Sewitch Maida J, Jiang Mengzhu, Joseph Lawrence, Barkun Alan N, Bitton Alain
Department of Medicine, McGill University, Montreal, Quebec.
Can J Gastroenterol. 2012 Sep;26(9):611-3. doi: 10.1155/2012/382149.
The rate of serious complications is one marker of the quality of colonoscopy services.
To estimate the rate of serious complications of colonoscopy according to colonoscopy indication and polypectomy status.
A prospective cohort study of patients scheduled for colonoscopy who were recruited from seven endoscopy facilities across Montreal (Quebec) was conducted. Before colonoscopy, patients completed a brief questionnaire and provided their health insurance numbers. Colonoscopy indication was based on patient-reported medical history. Polypectomy status was obtained from provincial physician billing records (Régie de l'assurance maladie du Québec). Diagnoses and procedures associated with hospitalization in the 30 days following colonoscopy were obtained from the provincial hospitalization database (MedEcho).
Of the 2134 patients enrolled (mean age 60.9 years, 50.1% male), 33 (1.55% [95% CI 1.06% to 2.16%]) were hospitalized within 30 days. One patient experienced bleeding following a colonoscopy that involved polypectomy and was diagnosed with carcinoma in situ of the rectum. Based on self-reported rectal bleeding in the previous six months, the colonoscopy was nonscreening. The provincial hospitalization data showed no occurrences of perforation, diverticulitis, myocardial infarction⁄stroke or death; thus, the rate of serious colonoscopy complications was 0.05% (95% CI 0.00% to 0.26%).
The rate of serious colonoscopy complications requiring hospitalization was low and comparable with what is reported in the literature. The serious complication occurred subsequent to polypectomy and in a nonscreening colonoscopy.
The findings support the relative safety of screening colonoscopy in persons without large bowel diseases and symptoms. However, future research to determine the rate of serious complications not requiring hospitalization is warranted to reassure decision makers of the safety of colonoscopy for colorectal cancer screening.
严重并发症发生率是结肠镜检查服务质量的一个指标。
根据结肠镜检查指征和息肉切除术情况估计结肠镜检查严重并发症的发生率。
对从蒙特利尔（魁北克）七个内镜检查机构招募的计划进行结肠镜检查的患者进行前瞻性队列研究。在结肠镜检查前，患者填写一份简短问卷并提供其健康保险号码。结肠镜检查指征基于患者报告的病史。息肉切除术情况从省级医生计费记录（魁北克医疗保险局）中获取。结肠镜检查后30天内与住院相关的诊断和操作从省级住院数据库（MedEcho）中获取。
在纳入的2134例患者中（平均年龄60.9岁，50.1%为男性），33例（1.55%[95%CI 1.06%至2.16%]）在30天内住院。1例患者在进行涉及息肉切除术的结肠镜检查后出现出血，并被诊断为直肠原位癌。基于前六个月自我报告的直肠出血情况，该结肠镜检查为非筛查性。省级住院数据显示未发生穿孔、憩室炎、心肌梗死/中风或死亡；因此，结肠镜检查严重并发症的发生率为0.05%（95%CI 0.00%至0.26%）。
需要住院治疗的结肠镜检查严重并发症发生率较低，与文献报道相当。严重并发症发生在息肉切除术后且为非筛查性结肠镜检查。
这些发现支持在无大肠疾病和症状的人群中进行筛查结肠镜检查具有相对安全性。然而，未来有必要开展研究以确定无需住院治疗的严重并发症发生率，从而让决策者放心结肠镜检查用于结直肠癌筛查的安全性。
