Ahn Y, Hong GS, Lee JH, Lee CW, Kim SO. Ischemic colitis after enema administration: Incidence, timing, and clinical features. World J Gastroenterol 2020; 26(41): 6442-6454 [PMID: 33244204 DOI: 10.3748/wjg.v26.i41.6442]
Corresponding Author of This Article
Gil-Sun Hong, MD, PhD, Assistant Professor, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine & Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, South Korea. hgs2013@gmail.com
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
Observational Study
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Ahn Y, Hong GS, Lee JH, Lee CW, Kim SO. Ischemic colitis after enema administration: Incidence, timing, and clinical features. World J Gastroenterol 2020; 26(41): 6442-6454 [PMID: 33244204 DOI: 10.3748/wjg.v26.i41.6442]
World J Gastroenterol. Nov 7, 2020; 26(41): 6442-6454 Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6442
Ischemic colitis after enema administration: Incidence, timing, and clinical features
Yura Ahn, Gil-Sun Hong, Ju Hee Lee, Choong Wook Lee, Seon-Ok Kim
Yura Ahn, Gil-Sun Hong, Ju Hee Lee, Choong Wook Lee, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine & Asan Medical Center, Seoul 05505, South Korea
Seon-Ok Kim, Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: All authors participated in performance of the research; Ahn Y collected clinical data, searched the literature, interpreted the data, and wrote the first draft of the manuscript; Hong GS designed the study, searched the literature, interpreted the data, and reviewed the manuscript; Lee JH and Choong WL contributed to the critical review of the manuscript; Kim SO performed statistical analyses; all authors approved the final version of the article.
Institutional review board statement: This retrospective study was conducted according to the principles of the Declaration of Helsinki. The study protocol was approved by the Institutional Review Board Committee of the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (No. 2018-0381).
Informed consent statement: The need for informed consent was waived by the Institutional Review Board Committee of the Asan Medical Center.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared according to the STROBE Statement—checklist of items.
Corresponding author: Gil-Sun Hong, MD, PhD, Assistant Professor, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine & Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, South Korea. hgs2013@gmail.com
Received: August 3, 2020 Peer-review started: August 3, 2020 First decision: August 22, 2020 Revised: September 5, 2020 Accepted: October 1, 2020 Article in press: October 1, 2020 Published online: November 7, 2020 Processing time: 94 Days and 19.7 Hours
ARTICLE HIGHLIGHTS
Research background
Many patients usually give themselves enema at home due to over-the-counter medications. However, the number of patients referred to the emergency department for enema has increased over time. Enema administration is one of the most common procedures in the emergency department.
Research motivation
Several published case reports of enema-related ischemic colitis (IC) have raised concerns regarding the safety of enema agents. However, information on its true incidence and characteristics are still lacking. There have been no studies that systemically investigate enema-related IC.
Research objectives
Our purpose is to investigate the incidence, timing and risk factors of IC in patients receiving enema.
Research methods
We analyzed data from the database of patients with IC after enema administration at the Emergency Department of the Asan Medical Center from 2010 to 2018. The symptoms, laboratory findings, age-adjusted Charlson comorbidity index score, constipation score, medication, time interval from enema administration to occurrence of IC, treatment, and treatment outcome were analyzed.
Research results
The incidence of IC was 0.23%, and it occurred mostly in elderly patients in the early period following glycerin enema administration but not after the use of other enema agents. The constipation score and leukocytosis were independent risk factors for glycerin-related IC.
Research conclusions
We found out that glycerin-related IC is very rare, but mainly occurs in the elderly in the early post-enema period. The constipation score and leukocytosis could help in prediction of an IC following glycerin enema.
Research perspectives
This could provide useful information for the triage of patients necessitating observation after glycerin enema administration in the emergency department.
