Colonoscopy-related adverse events and mortality in an Italian organized colorectal cancer screening program

Abstract

Background Post-colonoscopy adverse events are a key quality indicator in population-based colorectal cancer screening programs, and affect safety and costs. This study aimed to assess colonoscopy-related adverse events and mortality in a screening setting.

Methods We retrieved data from patients undergoing colonoscopy within a screening program (fecal immunochemical test every 2 years, 50–69-year-olds, or post-polypectomy surveillance) in Italy between 2002 and 2014, to assess the rate of post-colonoscopy adverse events and mortality. Any admission within 30 days of screening colonoscopy was reviewed to capture possible events. Mortality registries were also matched with endoscopy databases to investigate 30-day post-colonoscopy mortality. Association of each outcome with patient-/procedure-related variables was assessed using multivariable analysis.

Results Overall, 117 881 screening colonoscopies (66 584, 56.5 %, with polypectomy) were included. Overall, 497 (0.42 %) post-colonoscopy adverse events occurred: 281 (0.24 %) bleedings (3.69‰/0.68‰, operative/diagnostic procedures) and 65 (0.06 %) perforations (0.75‰/0.29‰, respectively). At multivariable analysis, bleeding was associated with polyp size (≥ 20 mm: odds ratio [OR] 16.29, 95 % confidence interval [CI] 9.38–28.29), proximal location (OR 1.46, 95 %CI 1.14–1.87), and histology severity (high risk adenoma: OR 5.6, 95 %CI 2.43–12.91), while perforation was associated with endoscopic resection (OR 2.91, 95 %CI 1.62–5.22), polyp size (OR 4.34, 95 %CI 1.46–12.92), and proximal location (OR 1.94, 95 %CI 1.12–3.37). Post-colonoscopy mortality occurred in 15 /117 881 cases (1.27/10 000 colonoscopies).

Conclusions In an organized screening program, post-colonoscopy adverse events were rare but not negligible. The most frequent event was post-polypectomy bleeding, especially after resection of large (≥ 20 mm) and proximal lesions.

Publikationsverlauf

Eingereicht: 20. Mai 2020

Angenommen: 28. Juli 2020

Accepted Manuscript online:
28. Juli 2020

Artikel online veröffentlicht:
21. September 2020

• References

• 1 Zorzi M, Zappa M. AIRTUM Working Group. Synthetic indicator of the impact of colorectal cancer screening programmes on incidence rates. Gut 2020; 69: 311-316
• 2 Zorzi M, Fedeli U, Schievano E. et al. Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test. Gut 2015; 64: 784-790
• 3 Zorzi M, Hassan C, Capodaglio G. et al. Long-term performance of colorectal cancer screening programmes based on the faecal immunochemical test. Gut 2018; 67: 2124-2130
• 4 Senore C, Basu P, Anttila A. et al. Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report. Gut 2019; 68: 1232-1244
• 5 Reumkens A, Rondagh EJA, Bakker CM. et al. Post-colonoscopy complications: a systematic review, time trends, and meta-analysis of population-based studies. Am J Gastroenterol 2016; 111: 1092-1101
• 6 Kothari ST, Huang RJ, Shaukat A. et al. ASGE review of adverse events in colonoscopy. Gastrointest Endosc 2019; 90: 863-876.e33
• 7 Atkin WS, Valori R, Kuipers EJ. et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Colonoscopic surveillance following adenoma removal. . Endoscopy 2012; 44 (Suppl. 03) SE151-163
• 8 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 9 Zorzi M, de’ Bianchi PS, Grazzini G. et al. [Ouality indicators for the evaluation of colorectal cancer screening programmes]. Epidemiol Prev 2007; 31: 6-56
• 10 Spadaccini M, Albéniz E, Pohl H. et al. Prophylactic clipping after colorectal endoscopic resection prevents bleeding of large, proximal polyps: meta-analysis of randomized trials. Gastroenterology 2020; 159: 148-158
• 11 Nishizawa T, Suzuki H, Goto O. et al. Effect of prophylactic clipping in colorectal endoscopic resection: a meta-analysis of randomized controlled studies. United European Gastroenterol J 2017; 5: 859-867
• 12 Amato A, Radaelli F, Dinelli M. et al. Early and delayed complications of polypectomy in a community setting: the SPoC prospective multicentre trial. Dig Liver Dis 2016; 48: 43-48
• 13 Blanks R, Nickerson C, Patnick J. et al. Evaluation of colonoscopy performance based on post-procedure bleeding complications: application of procedure complexity-adjusted model. Endoscopy 2015; 47: 910-916
• 14 Rutter M, Nickerson C, Rees C. et al. Risk factors for adverse events related to polypectomy in the English Bowel Cancer Screening Programme. Endoscopy 2014; 46: 90-97
• 15 Day LW, Kwon A, Inadomi JM. et al. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2011; 74: 885-896