Global rates of post-colonoscopy complications remain low
Worldwide rates of post-colonoscopy complications either remained low or decreased in the past 15 years, confirming the global safety of colonoscopy as a diagnostic, screening, surveillance and therapeutic procedure, according to the results of a systematic review and meta-analysis.
“To date, there has been no systematic review with meta-analysis of data to estimate the post-colonoscopy complication rate in routine clinical practice,” the researchers wrote. “It is also unclear whether improvements in colonoscopy training and technological progress over the past years lead to a change in the post-colonoscopy complication rate.”
The researchers included 21 population-based studies (14 retrospective; seven prospective) evaluating complications within 30 days of 1,966,340 colonoscopies performed from January 2001 through August 2012 in the United States, Canada, Europe, South Korea and New Zealand. They estimated the pooled prevalence of post-colonoscopy bleeding, post-polypectomy bleeding, perforation and mortality rates, and also evaluated annual trends in post-colonoscopy complication rates.
The overall perforation rate was 0.5 per 1,000 colonoscopies (95% CI, 0.4-0.7), the post-colonoscopy bleeding rate was 2.6 per 1,000 colonoscopies (95% CI, 1.7-3.7) and the mortality rate was 2.9 per 100,000 colonoscopies (95% CI, 1.1-5.5).
The perforation rate was higher after colonoscopies with polypectomy (0.8/1,000 colonoscopies; 95% CI, 0.6-1) compared with colonoscopies performed without polypectomy (0.4/1,000 colonoscopies; 95% CI, 0.2-0.8; P = .07). The post-polypectomy bleeding rate was also higher after colonoscopies with polypectomy (9.8/1,000 colonoscopies; 95% CI, 7.7-12.1) compared with colonoscopies performed without polypectomy (0.6/1,000 colonoscopies; 95% CI, 0.2-1.1; P < .001).
Colonoscopies performed in symptomatic patients had higher perforation and bleeding rates compared with screening or surveillance colonoscopies (both P < .001).
Heterogeneity across studies was high for perforation and bleeding but low for mortality.
The post-colonoscopy bleeding rate dropped from 6.4 per 1,000 colonoscopies in 2001 to 1 per 1,000 colonoscopies in 2015 (P = .07), but perforation and mortality rates remained stable.
“Despite increasing numbers and technical difficulty of colonoscopy over the past years, the post-colonoscopy complication rate remained relatively stable or even declined, likely reflecting positive changes and improvements in colonoscopy practice,” the researchers concluded. They also called for global definitions of post-colonoscopy complications to improve future research efforts and ultimately reduce patient risk. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.