Adverse events related to colonoscopy: Global trends and future challenges

Abstract

Colonoscopy is a widely used method for diagnosing and treating colonic disease. The number of colonoscopies is increasing worldwide, and concerns about associated adverse events are growing. Large-scale studies using big data for post-colonoscopy complications have been reported. A colon perforation is a severe complication with a relatively high mortality rate. The perforation rate, as reported in large studies (≥ 50,000 colonoscopies) published since 2000, ranges from 0.005-0.085%. The trend in the overall perforation rate in the past 15 years has not changed significantly. Bleeding is a more common adverse event than perforation. Recent large studies (≥ 50,000 colonoscopies) have reported post-colonoscopy bleeding occurring in 0.001-0.687% of cases. Most studies about adverse events related to colonoscopy were performed in the West, and relatively few studies have been conducted in the East. The incidence of post-colonoscopy complications increases in elderly patients or patients with inflammatory bowel diseases. It is important to use a unified definition and refined data to overcome the limitations of previous studies. In addition, a structured training program for endoscopists and a systematic national management program are needed to reduce post-colonoscopy complications. In this review, we discuss the current trends in colonoscopy related to adverse events, as well as the challenges to be addressed through future research.

Factors affecting bowel preparation adequacy and procedural time

“…Repeat colonoscopies due to poor bowel preparation and prolonged procedure time carry risks for the patient. Anesthetic or procedural adverse events during or after the colonoscopy have been extensively investigated in literature . Patients aged 65 years or older, the primary demographic undergoing colonoscopy, have been shown to be at an even higher risk of complications .…”

Quality indicators in colonoscopy: an evolving paradigm

“…The rate of serious adverse events of colonoscopy is variable in the literature and ranges from 2 to 7 per 1000 colonoscopies . Serious adverse events are far more common after polypectomy (7.4 versus 2.4/1000).…”

“…Serious adverse events are far more common after polypectomy (7.4 versus 2.4/1000). Perforation is the most feared complication and fortunately occurs rarely at a rate of 0.5/1000 for screening colonoscopies, with higher rates again post polypectomy (0.6 versus 0.3/1000) . Haemorrhage occurs more often than perforation, and it too is a higher risk in patients undergoing polypectomy.…”

“…Readmission to hospital is often due to pain or bleeding with overall rates being around 12/1000. Patients who have had a polypectomy are nearly twice as likely to require readmission than those without (14.3/1000 versus 9.4/1000) …”

“…Studies have found a 70% increased risk of adverse events in patients ≥80 years. Therefore, this increased risk of complications needs to be balanced against the potential benefit from adenoma and CRC detection, especially amongst frail elderly patients …”