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Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice.

https://arctichealth.org/en/permalink/ahliterature154626
Source
Gastroenterology. 2008 Dec;135(6):1899-1906, 1906.e1
Publication Type
Article
Date
Dec-2008
Author
Linda Rabeneck
Lawrence F Paszat
Robert J Hilsden
Refik Saskin
Des Leddin
Eva Grunfeld
Elaine Wai
Meredith Goldwasser
Rinku Sutradhar
Therese A Stukel
Author Affiliation
Department of Medicine, University of Toronto, Toronto, Ontario, Canada. linda.rabeneck@sunnybrook.ca
Source
Gastroenterology. 2008 Dec;135(6):1899-1906, 1906.e1
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Aged
Alberta - epidemiology
British Columbia - epidemiology
Colonic Diseases - diagnosis - surgery
Colonoscopy - adverse effects
Female
Follow-Up Studies
Gastrointestinal Hemorrhage - epidemiology - etiology
Humans
Incidence
Intestinal Perforation - epidemiology - etiology
Male
Middle Aged
Nova Scotia - epidemiology
Ontario - epidemiology
Outpatients - statistics & numerical data
Population Surveillance
Prognosis
Retrospective Studies
Risk factors
Survival Rate - trends
Abstract
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.
Notes
Comment In: Gastroenterology. 2008 Dec;135(6):1845-719000685
PubMed ID
18938166 View in PubMed
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Canadian Association of Gastroenterology Indicators of Safety Compromise following Colonoscopy in Clinical Practice.

https://arctichealth.org/en/permalink/ahliterature281167
Source
Can J Gastroenterol Hepatol. 2016;2016:2729871
Publication Type
Article
Date
2016
Author
Mark R Borgaonkar
David Pace
Muna Lougheed
Curtis Marcoux
Bradley Evans
Nikita Hickey
Meghan O'Leary
Jerry McGrath
Source
Can J Gastroenterol Hepatol. 2016;2016:2729871
Date
2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Colonoscopy - adverse effects - standards - statistics & numerical data
Conscious Sedation - adverse effects - statistics & numerical data
Female
Fentanyl - therapeutic use
Humans
Hypnotics and Sedatives - therapeutic use
Incidence
Male
Midazolam - therapeutic use
Middle Aged
Newfoundland and Labrador - epidemiology
Postoperative Complications - epidemiology - etiology
Quality Indicators, Health Care - statistics & numerical data
Safety - statistics & numerical data
Abstract
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.
Notes
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PubMed ID
27446832 View in PubMed
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Colonoscopy and its complications across a Canadian regional health authority.

https://arctichealth.org/en/permalink/ahliterature152176
Source
Gastrointest Endosc. 2009 Mar;69(3 Pt 2):665-71
Publication Type
Article
Date
Mar-2009
Author
Harminder Singh
Robert B Penfold
Carolyn DeCoster
Lisa Kaita
Cindy Proulx
Gerry Taylor
Charles N Bernstein
Michael Moffatt
Author Affiliation
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. singh@cc.umanitoba.ca
Source
Gastrointest Endosc. 2009 Mar;69(3 Pt 2):665-71
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Colonoscopy - adverse effects
Female
Humans
Male
Manitoba
Middle Aged
Postoperative Complications - epidemiology - etiology
Retrospective Studies
Abstract
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
Notes
Comment In: Gastrointest Endosc. 2009 Mar;69(3 Pt 2):672-419251008
PubMed ID
19251007 View in PubMed
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Colonoscopy procedures at a small rural hospital.

https://arctichealth.org/en/permalink/ahliterature176947
Source
Can J Rural Med. 2004;9(2):89-93
Publication Type
Article
Date
2004
Author
Erle Kirby
Author Affiliation
Lady Dunn General Hospital, Wawa, Ontario.
Source
Can J Rural Med. 2004;9(2):89-93
Date
2004
Language
English
Publication Type
Article
Keywords
Aged
Cecum
Colonic Neoplasms - diagnosis
Colonic Polyps - diagnosis
Colonoscopy - adverse effects
Family Practice
Hospitals, Rural
Humans
Intubation, Gastrointestinal
Middle Aged
Ontario
Retrospective Studies
Safety
Abstract
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.
PubMed ID
15603681 View in PubMed
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Colonoscopy: Reducing faecal incontinence following colonoscopy.

https://arctichealth.org/en/permalink/ahliterature124401
Source
Nat Rev Gastroenterol Hepatol. 2012 Jun;9(6):308-9
Publication Type
Article
Date
Jun-2012

The Colorado Behavioral Numerical Pain Scale in assessing medication-free colonoscopy patients' pain.

https://arctichealth.org/en/permalink/ahliterature135698
Source
Gastroenterol Nurs. 2011 Mar-Apr;34(2):136-43
Publication Type
Article
Author
Eeva-Riitta Ylinen
Katri Vehviläinen-Julkunen
Anna-Maija Pietilä
Author Affiliation
University of Eastern Finland, Department of Nursing Science, Kuopio, Finland. eeva-riitta.ylinen@savonia.fi
Source
Gastroenterol Nurs. 2011 Mar-Apr;34(2):136-43
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Algorithms
Colonoscopy - adverse effects - nursing
Conscious Sedation
Female
Finland
Humans
Male
Middle Aged
Nursing Evaluation Research
Nursing Staff, Hospital
Pain - etiology - nursing
Pain Measurement - methods - nursing
Patient satisfaction
Questionnaires
Retrospective Studies
Abstract
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.
PubMed ID
21455046 View in PubMed
Less detail
Source
Tidsskr Nor Laegeforen. 2010 Aug 26;130(16):1598
Publication Type
Article
Date
Aug-26-2010
Author
Eivind Meland
Author Affiliation
Institutt for samfunnsmedisinske fag Universitetet i Bergen, Kalfarveien 31, 5018 Bergen, Norway.
Source
Tidsskr Nor Laegeforen. 2010 Aug 26;130(16):1598
Date
Aug-26-2010
Language
Norwegian
Publication Type
Article
Keywords
Colonoscopy - adverse effects
Colorectal Neoplasms - mortality - psychology
False Positive Reactions
Humans
Mass Screening - adverse effects - psychology
Norway - epidemiology
PubMed ID
20805854 View in PubMed
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[Colorectal cancer screening--at last discussed!].

https://arctichealth.org/en/permalink/ahliterature100218
Source
Tidsskr Nor Laegeforen. 2010 Oct 21;130(20):2012
Publication Type
Article
Date
Oct-21-2010

Complications of diagnostic and therapeutic colonoscopy within a defined population in Sweden.

https://arctichealth.org/en/permalink/ahliterature193491
Source
Gastrointest Endosc. 2001 Sep;54(3):302-9
Publication Type
Article
Date
Sep-2001
Author
G. Dafnis
A. Ekbom
L. Pahlman
P. Blomqvist
Author Affiliation
Department of Surgery, University Hospital, Uppsala, Sweden.
Source
Gastrointest Endosc. 2001 Sep;54(3):302-9
Date
Sep-2001
Language
English
Publication Type
Article
Keywords
Colon - injuries
Colonic Diseases - diagnosis - therapy
Colonoscopy - adverse effects - statistics & numerical data
Female
Gastrointestinal Hemorrhage - epidemiology - etiology
Humans
Intestinal Perforation - epidemiology - etiology
Male
Middle Aged
Morbidity
Rectal Diseases - diagnosis - therapy
Registries - statistics & numerical data
Sweden
Time Factors
Abstract
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.
PubMed ID
11522969 View in PubMed
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Could laparoscopic colon and rectal surgery become the standard of care? A review and experience with 750 procedures.

https://arctichealth.org/en/permalink/ahliterature182335
Source
Can J Surg. 2003 Dec;46(6):432-40
Publication Type
Article
Date
Dec-2003
Author
Christopher M Schlachta
Joseph Mamazza
Roger Gregoire
Stephen E Burpee
Eric C Poulin
Author Affiliation
Division of General Surgery, Centre for Minimally Invasive Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont. christopher.schlachta@utoronto.ca
Source
Can J Surg. 2003 Dec;46(6):432-40
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Clinical Competence - standards
Colectomy - methods - statistics & numerical data
Colonic Pouches - statistics & numerical data
Colonoscopy - adverse effects - standards - statistics & numerical data
Colostomy - methods - statistics & numerical data
Evidence-Based Medicine
Feasibility Studies
Hospitals, University
Humans
Intraoperative Complications - epidemiology - etiology
Length of Stay - statistics & numerical data
Ontario - epidemiology
Patient Selection
Postoperative Complications - etiology - mortality
Practice Guidelines as Topic
Proctoscopy - adverse effects - standards - statistics & numerical data
Prospective Studies
Quebec - epidemiology
Reoperation - statistics & numerical data
Safety
Time Factors
Treatment Outcome
Abstract
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.
Notes
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PubMed ID
14680350 View in PubMed
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44 records – page 1 of 5.