Complications of Colonoscopy in an Integrated Health Care Delivery System

Levin, Theodore R.; Zhao, Wei; Conell, Carol; Seeff, Laura C.; Manninen, Diane L.; Shapiro, Jean A.; Schulman, Jane

doi:10.7326/0003-4819-145-12-200612190-00004

Cited by 521 publications

(395 citation statements)

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“…6 Gastrointestinal bleeding has also been reported as the most prevalent complication in adult studies. 7 Adult studies have also reported that older age is a risk factor for gastrointestinal bleeding, 7,9 In this study, the higher complication rate associated with younger age can be largely accounted for by bleeding complications. Our regression analysis showed that younger age was an independent predictor of bleeding-related complications, and 71% (24/34) of bleeding events in our cohort were reported in children younger than 10 years of age.…”

Section: Discussionmentioning

confidence: 66%

“…The rate of perforation in adult colonoscopies is also very low, estimated at less than 0.2% (range, 0.03%-0.81%). 4,8,9,19,26 Overall, adult studies did not demonstrate a clear association between polypectomy and the rate of perforation. 6 Predisposing factors to perforations included the presence of adhesions, strictures, or severe diverticular disease; these conditions are less common in pediatrics.…”

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confidence: 99%

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Complications of Pediatric Colonoscopy: A Five-Year Multicenter Experience

Thakkar

El–Serag

Mattek

et al. 2008

Clinical Gastroenterology and Hepatology

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Colonoscopy has become a routine modality for the evaluation and treatment of colonic disorders in children. Although generally considered a safe procedure, colonoscopy has the potential for complications. Most informed consent forms describe adverse effects of sedative medicines, perforation, infection, and bleeding as possible risks of colonoscopy. However, the frequency of these complications remains unclear. There are limited pediatric data showing complication rates, and most prior studies involved small numbers of procedures. Furthermore, there might be additional complications that need to be added to consent protocols, because most current complication data are extrapolated from the much larger experience in adult populations.A review of pediatric literature demonstrated a wide array of potential complications and no large multicenter studies during the past 25 years. The largest study was conducted in [1978][1979] and included a survey of 1400 proctosigmoidoscopies performed during an 18-month period at 25 medical centers in the U.S. 1 This study was only published in abstract form and reported complications in 0.2% of all colonoscopy procedures. These complications included one hemorrhage requiring transfusion and one perforation. In the second largest study, Stringer et al 2 prospectively described a series of 250 flexible colonoscopies done in the United Kingdom during a 3.5-year period with no adverse events. Several other studies reported complications (Table 1) in pediatric colonoscopy, but the majority of these studies examined a small number of procedures.Determination of potential colonoscopy-related complications and their expected frequency in children can lead to enhanced risk-benefit analysis by physicians and patients and improved informed consent. There is a lack of systematic, multicenter studies in the pediatric population. Therefore, we conducted the current study to examine the frequency, type, and clinical determinants of immediate complications encountered during pediatric Address requests for reprints to: Kalpesh Thakkar, MD, 6621 Fannin St CCC 1010, Houston, TX 77030. kthakkar@bcm.tmc.edu; fax: 832-825-3633. Simple logistic regression was used to estimate the crude risk of cardiopulmonary events and gastrointestinal bleeding for variables that were identified as significantly associated with the outcomes during categorical analysis (P < .05). Multiple logistic regression models included all variables determined significant on univariate analysis. In constructing the models, we followed the commonly used heuristic of 10 outcome events for each explanatory variable. The adjusted risks estimate for each independent predictor variable was expressed as odds ratios. All analyses were performed by using SAS software (SAS Institute, Inc, Cary, NC). HHS Public Access ResultsDuring the study period, 8841 colonoscopies were recorded at 12 PEDS-CORI sites, and 1049 (11.9%) were excluded for incomplete procedure notes, duplicate records, or patient age older than 18 years. Thus, a total of 77...

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Section: Discussionmentioning

confidence: 66%

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confidence: 99%

Complications of Pediatric Colonoscopy: A Five-Year Multicenter Experience

Thakkar

El–Serag

Mattek

et al. 2008

Clinical Gastroenterology and Hepatology

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“…There were also 4.8 occurrences of postprocedure bleeding per 1000 colonoscopies that included biopsy or polypectomy. 43 In conclusion, in a large community-based U.S. population across multiple medical centers, physicians' adenoma detection rates were inversely related to the risk of interval colorectal cancer, including advanced-stage cancer and fatal interval colorectal cancer, among patients with up to 10 years of follow-up. This association was approximately linear across quintiles of adenoma detection rates in our population and was observed for male and female patients, cancers in the proximal and distal colon, and early and delayed interval cancers.…”

Section: Discussionmentioning

confidence: 99%

Adenoma Detection Rate and Risk of Colorectal Cancer and Death

Barret¹,

Chaussade²,

Coriat³

2014

N Engl J Med

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“…However, colonoscopy is an invasive procedure and carries with it an inherent risk, although the risk is low. Studies reported an overall complication rate of 2.9-5 per 1000 endoscopies and a perforation rate of 0.9-1.8 per 1000 endoscopies [42,43]. A screening colonoscopy program also reported a complication rate of 0.1% [44].…”

Section: Colon Examinations Colonoscopymentioning

confidence: 99%