Bleeding and Perforation After Outpatient Colonoscopy and Their Risk Factors in Usual Clinical Practice

Published:September 16, 2008DOI:https://doi.org/10.1053/j.gastro.2008.08.058

      Background & Aims

      The most widely quoted complication rates for colonoscopy are from case series performed by expert endoscopists. Our objectives were to evaluate the rates of bleeding, perforation, and death associated with outpatient colonoscopy and their risk factors in a population-based study.

      Methods

      We identified all individuals 50 to 75 years old who underwent an outpatient colonoscopy during April 1, 2002, to March 31, 2003, in British Columbia, Alberta, Ontario, and Nova Scotia, Canada. Using administrative data, we identified all individuals who were admitted to hospital with bleeding or perforation within 30 days following the colonoscopy in each province. We calculated the pooled rates of bleeding and perforation from the 4 provinces. In Ontario, we abstracted the hospital charts of all deaths that occurred within 30 days following the procedure. We used generalized estimating equations models to evaluate factors associated with bleeding and perforation.

      Results

      We identified 97,091 persons who had an outpatient colonoscopy. The pooled rates of colonoscopy-related bleeding and perforation were 1.64/1000 and 0.85/1000, respectively. The death rate was 0.074/1000 or approximately 1/14,000. Older age, male sex, having a polypectomy, and having the colonoscopy performed by a low-volume endoscopist were associated with increased odds of bleeding or perforation.

      Conclusions

      Although colonoscopy has established benefits for the detection of colorectal cancer and adenomatous polyps, the procedure is associated with risks of serious complications, including death. Older age, male sex, having a polypectomy, and having the procedure done by a low-volume endoscopist were independently associated with colonoscopy-related bleeding and perforation.

      Abbreviations used in this paper:

      CIHI (Canadian Institute for Health Information)
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      Linked Article

      • Continuing Medical Education Exam 2, December 2008
        GastroenterologyVol. 135Issue 6
      • In Search of Quality Colonoscopy
        GastroenterologyVol. 135Issue 6
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          Recent guidelines representing multiple societies promote colonoscopy as the optimal test for colorectal cancer (CRC) screening.1 Although no direct evidence (ie, randomized, controlled trials) exist to prove the efficacy of colonoscopy to reduce mortality from CRC, substantial indirect evidence has been published supporting a general belief that this strategy will decrease cancer incidence and mortality more effectively than other available means.2,3 The recent decline in CRC mortality has been attributed to the wide-scale implementation of CRC screening and, because all screening strategies involve colonoscopy as either a primary or evaluative instrument, this seems to further support colonoscopy as the best intervention.
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