Colonoscopy related adverse events in patients with abnormal stool-based tests – A systematic review of literature and meta-analysis of outcomes

Abstract

INTRODUCTION:Colorectal cancer (CRC) screening programs based on the fecal immunochemical test (FIT) and guaiac-based fecal occult blood (gFOBT) are associated with a substantial reduction in CRC incidence and mortality. We conducted a systematic review and comprehensive meta-analysis to evaluate colonoscopy-related adverse events in individuals with a positive FIT or gFOBT.METHODS:A systematic and detailed search was run in January 2021, with the assistance of a medical librarian for studies reporting on colonoscopy-related adverse events as part of organized CRC screening programs. Meta-analysis was performed using the random-effects model, and the results were expressed for pooled proportions along with relevant 95% confidence intervals (CIs).RESULTS:A total of 771,730 colonoscopies were performed in patients undergoing CRC screening using either gFOBT or FIT across 31 studies. The overall pooled incidence of severe adverse events in the entire patient cohort was 0.42% (CI 0.20–0.64); I2 = 38.76%. In patients with abnormal gFOBT, the incidence was 0.2% (CI 0.1–0.3); I2 = 24.6%, and in patients with a positive FIT, it was 0.4% (CI 0.2–0.7); I2 = 48.89%. The overall pooled incidence of perforation, bleeding, and death was 0.13% (CI 0.09–0.21); I2 = 22.84%, 0.3% (CI 0.2–0.4); I2 = 35.58%, and 0.01% (CI 0.00–0.01); I2 = 33.21%, respectively.DISCUSSION:Our analysis shows that in colonoscopies performed after abnormal stool-based testing, the overall risk of severe adverse events, perforation, bleeding, and death is minimal.

Comparison with first round findings of faecal haemoglobin concentrations and clinical outcomes in the second round of a biennial faecal immunochemical test based colorectal cancer screening programme

“…The third lowest rate was in those with a previous negative colonoscopy, and this might be expected owing to a reluctance to undergo another unproductive and unpleasant procedure with some, albeit small, risk. 18 …”

“…The third lowest rate was in those with a previous negative colonoscopy, and this might be expected owing to a reluctance to undergo another unproductive and unpleasant procedure with some, albeit small, risk. 18 The number of participants with CRC in the first round who underwent colonoscopy for a positive second round FIT was very small (n = 5) so only limited conclusions can be drawn, although it is interesting that 40.0% had HRA. A diagnosis of adenoma was also common in all those who had adenoma diagnosed in the first round, and the risk of a diagnosis of CRC was not negligible (2.3% overall).…”

Periprocedural Anticoagulation Management of Patients Undergoing Colonoscopy with Polypectomy

“… 1 Bleeding is the most common complication after colonoscopy occurring in 0.3% of patients. 2 3 Individuals on anticoagulants are at increased risk of bleeding and additional risk factors including bridging anticoagulation with low molecular weight heparin (LMWH), hot snare polypectomy, and large polyp removed further exacerbate this risk. 4 Periprocedural anticoagulation management is controversial due to the limited data on the bleeding risk associated with uninterrupted anticoagulation and on the thromboembolic risk associated with anticoagulation interruption.…”

Faecal haemoglobin concentration in adenoma, before and after polypectomy, approaches the ideal tumour marker

“…In addition, if f-Hb could replace colonoscopy, especially in surveillance programmes, scarce endoscopy resources could be saved and patients could benefit from not having to undergo an unpleasant invasive procedure with some, albeit small, risk. 9 …”

“…In addition, if f-Hb could replace colonoscopy, especially in surveillance programmes, scarce endoscopy resources could be saved and patients could benefit from not having to undergo an unpleasant invasive procedure with some, albeit small, risk. 9 However, compared to CRC screening and detection of significant colorectal disease (SCD = CRC + advanced adenoma [AA] + inflammatory bowel disease [IBD]) in patients with symptoms, the role of f-Hb estimation using faecal immunochemical tests for haemoglobin (FIT) in surveillance following polypectomy remains unclear. It has been stated that further research is warranted to better define potential applications.…”