Clinical Gastroenterology and Hepatology
Volume 8, Issue 2 , Pages 166-173, February 2010

Serious Complications Within 30 Days of Screening and Surveillance Colonoscopy Are Uncommon

  • Cynthia W. Ko

      Affiliations

    • University of Washington, Seattle, Washington
    • Corresponding Author InformationReprint requests Address requests for reprints to: Cynthia Ko, MD, MS, Division of Gastroenterology, Box 356424, University of Washington, Seattle, Washington 98195. fax: (206) 685-8684
    • ,
  • Stacy Riffle

      Affiliations

    • University of Washington, Seattle, Washington
    • ,
  • Leann Michaels

      Affiliations

    • Oregon Health and Science University, Portland, Oregon
    • ,
  • Cynthia Morris

      Affiliations

    • Oregon Health and Science University, Portland, Oregon
    • ,
  • Jennifer Holub

      Affiliations

    • Oregon Health and Science University, Portland, Oregon
    • ,
  • Jean A. Shapiro

      Affiliations

    • Centers for Disease Control and Prevention, Atlanta, Georgia
    • ,
  • Marcia A. Ciol

      Affiliations

    • University of Washington, Seattle, Washington
    • ,
  • Michael B. Kimmey

      Affiliations

    • University of Washington, Seattle, Washington
    • ,
  • Laura C. Seeff

      Affiliations

    • Centers for Disease Control and Prevention, Atlanta, Georgia
    • ,
  • David Lieberman

      Affiliations

    • Oregon Health and Science University, Portland, Oregon

published online 21 October 2009.

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.

Abbreviations used in this paper: ASA, American Society of Anesthesiologists, CI, confidence interval, CORI, Clinical Outcomes Research Initiative National Endoscopic Database, OR, odds ratio, VA, Veterans Administration

 

 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.

PII: S1542-3565(09)01042-8

doi:10.1016/j.cgh.2009.10.007

Clinical Gastroenterology and Hepatology
Volume 8, Issue 2 , Pages 166-173, February 2010