Arora Gaurav, Mannalithara Ajitha, Singh Gurkirpal, Gerson Lauren B, Triadafilopoulos George
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California 94305-5187, USA.
Gastrointest Endosc. 2009 Mar;69(3 Pt 2):654-64. doi: 10.1016/j.gie.2008.09.008.
Previous studies that reported the incidence of perforation from a colonoscopy are limited by small sample sizes, restricted age groups, or single-center data.
To determine the incidence and risk factors of colonic perforation from a colonoscopy in a large population cohort.
Retrospective, population-based, cohort study, followed by a nested case-control study.
California Medicaid program claims database.
A total of 277,434 patients (aged 18 years and older) who underwent a colonoscopy during 1995 to 2005, age, sex, and time matched to 4 unique general-population controls.
Perforation incidence in the 7 days after colonoscopy (or matched index date for controls) with odds ratio (OR); multivariate logistic regression to calculate adjusted ORs for subsequent analysis of risk factors.
A total of 228 perforations were diagnosed after 277,434 colonoscopies, which corresponded to a cumulative 7-day incidence of 0.082%. The OR of getting a perforation from a colonoscopy compared with matched controls (n = 1,072,723) who did not undergo a colonoscopy was 27.6 (95% CI, 19.04-39.92), P < .001. On multivariate analysis, when comparing the group that had a perforation after a colonoscopy (n = 216) with those who did not (n = 269,496), increasing age, significant comorbidity, obstruction as an indication for the colonoscopy, and performance of invasive interventions during colonoscopy were significant positive predictors. Performance of biopsy or polypectomy did not affect the perforation risk. The rate of perforation did not change significantly over time.
Validity of coding and capturing of all perforation diagnoses may possibly be deficient.
The risk of perforation from a colonoscopy is low, but, despite increased experience with the procedure, it remains unchanged over time.
既往报道结肠镜检查穿孔发生率的研究存在样本量小、年龄组受限或单中心数据等局限性。
确定大型人群队列中结肠镜检查导致结肠穿孔的发生率及危险因素。
回顾性、基于人群的队列研究，随后进行巢式病例对照研究。
加利福尼亚医疗补助计划索赔数据库。
1995年至2005年期间接受结肠镜检查的277434例患者（年龄18岁及以上），年龄、性别和时间与4名独特的普通人群对照匹配。
结肠镜检查后7天内的穿孔发生率（或对照的匹配索引日期）及比值比（OR）；多因素逻辑回归分析以计算调整后的OR，用于后续危险因素分析。
277434例结肠镜检查后共诊断出228例穿孔，对应7天累计发生率为0.082%。与未接受结肠镜检查的匹配对照（n = 1072723）相比，结肠镜检查发生穿孔的OR为27.6（95%CI，19.04 - 39.92），P <.001。多因素分析显示，将结肠镜检查后发生穿孔的组（n = 216）与未发生穿孔的组（n = 269496）进行比较时，年龄增加、显著合并症、结肠镜检查指征为梗阻以及结肠镜检查期间进行侵入性干预是显著的阳性预测因素。活检或息肉切除术的实施不影响穿孔风险。穿孔率随时间未发生显著变化。
所有穿孔诊断的编码和捕获有效性可能不足。
结肠镜检查导致穿孔的风险较低，但尽管该操作经验增加，其发生率随时间保持不变。
