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.
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.
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.
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.
In 2012 the Canadian Association of Gastroenterology published 19 indicators of safety compromise. We studied the incidence of these indicators by reviewing all colonoscopies performed in St. John's, NL, between January 1, 2012, and June 30, 2012. Results. A total of 3235 colonoscopies were included. Adverse events are as follows. Medication-related includes use of reversal agents 0.1%, hypoxia 9.9%, hypotension 15.4%, and hypertension 0.9%. No patients required CPR or experienced allergic reactions or laryngospasm/bronchospasm. The indicator, "sedation dosages in patients older than 70," showed lower usage of fentanyl and midazolam in elderly patients. Procedure-related immediate includes perforation 0.2%, immediate postpolypectomy bleeding 0.3%, need for hospital admission or transfer to the emergency department 0.1%, and severe persistent abdominal pain proven not to be perforation 0.4%. Instrument impaction was not seen. Procedure-related delayed includes death within 14 days 0.1%, unplanned health care visit within 14 days of the colonoscopy 1.8%, unplanned hospitalization within 14 days of the colonoscopy 0.6%, bleeding within 14 days of colonoscopy 0.2%, infection 0.03%, and metabolic complication 0.03%. Conclusions. The most common adverse events were mild and sedation related. Rates of serious adverse events were in keeping with published reports.
Defining the complication rate of endoscopy performed across an entire city will capture usual as opposed to referral center data.
Our purpose was to evaluate the current practice of colonoscopy and complications associated with lower GI endoscopy in usual clinical practice.
All admissions within 30 days of an outpatient lower GI endoscopy at any of the 6 adult-care Winnipeg hospitals were identified. This includes endoscopy for both complex and routine patients. A chart audit of all cases with potential complications was performed.
A total of 24,509 outpatient lower GI endoscopies for adults were performed at the 6 hospitals over the 2 study years (April 1, 2004, to March 31, 2006). There were 303 admissions with potential complications. The colonoscopy completion rate was 65% (72% for gastroenterologists vs 59% for general surgeons, P
Screening for colon cancer by colonoscopy is increasingly recommended in the medical literature. There are few, if any, reports in the medical literature regarding the provision of colonoscopy services in small rural hospitals by non-specialist endoscopists.
This study, carried out in a small rural hospital in northern Ontario, tracks the development of a colonoscopy service provided by a general practitioner with some basic colonoscopy training. It compares the GP's past and present level of expertise with literature-derived benchmarks and gauges the safety and effectiveness of the procedure.
A retrospective chart review of 616 colonoscopies performed by this GP between April 1992 and September 2003.
The results of the study support the idea that colonoscopy in a rural setting can be provided safely and effectively.
Colonoscopy has a high safety profile when provided by general practitioners, and training in the procedure should be available to interested family practitioners and family practice residents.
Pain scales have been tested in clinical settings, but rarely with colonoscopy. The aim of this study was to evaluate the Colorado Behavioral Numerical Pain Scale (CBNPS) when assessing medication-free colonoscopy patients' pain intensity. During the first phase in 2005, the expert panelists (n = 17) described medication-free colonoscopy patients' behavior on a scale ranging from 0 to 5 scale. The descriptions were analyzed by quantitative and qualitative content analysis and compared with those of CBNPS. During the second phase in 2006, data from 138 medication- free colonoscopy patients and 11 nurses were collected using questionnaires (CBNPS, visual analogue scale [VAS], and verbal rating scale [VRS]) and analyzed statistically. The descriptions made by expert nurses were found similar to those of the CBNPS. Nurses' estimations with the CBNPS, VAS, and VRS of patients' pain were correlated with each other. According to our results, the CBNPS is an adequate instrument when assessing patients' pain intensity during medication-free colonoscopy. It provides an opportunity to evaluate the total pain intensity and the pain during the phases of the procedure. It is also a proper tool for improving nursing documentation. Results from this study highlight the need for further research to examine the pain scales.
Colonoscopy, introduced in the late 1960s, has become the principal method for diagnosis, treatment, and follow-up of colorectal diseases. Being invasive, colonoscopy is associated with a risk of complications. The aim of this study was to analyze the rate of complications of diagnostic and therapeutic colonoscopy in a population-based setting.
All colonoscopy records for 1979 to 1995 in 1 Swedish county (population 258,000) were retrieved. Information was obtained about patients' demographics, date of examination, endoscopist, indications, findings, colonoscopy type, completion level, and complications. Records were linked to the Cause of Death Register and the Swedish Hospital Discharge Register to ascertain mortality and morbidity.
In 6066 colonoscopies, the overall morbidity was 0.4% (diagnostic 0.2%, therapeutic 1.2%). The most frequent complications were bleeding (0.2%) and perforation (0.1%), with no colonoscopy-related mortality. Bleeding was confined to therapeutic colonoscopy and occurred immediately, mainly after removal of large polyps with thick stalks. Perforations at diagnostic colonoscopy occurred in the left colon; they were diagnosed sooner than perforations associated with therapeutic colonoscopy where the cecum was the most frequent site. The bleeding rate was correlated to the experience of the endoscopists.
Colonoscopy is a safe procedure, and the rate of adverse events in this population-based setting was low.
The benefits of the laparoscopic approach to colon and rectal surgery do not seem as great as for other laparoscopic procedures. To study this further we decided to review the current literature and the 10-year experience of a surgical group from university teaching hospitals in Montréal, Québec and Toronto in performing laparoscopic colon and rectal surgery.
The prospectively designed case series comprised all patients having laparoscopic colon and rectal surgery. The procedures were carried out by a group of 4 surgeons between April 1991 and November 2001. We noted intraoperative complications, any conversions to open surgery, operating time, postoperative complications and postoperative length of hospital stay.
The group attempted 750 laparoscopic colon and rectal procedures of which 669 were completed laparoscopically. Malignant disease was the indication for surgery in 49.6% of cases. Right hemicolectomy and sigmoid colectomy accounted for 54.5% of procedures performed. Intraoperative complications occurred in 8.3%, with 29.0% of these resulting in conversion to open surgery. The overall rate of conversion to open surgery was 10.8%, most commonly for oncologic concerns. Median operating time was 175 minutes for all procedures. Postoperative complications occurred in 27.5% of procedures completed laparoscopically but were mostly minor wound complications. Pulmonary complications occurred in only 1.0%. The anastomotic leak rate was 2.5%. The early reoperation rate was 2.4%. Postoperative mortality was 2.2%. No port site metastases have yet been detected. The median postoperative length of stay was 5 days.
The clinical outcomes of laparoscopic colon and rectal surgery in this 10-year experience are consistent with numerous cohort studies and randomized clinical trials. Laparoscopic colon and rectal surgery in the hands of well-trained surgeons can be performed safely with short hospital stay, low analgesic requirements and acceptable complication rates compared with historical controls and other reports in the literature. Evidence from published randomized clinical trials is emerging that under these conditions laparoscopic resection represents the better treatment option for most benign conditions, but concerns regarding its appropriateness for malignant disease are still to be resolved.
Cites: Surg Oncol Clin N Am. 2001 Jul;10(3):625-3811685932