Volume 85 - 2022 - Fasc.1 - Case series
An Israeli national survey on ischemic colitis induced by pre-colonoscopy bowel preparation (R1)
Background and study aims: Ischemic colitis (IC) may occur as a complication of colonoscopy. The aim of this study was to characterize patients with IC that occurred after exposure to bowel preparation laxatives, prior to an elective colonoscopy.
Patients and methods: A survey among Israeli gastroenterologists. Information was collected regarding individual cases.
Results: Eight patients, who developed IC after bisacodyl ingestion that was taken as part of pre-colonoscopy bowel preparation protocol, were reported. In all patients, severe abdominal pain and/or hematochezia started shortly after the ingestion of the first dose of bisacodyl. IC was found in 7 patients during the planned colonoscopy and in 1 patient using computerized tomography. All patients received supportive treatment and recovered.
Conclusions: IC induced by bisacodyl is a rare phenomenon. Regardless of being rare, we would advise withholding bisacodyl bowel preparation in elderly subjects with risk factors for IC that are scheduled for a colonoscopy.
Risk factors and clinical outcomes of acute esophageal necrosis: retrospective case series of a rare disease with “black” prognosis
Acute esophageal necrosis is a rare syndrome classically
characterized by black distal esophagus with a complex
pathophysiology that usually involves a combination of esophageal
ischemia, gastroesophageal reflux and impaired mucosal
reparative mechanisms. We retrospectively analyzed the main
risk factors, clinical characteristics and outcome in all patients
diagnosed with acute esophageal necrosis between January 2015
and December 2020 at our center. Ten patients were identified
in a total of 26854 upper digestive endoscopies (0.04%). Most
patients were male (8/10) and the mean age of presentation was
71.1 years. The most common presenting symptoms were melena
and hematemesis and half the patients required red blood cell
transfusion. The most common risk factors were hypertension,
diabetes mellitus, dyslipidemia, chronic kidney disease, peripheral
artery disease, coronary artery disease, cerebrovascular disease,
heart failure and malignancy. Compromised hemodynamic state
was the most common precipitating event in four patients. Other
recognized precipitating events included surgical interventions,
decompensated heart failure, gastrointestinal bleeding from gastric
malignancy and methotrexate. Endoscopic findings revealed diffuse
and circumferential black distal esophagus with abrupt transition
at gastroesophageal junction and variable proximal extension at
presentation. The 1-month mortality rate was 30%, mostly from
severe underlying illness. In conclusion, acute esophageal necrosis
is a rare cause of upper gastrointestinal bleeding that should be
suspected in older patients with multiple comorbidities. Although
associated with a high mortality rate, appropriate treatment may
result in favorable outcome in most patients.