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

Abstract

Background and study aims: The likelihood of advanced or synchronous neoplasms is significantly higher in fecal immunochemical test (FIT)-positive subjects than in the general population. The magnitude of colonoscopy-related complication rate in FIT-positive subjects, however, remains unknown. This study aims to elucidate the colonoscopy-related complication rate after positive FIT and compared with colonoscopy performed for other purposes. Patients and methods: Information regarding colonoscopy after positive FIT (FIT-colonoscopy) and ordinary colonoscopy related severe complications during 2010-2014 was ascertained from the Taiwanese Colorectal Cancer (CRC) Screening Program Database and National Health Insurance Research Database (NHIRD). Severe complications included significant bleeding, perforation, and cardiopulmonary events <14 days of 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 in comparison with ordinary colonoscopy. Results: A total of 319,114 FIT-colonoscopies (214,955 subjects) were identified. Of those, 51,242 (16.1%) underwent biopsy and 94,172 (29.5%) underwent polypectomy; 2,125 had significant bleeding (6.7‰) and 277 had perforation (0.9‰) <14 days after 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); 1.35 (95%CI=1.12–1.53); and 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 more than two-fold risk of significant bleeding, especially when polypectomy is performed.

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

“…Hsu et al (44) used National Health Insurance Research Database codes for stringent and broad definitions of colonoscopy-related complications. All cases who had an episode of admission within 30 days after colonoscopy were assessed to determine colonoscopy-related adverse events in another study (43).…”

“…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).…”

The effect of antithrombotic treatment on the fecal immunochemical test for colorectal cancer screening: a nationwide cross-sectional study

“…In conclusion, patients receiving antithrombotic treatment are at increased risk of a positive FIT and at a marginally decreased risk of CRC or high risk adenoma detection at subsequent colonoscopy. Treatment with NOACs is increasing and the fact that it leads to a more than twofold increase in FIT positive results could highlight the need for other adjunctive testing (using novel blood-or stool-based biomarkers), both to decrease the number of colonoscopy-related complications and to lessen the burden on colonoscopy units [33,34]. Future studies should address this issue when these biomarkers are being employed in clinical practice.…”

Revisiting bowel preparation: The quest for the optimal low‐residue diet duration

“…Key quality indicators for colonoscopy include adequate bowel preparation, cecal intubation rate, withdrawal time, and adenoma detection rate. By assessing and monitoring key quality indicators, medical professionals can identify areas for improvement, implement necessary changes, and ensure that patients receive the highest standard of care during colonoscopy procedures 7,8 …”

“…By assessing and monitoring key quality indicators, medical professionals can identify areas for improvement, implement necessary changes, and ensure that patients receive the highest standard of care during colonoscopy procedures. 7,8 High-quality bowel preparation plays a crucial role in ensuring optimal outcomes during colonoscopy procedures. Inadequate bowel preparation is associated with lower rates of detecting neoplastic polyps, higher rates of incomplete procedures, and the need for more frequent repeat procedures.…”