COLONOSCOPY OF ACUTE COLITIS - A SAFE AND RELIABLE TOOL FOR ASSESSMENT OF SEVERITY

Complications that might lead to surgery in severe attacks of ulcerati ve colitis have been found to be correlated with the depth of colonic ulcerations as measured by pathological examination of colectomy speci mens. In order to evaluate the value of colonoscopy for the assessment of colonic ulcerations, we have reviewed the clinical, biological, co lonoscopic, and anatomical findings in 85 consecutive patients with at tacks of ulcerative colitis involving at least the rectosigmoid and pa rt of the descending colon, seen in our center between 1981 and 1989. All had colonoscopy performed by a senior endoscopist at entry. Extens ive deep colonic ulcerations were diagnosed in 46 of them, and moderat e endoscopic colitis in 39. No complication related to colonoscopy occ urred except for one colonic dilatation. Forty-three of the 46 patient s with severe endoscopic colitis were operated upon: 38 of them failed to improve with high-dose corticosteroids and five had a to;dc megaco lon. Extensive ulcerations reaching at least the circular muscle layer were found at pathological examination of colectomy specimen in 42 of the 43 patients. Conversely, 30 of 39 patients with moderate endoscop ic colitis went into clinical remission with medical treatment, and on ly nine patients needed further surgery because of medical treatment f ailure. Six of these nine patients underwent another colonoscopy prior to colectomy, and all six showed features of severe endoscopic coliti s. Deep ulcerations reaching the circular muscle layer were found at p athological examination in five of these six patients and in one addit ional patient whose colonoscopy had been performed 21 days before cole ctomy. We conclude that, in expert hands, colonoscopy is safe and accu rately selects patients with high risk of surgical complications who n eed early surgery in case of failure of medical treatment.