Risk factors for severe complications of colonoscopy in screening programs

Vanaclocha-Espí, Mercedes; Ibáñez, Josefa; Molina-Barceló, Ana; Valverde-Roig, María José; Pérez, Elena; Nolasco, Andreu; Vega, Mariola de la; Lastra-Bosch, Isabel Diez de la; Oceja, María Elena; Espinàs, Josep Alfons; Font, Rebeca; Pérez-Riquelme, Francisco; Arana-Arri, Eunate; Portillo, Isabel; Salas, Dolores

doi:10.1016/j.ypmed.2018.11.010

Cited by 9 publications

(10 citation statements)

References 23 publications

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“…A total of 13,592,454 patients across 31 studies underwent CRC screening using either gFOBT or FIT. Seventeen studies (3,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) reported on outcomes in patients using gFOBT and 14 studies (39,(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55) reported on FIT. Overall, 771,730 colonoscopies were performed in patients with an abnormal FIT (571,971) or positive gFOBT (199,759).…”

Section: Resultsmentioning

confidence: 99%

Colonoscopy-Related Adverse Events in Patients With Abnormal Stool-Based Tests: A Systematic Review of Literature and Meta-analysis of Outcomes

et al. 2021

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INTRODUCTION:Colorectal cancer (CRC) screening programs based on the fecal immunochemical test (FIT) and guaiac-based fecal occult blood (gFOBT) are associated with a substantial reduction in CRC incidence and mortality. We conducted a systematic review and comprehensive meta-analysis to evaluate colonoscopy-related adverse events in individuals with a positive FIT or gFOBT.METHODS:A systematic and detailed search was run in January 2021, with the assistance of a medical librarian for studies reporting on colonoscopy-related adverse events as part of organized CRC screening programs. Meta-analysis was performed using the random-effects model, and the results were expressed for pooled proportions along with relevant 95% confidence intervals (CIs).RESULTS:A total of 771,730 colonoscopies were performed in patients undergoing CRC screening using either gFOBT or FIT across 31 studies. The overall pooled incidence of severe adverse events in the entire patient cohort was 0.42% (CI 0.20–0.64); I2 = 38.76%. In patients with abnormal gFOBT, the incidence was 0.2% (CI 0.1–0.3); I2 = 24.6%, and in patients with a positive FIT, it was 0.4% (CI 0.2–0.7); I2 = 48.89%. The overall pooled incidence of perforation, bleeding, and death was 0.13% (CI 0.09–0.21); I2 = 22.84%, 0.3% (CI 0.2–0.4); I2 = 35.58%, and 0.01% (CI 0.00–0.01); I2 = 33.21%, respectively.DISCUSSION:Our analysis shows that in colonoscopies performed after abnormal stool-based testing, the overall risk of severe adverse events, perforation, bleeding, and death is minimal.

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Section: Resultsmentioning

confidence: 99%

Colonoscopy-Related Adverse Events in Patients With Abnormal Stool-Based Tests: A Systematic Review of Literature and Meta-analysis of Outcomes

et al. 2021

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“…Studies that reported on fatal complications within 30 days postcolonoscopy after a positive fecal occult blood test described 0-0.21 (95% CI, 0.0-1.16) fatal complications per 10,000 participants. 6,7,[15][16][17][18][19] However, those studies included small sample sizes of between 3000 and 60,000 colonoscopies and some indicated a suspected underestimation caused by incomplete registration.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopy-Related Mortality in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program

Kooyker

Toes‐Zoutendijk

Winden

et al. 2021

Clinical Gastroenterology and Hepatology

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172,797 participants underwent colonoscopy after a positive result from a FIT in the Dutch national CRC screening program; 13,848 participants received a diagnosis of CRC. The reported fatal complication rate was 0.23 per 10,000 FITpositive participants (or 1 per 43,199; 95% CI, 0.090 -0.60) undergoing colonoscopy, whereas this was 0.91 per 10,000 FIT-positive participants (or 1 per 10,961; 95% CI, 0.44 -1.38) according to the excess death rate. Likely colonoscopy-related causes of death were reported in 0.86 per 10,000 FIT-positive participants (or 1 per 11,236; 95% CI, 0.48 -1.63) who underwent colonoscopy, of which 50% considered cardiovascular events. CONCLUSIONS:Colonoscopy-related mortality within the Dutch FIT-based CRC screening program was estimated to range from 0.23 to 0.91 per 10,000 FIT-positive participants undergoing colonoscopy. These findings indicate underreporting of fatal complications in registries and a noteworthy incidence of fatal cardiovascular adverse events that requires further investigation. Nevertheless, the harm of FIT-based CRC screening is vastly outweighed by the benefits.

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“…However, while there seems to be uncertainty in the case of breast cancer screening by mammography or prostate cancer screening by blood antigen detection, the benefit observed in colon cancer mortality rates with participation in screening generates a more favourable opinion (Hersch et al, 2017;Kalager et al, 2018). On the other hand, in the CRIBEA study in which the BCSP of the Basque Country participated, complications were reported in 3.3‰ of diagnostic colonoscopies (Vanaclocha-Espi et al, 2019). All this information is used in training sessions and is available to both professionals and the general public on the programme's website (Osakidetza-Servicio Vasco de Salud, 2021).…”

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to participation in population‐based colorectal cancer screening programme from the perspective of healthcare professionals: Qualitative research study

et al. 2021

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Objective: High participation determines the success of colorectal cancer screening programmes in reducing incidence and mortality. The factors that determine participation must be studied from the perspective of professionals that implement the programme. The aim was to identify factors that facilitate or hinder the participation of the invited people in the bowel cancer screening programme of the Basque Country (Spain) from professional's perspective.Methods: Qualitative design based on individual interviews and focus groups.Thirty-eight primary care professionals who implement the programme participated (administrative staff, nurses and general practitioners). Thematic analysis was performed.Results: Professionals show high satisfaction with the programme, and they believe firmly in its benefits. Facilitators for participation include professionals' commitment to the programme, their previous positive experiences, their optimistic attitude towards the prognosis of cancer and their trust in the health system and accessibility.Barriers include invitees' lack of independence to make decisions, fear of a positive test result and patient vulnerability and labour mobility of the health professionals.Conclusions: Professionals show a high degree of involvement and identify primary care is an appropriate place to carry out disease prevention. They identify the closeness to patients, the personal attitude and the characteristics of the health system as key factors that influence participation.

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Risk factors for severe complications of colonoscopy in screening programs

Cited by 9 publications

References 23 publications

Colonoscopy-Related Adverse Events in Patients With Abnormal Stool-Based Tests: A Systematic Review of Literature and Meta-analysis of Outcomes

Colonoscopy-Related Adverse Events in Patients With Abnormal Stool-Based Tests: A Systematic Review of Literature and Meta-analysis of Outcomes

Colonoscopy-Related Mortality in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program

Facilitators and barriers to participation in population‐based colorectal cancer screening programme from the perspective of healthcare professionals: Qualitative research study

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