Risk of Perforation After Colonoscopy and Sigmoidoscopy: A Population-Based Study

Abstract

The risk of perforation after colonoscopy is approximately double that after sigmoidoscopy, but this difference appears to be decreasing. These observations should be useful to clinicians making screening and diagnostic decisions for individual patients and to policy officials setting guidelines for colorectal cancer screening programs.

Adverse events of computed tomography colonography: An Italian National Survey

“…When comparing our data with the endoscopic series, the perforation rate at colonoscopy, whether diagnostic or therapeutic, would appear to be higher than that of CTC. The reported perforation rates for colonoscopy range from one case in 3115 procedures (0.032%) to one case in 510 procedures (0.196%) [17,[39][40][41][42][43][44]. Thus, our 0.02% estimate of post-CT colonography perforations imparts a significantly more favorable profile for CTC compared to colonoscopy.…”

“…However, concerns were raised about recommending CTC as routine screening tool because of potential harm [14,15]. While CTC is widely considered to be much safer than colonoscopy [16][17][18], it is not exempt from potential serious complications, mainly represented by large bowel perforations [18][19][20][21][22]. The National Survey of United Kingdom [18] has suggested a perforation rate, for diagnostic studies, of 1 in every 1889 examinations.…”

Assessing the Impact of Screening Colonoscopy on Mortality in the Medicare Population

“…Subtracting the latter mortality rate from the former yielded an overall SC-attributable mortality estimate that was distinct from the overall risk of death. Because stratumspecific outcomes were so rare that reliable estimates of stratum-specific SC-related mortality were not feasible, we used estimates of the relative risk of SC mortality associated with increasing age and comorbidity derived from prior studies 42,43 . Specifically, we estimated that the relative risks for the group with 1-2 and ≥3 comorbidities were 1.5 and 3 times that of the zero comorbidity group, respectively 43 .…”

“…Similarly, we estimated that the relative risk of mortality for patients 75-79 years and ≥80 years were 1.5 and 2 times the risk in patients 67-74 years, respectively 42,43 .…”

Editorial on the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guideline on clinical indications for CT colonography in the colorectal cancer diagnosis

“…Moreover, more and more frequently, elderly and frail patients, with significant comorbidities and/or in therapy with anticoagulant drugs, are immediately referred to CTC after a first unsuccessful attempt with CS. This is reasonable since in this sub-group of patients risks of either perforation [13] or bleeding [14] during CS are extremely high and diagnostic accuracy of CTC is absolutely adequate to either confirm or rule out CRC.…”