Original article—alimentary tract
Serious Complications Within 30 Days of Screening and Surveillance Colonoscopy Are Uncommon

https://doi.org/10.1016/j.cgh.2009.10.007Get rights and content

Background & Aims

The risk of serious complications after colonoscopy has important implications for the overall benefits of colorectal cancer screening programs. We evaluated the incidence of serious complications within 30 days after screening or surveillance colonoscopies in diverse clinical settings and sought to identify potential risk factors for complications.

Methods

Patients age 40 and over undergoing colonoscopy for screening, surveillance, or evaluation based an abnormal result from another screening test were enrolled through the National Endoscopic Database (CORI). Patients completed a standardized telephone interview approximately 7 and 30 days after their colonoscopy. We estimated the incidence of serious complications within 30 days of colonoscopy and identified risk factors associated with complications using logistic regression analyses.

Results

We enrolled 21,375 patients. Gastrointestinal bleeding requiring hospitalization occurred in 34 patients (incidence 1.59/1000 exams; 95% confidence interval [CI], 1.10–2.22). Perforations occurred in 4 patients (0.19/1000 exams; 95% CI, 0.05–0.48), diverticulitis requiring hospitalization in 5 patients (0.23/1000 exams; 95% CI, 0.08–0.54), and postpolypectomy syndrome in 2 patients (0.09/1000 exams; 95% CI, 0.02–0.30). The overall incidence of complications directly related to colonoscopy was 2.01 per 1000 exams (95% CI, 1.46–2.71). Two of the 4 perforations occurred without biopsy or polypectomy. The risk of complications increased with preprocedure warfarin use and performance of polypectomy with cautery.

Conclusions

Complications after screening or surveillance colonoscopy are uncommon. Risk factors for complications include warfarin use and polypectomy with cautery.

Section snippets

Setting and Participants

This prospective cohort study was performed within the Clinical Outcomes Research Initiative National Endoscopic Database (CORI), a nationwide data repository for gastrointestinal endoscopy procedures.20 Eighty-five centers and over 530 physicians participate in CORI. For this study, 18 CORI practices volunteered to participate, including 1 academic, 5 Veterans Administration (VA), and 12 private practice sites. VA sites were relatively overrepresented compared with CORI sites in general. The

Results

We recruited 21,375 patients, and were able to contact 18,271 at the 30 day time point. Seventy-six percent of subjects were enrolled from community-based practice settings. Characteristics of enrolled subjects were similar overall to eligible but not enrolled patients, except that a slightly higher percentage of nonenrolled subjects were from community-based practices (Table 1).

Discussion

The risk of serious complications within 30 days after screening and surveillance colonoscopy was low in our study, with an incidence of perforations of 0.19/1000 exams and gastrointestinal bleeding requiring hospitalization in 1.59/1000 exams. The overall incidence of serious, directly related complications was 2.01/1000 exams, and the incidence of all directly and potentially related events was 3.18/1000 exams (Table 3). Immediate procedure-related complications were uncommon (Table 2), and

Acknowledgments

The Centers for Disease Control and Prevention assisted in design, conduct, and analysis of this study. The funding sources had no role in the decision to submit the manuscript for publication.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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    Conflict of interest The authors disclose no conflicts.

    Funding This work was supported by the Centers for Disease Control and Prevention, Prevention Research Program, through the University of Washington Health Promotion Research Center, cooperative agreement numbers U48/CCU009654 and 1-U48-DP-000050, and by the National Institutes of Health grant (U01 DK057132) to Oregon Health and Sciences University.

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