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Endoscopy 2022; 54(03): 290-298
DOI: 10.1055/a-1328-5126
Original article

Risk of colonoscopy-related complications in a fecal immunochemical test-based population colorectal cancer screening program

Wen-Feng Hsu
 1   Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
 2   College of Medicine, National Taiwan University, Taipei, Taiwan
,
Chi-Yang Chang
 3   School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
 4   Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
,
Chun-Chao Chang
 5   Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
 6   Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
,
Li-Chun Chang
 2   College of Medicine, National Taiwan University, Taipei, Taiwan
 7   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
,
Chien-Hua Chen
 8   Digestive Disease Center, Chang-Bing Show-Chwan Memorial Hospital, Changhua, Taiwan
,
Chun-Che Lin
 9   Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
,
Yu-Min Lin
10   Department of Internal Medicine, Shin Kong Wu Ho‐Su Memorial Hospital, Taipei, Taiwan
,
Chia-Long Lee
11   Department of Internal Medicine, Cathay General Hospital Medical Center, Taipei, Taiwan
,
Hong-Yuan Wu
 2   College of Medicine, National Taiwan University, Taipei, Taiwan
,
Hsin-Chung Lee
 3   School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
12   Department of Surgery, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
,
Yi-Chia Lee
 2   College of Medicine, National Taiwan University, Taipei, Taiwan
 7   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
,
Ming-Yao Su
13   Department of Medicine, Division of Gastroenterology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
,
Li-Ju Lin
14   Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
,
Shu-Li Chia
14   Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
,
Ming-Shiang Wu
 2   College of Medicine, National Taiwan University, Taipei, Taiwan
 7   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
,
Han-Mo Chiu
 2   College of Medicine, National Taiwan University, Taipei, Taiwan
 7   Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
,
for the Colonoscopy Quality Assurance Joint Working Group of Taiwan Colorectal Cancer Screening Program and Digestive Endoscopy Society of Taiwan › Author AffiliationsSupported by: The Health Promotion Administration, Ministry of Health and Welfare A1060407, A1061224
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Author commentary on Wen-Feng Hsu et al.Endoscopy 2022; 54(03): v11-v11
DOI: 10.1055/a-1345-4740

Abstract

Background The likelihood of advanced or synchronous neoplasms is significantly higher in fecal immunochemical test (FIT)-positive individuals than in the general population. The magnitude of the colonoscopy-related complication rate in FIT-positive individuals remains unknown. This study aimed to elucidate the colonoscopy-related complication rate after a positive FIT result and compare it with the rate when colonoscopy was performed for other purposes.

Methods Information regarding colonoscopy-related severe complications after a positive FIT result (FIT-colonoscopy) and ordinary colonoscopy during 2010–2014 was collected from the Taiwanese Colorectal Cancer Screening Program Database and National Health Insurance Research Database. Severe complications included significant bleeding, perforation, and cardiopulmonary events ≤ 14 days after colonoscopy. The number of events per 1000 procedures was used to quantify complication rates. Multivariate analysis was conducted to assess the association of various factors with severe complications associated with FIT-colonoscopy compared with ordinary colonoscopy.

Results 319 114 FIT-colonoscopies (214 955 patients) were identified, 51 242 (16.1 %) of which included biopsy and 94 172 (29.5 %) included polypectomy. Overall, 2125 significant bleedings (6.7 ‰) and 277 perforations (0.9 ‰) occurred ≤ 14 days after FIT-colonoscopy. Polypectomy, antiplatelet use, and anticoagulant use were associated with higher risk of complications (adjusted odds ratio [aOR] 4.41, 95 % confidence interval [CI] 4.05–4.81); aOR 1.35, 95 %CI 1.12–1.53; aOR 1.88, 95 %CI 0.61–5.84, respectively). Compared with ordinary colonoscopy, FIT-colonoscopy involved significantly higher risk of significant bleeding (aOR 3.10, 95 %CI 2.90–3.32).

Conclusions FIT-colonoscopy was associated with a more than two-fold risk of significant bleeding, especially when polypectomy was performed.

Tables 1s–4s



Publication History

Received: 21 May 2020

Accepted: 03 December 2020

Accepted Manuscript online:
03 December 2020

Article published online:
11 February 2021

© 2020. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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