ASGE review of adverse events in colonoscopy

Kothari, Shivangi; Huang, Robert J.; Shaukat, Aasma; Agrawal, Deepak; Buxbaum, James; Fehmi, Syed M. Abbas; Fishman, Douglas S.; Gurudu, Suryakanth R.; Khashab, Mouen A.; Jamil, Laith H.; Jue, Terry L.; Law, Joanna K.; Lee, Jeffrey K.; Naveed, Mariam; Qumseya, Bashar J.; Sawhney, Mandeep S.; Thosani, Nirav; Yang, Julie; DeWitt, John M.; Wani, Sachin

doi:10.1016/j.gie.2019.07.033

Cited by 113 publications

(112 citation statements)

References 107 publications

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“…There is substantial heterogeneity among studies reporting iatrogenic perforation rate after EMR, because of differences in perforation definition, polyp size, polyp morphology, and center experience. Two recent meta-analyses report pooled rates of 0.9 % and 1.1 % [227,228]. The perforation rate for colorectal ESD is higher, ranging from 4 % to 10 %, with lower complication rates reported from high volume centers [165,227,228].…”

Section: Colorectal Iatrogenic Perforationsmentioning

confidence: 99%

“…Two recent meta-analyses report pooled rates of 0.9 % and 1.1 % [227,228]. The perforation rate for colorectal ESD is higher, ranging from 4 % to 10 %, with lower complication rates reported from high volume centers [165,227,228]. Predictive risk factors include endoscopist experience (< 50 ESDs), tumor size, and presence of submucosal fibrosis [229,230].…”

Section: Colorectal Iatrogenic Perforationsmentioning

confidence: 99%

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Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

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Summary of Recommendations 1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

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Section: Colorectal Iatrogenic Perforationsmentioning

confidence: 99%

Section: Colorectal Iatrogenic Perforationsmentioning

confidence: 99%

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

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“…As a result, adverse events, especially bleeding and perforation, have also increased in absolute numbers. A meta-analysis that included 6529 colonoscopies involving mucosectomies showed a delayed bleeding rate of 4% and a perforation rate of 1.1% [ 43 ]. Patient-related perforation risk factors include the presence of diverticulosis, inflammatory bowel disease and corticosteroid use.…”

Section: Prophylactic Use Of Endoclipsmentioning

confidence: 99%

“…The endoscopist’s experience and polyp morphology also influence the rate of adverse events. Risk factors described for bleeding after polypectomy include polyp size above 2 cm, right sided colonic polyps, intraprocedural bleeding, use of antithrombotic agents, and exposed vessels in the submucosa after resection [ 43 , 44 ]. The use of microprocessor-controlled electrocautery confers a lower risk of bleeding and perforation after polypectomy [ 45 , 46 ].…”

Section: Prophylactic Use Of Endoclipsmentioning

confidence: 99%

“…Thus if such lesions were not clipped, there would be 4-fold increase in the baseline risk of post-polypectomy bleeding [ 51 ]. According to 2 American guidelines, in non-pedunculated polyps >20 mm, whose Paris classification is of type 0-Is or type 0-II [ 52 ], the closure of the endoscopic resection area with clips decreases the incidence of late bleeding, especially in the right colon [ 42 , 43 ] ( Fig. 1 ).…”

Section: Prophylactic Use Of Endoclipsmentioning

confidence: 99%

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Endoscopic clipping for gastrointestinal bleeding: emergency and prophylactic indications

Xavier

Campos

Robinson

et al. 2020

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Endoscopic clipping has become a common practice among endoscopists. Several models are available, most frequently being introduced via the working channel of the endoscope (through-the-scope); however, larger clips can also be mounted onto the distal tip of the endoscope (over-the-scope). The main indications for endoclip placement include providing effective mechanical hemostasis for bleeding lesions and allowing endoscopic closure of gastrointestinal perforations. Endoclips can also be used prophylactically after endoscopic resection; however, this practice is still controversial. This review discusses the main indications for endoscopic clipping in the esophagus, stomach, duodenum and colon to manage acute bleeding lesions, and the criteria to be used in the prevention of delayed post-polypectomy bleeding.

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Frequency of Use and Outcomes of Colonoscopy in Individuals Older Than 75 Years

et al. 2023

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ImportanceThe benefits from colorectal cancer (CRC) screening may take 10 to 15 years to accrue. Therefore, screening is recommended for older adults who are in good health.ObjectiveTo determine the number of screening colonoscopies done in patients older than 75 years with a life expectancy of fewer than 10 years, diagnostic yield, and associated adverse events within 10 days and 30 days of the procedure.DesignThis cross-sectional study with a nested cohort between January 2009 and January 2022 in an integrated health system assessed asymptomatic patients older than 75 years who underwent screening colonoscopy in the outpatient setting. Reports with incomplete data, any indication other than screening, patients who had a colonoscopy within the previous 5 years, and patients with a personal history of inflammatory bowel disease or CRC were excluded.ExposuresLife expectancy based on a prediction model from previous literature.Main Outcomes and MeasuresThe primary outcome was the percentage of screened patients who had limited (&lt;10 years) life expectancy. Other outcomes included colonoscopy findings and adverse events that developed within 10 days and 30 days of the procedure.ResultsA total of 7067 patients older than 75 years were included. The median (IQR) age was 78 (77-79) years, 3967 (56%) were women, and 5431 (77%) were White with an average of 2 comorbidities (taken from a select group of comorbidities). The proportion of colonoscopies performed on patients with a life expectancy of fewer than 10 years aged 76 to 80 years was 30% in both sexes and increased with age—82% of men and 61% of women aged 81 to 85 years (71% total), and 100% of patients beyond the age of 85 years. Adverse events requiring hospitalizations were common at 10 days (13.58 per 1000) and increased with age, particularly among patients older than 85 years. The detection of advanced neoplasia varied from 5.4% among patients aged 76 to 80 years to 6.2% in those aged 81 to 85 years and 9.5% among patients older than 85 years (P = .02). Of the total population, 15 patients (0.2%) had invasive adenocarcinoma; among patients with a life expectancy of fewer than 10 years, 1 of 9 was treated, whereas 4 of 6 patients with a life expectancy of greater than or equal to 10 years were treated.Conclusions and RelevanceIn this cross-sectional study with a nested cohort, most screening colonoscopies performed in patients older than 75 years were in patients with limited life expectancy and associated with increased risk of complications. Colorectal cancer was exceedingly rare.

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ASGE review of adverse events in colonoscopy

Cited by 113 publications

References 107 publications

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Endoscopic clipping for gastrointestinal bleeding: emergency and prophylactic indications

Frequency of Use and Outcomes of Colonoscopy in Individuals Older Than 75 Years

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