Endoscopy in C. difficile Infection

Indications for Endoscopy

Flexible sigmoidoscopy is appropriate for diagnosing C. difficile infection in patients with high clinical suspicion and negative stool tests, as recommended by the World Journal of Emergency Surgery 1
The European Society of Gastrointestinal Endoscopy suggests that flexible sigmoidoscopy can be used to differentiate C. difficile colitis from other causes of acute colitis when urgent diagnosis is needed 2
Endoscopic visualization of pseudomembranes is a marker of severe colitis and can suffice for diagnosis in the absence of another obvious cause, according to the Clinical Microbiology and Infection guidelines 3, 4, 5

The World Journal of Emergency Surgery recommends that laboratory testing and imaging should be prioritized over endoscopy for diagnosing C. difficile infection 1, 8, 9
CT imaging findings, such as colonic wall thickening >4mm, accordion sign, pericolonic stranding, and unexplained ascites, can aid in diagnosis, as suggested by the World Journal of Emergency Surgery 1, 8, 9
Point-of-care ultrasound may be useful in critically ill patients who cannot be transported to CT, showing thickened colonic wall with heterogeneous echogeneity and hyperechoic pseudomembranes, according to the World Journal of Emergency Surgery 1, 8

The World Journal of Emergency Surgery advises that full colonoscopy should be avoided in severe or fulminant colitis settings due to increased perforation risk 1
The Journal of Crohn's and Colitis recommends that complete ileocolonoscopy is not usually recommended in acute severe colitis due to perforation risk, and bowel purgatives should be avoided 2, 7
The Journal of Crohn's and Colitis found that there is no relationship between complication rate and disease activity during endoscopy, suggesting sigmoidoscopy can be safely performed to establish diagnosis 7