls. Both the groups were of similar age (54.7 years vs 54.5 years, P = 0.906) and comprised predominantly males (87.1% vs 86.3%, P = 0.919). SCI colonoscopies were more often performed to investigate abnormalities (85.1% vs 58.2%, P<0.001) than for screening or surveillance (18.2% vs 40.8%, P<0.001). Unsatisfactory bowel preparation was recorded more often in the SCI group (36.0% vs 13.0%, P<0.001) and completion rates were lower (75.7% vs 93.1%, P<0.001). Overall disease detection was lower in the SCI group (45.3% vs 59.6%, P<0.006). The polyp detection rate was lower for SCI (11.4% vs 25.3%, P = 0.001). The rate of diagnosis of malignancy was equivalent (2.7% vs 3.0%, P = 0.904). Conclusion: SCI patients have the same risk of malignancy as the general population and are less likely to undergo screening colonoscopy. Colonoscopy is then limited by poor bowel preparation and lower completion rates with a subsequent lower polyp detection rate.