Singh Harminder, Penfold Robert B, De Coster Carolyn, Au Wendy, Bernstein Charles N, Moffatt Michael
Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada.
Can J Gastroenterol. 2010 Jul;24(7):425-30. doi: 10.1155/2010/714591.
There are limited data regarding complications associated with colonoscopy and flexible sigmoidoscopy in usual clinical practice in Canada.
To determine the risk factors for lower gastrointestinal (GI) endoscopy-associated complications in usual clinical practice.
All outpatient lower GI endoscopies performed in Winnipeg (Manitoba) between April 1, 2004 and March 31, 2006, were identified from the provincial physicians' claims database. All subsequent hospital admissions within 30 days that documented potential complications associated with lower GI endoscopies were identified from the electronic hospital discharges database and reviewed. Multivariate generalized estimating equation regression analysis was performed to determine independent factors (patient, endoscopist and procedure) associated with the risk of developing complications.
There were 29,990 outpatient lower GI endoscopies performed in Winnipeg during the years studied. Seventy-seven (0.26%) procedures were associated with complications requiring hospitalization within 30 days of the index procedure. Stricture dilation (rate ratio [RR] 23.14; 95% CI 6.70 to 76.51), polypectomy (RR 5.93; 95% CI 3.66 to 9.62), increasing patient age (for each year increase in age, RR 1.03; 95% CI 1.01 to 1.05) and performance of endoscopy by low-volume endoscopists (fewer than 200 procedures per year, RR 2.28; 95% CI 1.18 to 4.42) and family physicians (RR 2.23; 95% CI 1.39 to 3.58) were independently associated with complications.
The results of the present study suggest that increasing patient age, complex procedures and performance of the index procedure by low-volume endoscopists are independent risk factors for lower GI endoscopy-associated complications in usual clinical practice. This suggests that it may be time to consider implementing minimum volume requirements for endoscopists performing non-screening lower GI endoscopies.
在加拿大的日常临床实践中，关于结肠镜检查和乙状结肠镜检查相关并发症的数据有限。
确定日常临床实践中与下消化道（GI）内镜检查相关并发症的危险因素。
从省级医生索赔数据库中识别出2004年4月1日至2006年3月31日在温尼伯（曼尼托巴省）进行的所有门诊下消化道内镜检查。从电子医院出院数据库中识别并审查所有在30天内记录有与下消化道内镜检查相关潜在并发症的后续住院情况。进行多变量广义估计方程回归分析，以确定与发生并发症风险相关的独立因素（患者、内镜医师和操作）。
在研究期间，温尼伯共进行了29990例门诊下消化道内镜检查。77例（0.26%）操作与在索引操作后30天内需要住院治疗的并发症相关。狭窄扩张（率比[RR]23.14；95%可信区间6.70至76.51）、息肉切除术（RR 5.93；95%可信区间3.66至9.62）、患者年龄增加（年龄每增加一岁，RR 1.03；95%可信区间1.01至1.05）以及由低工作量内镜医师（每年少于200例操作，RR 2.28；95%可信区间1.18至4.42）和家庭医生进行内镜检查（RR 2.23；95%可信区间1.39至3.58）均与并发症独立相关。
本研究结果表明，患者年龄增加、复杂操作以及由低工作量内镜医师进行索引操作是日常临床实践中与下消化道内镜检查相关并发症的独立危险因素。这表明可能是时候考虑对进行非筛查性下消化道内镜检查的内镜医师实施最低工作量要求了。
