Association of polypectomy techniques, endoscopist volume, and facility type with colonoscopy complications

Abstract

Background and Objective Serious GI adverse events in the outpatient setting were examined by polypectomy technique, endoscopist volume, and facility type (ambulatory surgery center and hospital outpatient department). Design Retrospective follow-up study. Setting Ambulatory surgery and hospital discharge datasets from Florida (1997-2004) were used. Patients A total of 2,315,126 outpatient colonoscopies performed in patients of all ages and payers were examined. Main Outcome Thirty-day hospitalizations because of colonic perforations and GI bleeding, measured as cumulative and specific outcomes, were investigated. Results Compared with simple colonoscopy, the adjusted risks of cumulative adverse events were greater with the use of cold forceps (1.21 [95% CI, 1.01-1.44]), ablation (3.75 [95% CI, 2.97-4.72]), hot forceps (5.63 [95% CI, 4.97-6.39]), snares (7.75 [95% CI, 6.95-8.64]), or complex colonoscopy (8.83 [95% CI, 7.70-10.12]). Low-volume endoscopists had higher risks of adverse events (1.18 [95% CI, 1.07-1.30]). A higher risk of adverse events was associated with procedures performed in ambulatory surgery centers (1.27 [95% CI, 1.16-1.40]). Important findings were also reported for the analyses stratified by specific outcomes and procedures. Limitation The study was constrained by limitations inherent in administrative data pertaining to a single state. Conclusions As the complexity of polypectomy increases, a higher risk of adverse events is reported. Using lower risk procedures when clinically appropriate or referring patients to high-volume endoscopists can reduce the rates of perforations and GI bleeding. Given the large number of colonoscopies performed in the United States, it is critical that the rates of adverse events be considered when choosing procedures.

What is the Risk of Colorectal Cancer After an Episode of Acute Diverticulitis in Conservatively Treated Patients?

“…These are well-known complications. 28 The main limitation of our study is the retrospective nature of this cohort. Colonoscopy was performed at the discretion of the treating physician and this may have led to bias.…”

Endoscopy Following Pediatric Intestinal Transplant

“…21 Serious upper endoscopy complication rate is estimated at 0.15% 22 while serious colonoscopy complication rate is 0.2% 23 . Rate of perforation in screening colonoscopies for adults ranged from 0.01% to 0.1%.…”

Quality indicators for colonoscopy

“…[17][18][19][20][21] Finally, technical expertise and experience will help prevent adverse events that might offset the benefits of removing neoplastic lesions. 22 Recent studies report that colonoscopy is less effective in preventing proximal colon cancer and cancer deaths (ie, colon cancer proximal to the splenic flexure) compared with distal cancer (ie, colon cancer at or distal to the splenic flexure). [23][24][25][26][27][28] Decreased protection against right-sided CRC is likely due to multiple factors.…”