Colonoscopy-related complications in a nationwide immunochemical fecal occult blood test-based colorectal cancer screening program

Abstract

BackgroundThe Danish national screening program for colorectal cancer (CRC) consists of an immunochemical fecal occult blood test (iFOBT) followed by colonoscopy. The Danish Colorectal Cancer Screening Database (DCCSD) records data on the incidence of hospital-registered complications after colonoscopy. However, the validity of these data is unknown, and the incidence of complications is potentially underreported.ObjectiveTo evaluate the validity of the colonoscopy complications registered in the DCCSD by using medical records as the reference. Further, to evaluate the incidence of complications leading to hospital contact.MethodsAmong 14,671 individuals with a positive iFOBT result and a colonoscopy procedure performed from March 3, 2014 to December 31, 2014, we selected 295 individuals for medical record review. We calculated sensitivity as the proportion of true complications registered in the DCCSD out of all complications found in the medical records, and the positive predictive value (PPV) as the number of true complications in the DCCSD out of all DCCSD-registered complications. On the basis of the medical record data, we calculated the incidence proportion of hospital-registered complications overall and by subtype.ResultsIn total, we reviewed 286 records and found 102 individuals with at least one complication. The sensitivity of the DCCSD for any complication was 29.4% (95% CI: 20.8–39.3) and the PPV was 88.2% (95% CI: 72.6–96.7). On the basis of the medical record data, the incidence proportion of any complication after colonoscopy was 0.70% (95% CI: 0.57–0.84) and that of perforation or lesion was 0.10% (95% CI: 0.06–0.17); bleeding, 0.41% (95% CI: 0.31–0.53); post-polypectomy syndrome, 0.16% (95% CI: 0.10–0.24); and other medical complications, 0.04 (95% CI: 0.02–0.09).ConclusionThe DCCSD has low sensitivity for complications, and improvements in data registration are warranted. The incidence proportion of any hospital-treated post-colonoscopy complication was 0.70% in 2014, which was the first year of the Danish national CRC screening program. This is within the range of complications reported by other studies.

Adverse events of colonoscopy in a colorectal cancer screening programme with faecal immunochemical test: a population-based community-based observational study

“…The less one seeks, the less one finds. All studies that rely on voluntary reporting underestimate actual complication rates 8,24. In our study, 15% of AEs requiring hospitalisation were not reported by gastroenterologists.…”

“…6,7 The rate of therapeutic colonoscopies varies more than twofold between series, from 32.9% in the German colonoscopy screening programme 21 to around 50% in gFOBT programmes and 55% to 70% in FIT programmes. 7,8 A way to compare different series is to analyse separately diagnostic and therapeutic colonoscopies. For diagnostic colonoscopies, our perforation and bleeding rates requiring hospitalisation were 0.9‰ and 0‰, in line with those reported in the meta-analysis (0.4‰ and 0.6‰, respectively).…”

“…in two FIT CRC screening pilots, notably higher than the upper limit of 5‰ recommended by the European Society of Gastrointestinal Endoscopy (ESGE). [7][8][9] Owing to the established risk factors (polypectomy, polyp size...) and since the neoplasia yield is significantly higher, AEs should be more prevalent in FIT-positive colonoscopies than in gFOBT-positive colonoscopies and, a fortiori, than in direct screening colonoscopies. 10,11 Valid real-world data is needed to inform target populations, caregivers, policy-makers and funders.…”

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

“…In the Danish National Colorectal Cancer Screening Programme, the incidence of any complication after colonoscopy was similar to what reported in the current study, but the incidence of complications after polypectomy was lower than ours. (1.15% vs. 1.7%) [23]. In the English Bowel…”

Colon capsule endoscopy in colorectal cancer screening: a randomised controlled trial

“…[2][3][4][5][6] During the roll-out of the Danish CRC screening programme between 2014 and 2017, some issues arose on decreasing participation, adherence to colonoscopy, colonoscopy capacity, major complications and high rates of clean colon after diagnostic colonoscopy. [7][8][9][10][11] Several procedures addressing these issues are becoming available to healthcare providers. One is the colon capsule endoscopy (CCE), which has been found to increase screening participation, 12 and which has been associated with less expected and experienced patient discomfort compared with colonoscopy.…”