Copyright ©The Author(s) 2021.
World J Gastroenterol. Nov 14, 2021; 27(42): 7299-7310
Published online Nov 14, 2021. doi: 10.3748/wjg.v27.i42.7299
Table 1 Summary of proposed pathogenetic factors for colonoscopy-related mesenteric ischemia and suggested interventions to reduce the risk
Pathogenetic factor
Mechanism of action
Type of ischemia
Splanchnic circulation impairmentChronic mesenteric ischemia (atherosclerosis, smoking habits), parietal vessels inflammation (connective tissue diseases, LES, antiphospholipid syndrome)Vascular thrombosis; microcirculatory mild ischemic injuryCareful evaluation of medical history. Specific and indirect symptoms assessment. Antiplatelet agents according to guidelines. Consider pre-colonoscopy assessments (serum electrolyte, color-Doppler ultrasound)
Bowel preparation (hypertonic, isotonic, laxative)Serum electrolyte imbalance, dehydration. Potential additional risk if laxative were used (i.e., bisacodyl)MultifactorialGive specific information. Consider high-volume isotonic formulations; split-dose regimens; avoid bisacodyl-containing preparations
Sedation (midazolam, opioids, propofol)Vasodilation, depression of myocardial contractility and hypotensionMultifactorialMinimal sedation protocol (response to verbal stimulation, patent airways, spontaneous ventilation, and normal cardiovascular function) in high-risk patients. Consider prophylactic fluid infusion
Air insufflation/barotraumaIncreased luminal pressure and consequent vascular resistanceNon-occlusive mesenteric ischemiaUse carbon dioxide (CO2) insufflation. Consider water-exchange colonoscopy technique
Scope manipulationMechanical stress on mesocolon, blood flow reduction, microcirculatory damage, and inflammatory cascade activationVascular thrombosisProcedure interruption in case of intense discomfort or endoscopic findings of ischemia. Consider pediatric or “ultra-slim” colonoscopes. Reschedule or reconsider indication in case of complex exams