Denis Bernard, Gendre Isabelle, Weber Sarah, Perrin Philippe
Department of Gastroenterology, Louis Pasteur Hospital, Colmar, France.
ADECA Alsace, Colmar, France.
Endosc Int Open. 2021 Feb;9(2):E224-E232. doi: 10.1055/a-1324-2763. Epub 2021 Feb 3.
The aim of this study was to assess adverse events (AEs) associated with colonoscopy in the French colorectal cancer screening program with fecal occult blood test (FOBT). A retrospective cohort study was performed of all colonoscopies performed from 2015 to 2018 for a positive fecal immunochemical test (FIT) in patients aged 50 to 74 years within the screening program in progress in Alsace, part of the French program. AEs were recorded through prospective voluntary reporting by community gastroenterologists and retrospective postal surveys addressed to individuals screened. They were compared with those recorded in the previous program following colonoscopies performed from 2003 to 2014 for a positive guaiac-based FOBT (gFOBT). Of 9576 colonoscopies performed for a positive FIT, 6194 (64.7 %) were therapeutic. Overall, 180 AEs were recorded (18.8 ‰, 95 % CI 16.1-21.5), 114 of them (11.9 ‰, 95 % CI 9.7-14.1) requiring hospitalization, 55 (5.7‰, 95 % CI 4.2-7.3) hospitalization > 24 hours, and eight (0.8 ‰, 95 % CI 0.3-1.4) surgery. The main complications requiring hospitalization were perforation (n = 18, 1.9 ‰, 95 % CI 1.0-2.7) and bleeding (n = 31, 3.2 ‰, 95 % CI 2.1-4.4). Despite a significant increase in several risk factors for complication, the rate of AEs remained stable between gFOBT and FIT programs. Overall, we observed one death (1/27,000 colonoscopies) and three splenic injuries. The harms of colonoscopy in a colorectal cancer screening program with FIT are more frequent than usually estimated. This study revealed six AEs requiring hospitalization > 24 hours (three bleeds, two perforations), one necessitating surgery, and 50 minor complications per 1000 colonoscopies.
本研究的目的是评估在法国采用粪便潜血试验（FOBT）的结直肠癌筛查项目中与结肠镜检查相关的不良事件（AE）。对2015年至2018年在法国阿尔萨斯地区（法国项目的一部分）正在进行的筛查项目中，因粪便免疫化学试验（FIT）呈阳性而接受结肠镜检查的所有50至74岁患者进行了一项回顾性队列研究。不良事件通过社区胃肠病学家的前瞻性自愿报告以及针对接受筛查个体的回顾性邮政调查进行记录。将这些不良事件与2003年至2014年因基于愈创木脂的FOBT（gFOBT）呈阳性而进行结肠镜检查的上一个项目中记录的不良事件进行比较。在因FIT呈阳性而进行的9576例结肠镜检查中，6194例（64.7%）为治疗性检查。总体而言，记录到180例不良事件（18.8‰，95%CI 16.1 - 21.5），其中114例（11.9‰，95%CI 9.7 - 14.1）需要住院治疗，55例（5.7‰，95%CI 4.2 - 7.3）住院时间超过24小时，8例（0.8‰，95%CI 0.3 - 1.4）需要手术治疗。需要住院治疗的主要并发症是穿孔（n = 18，1.9‰，95%CI 1.0 - 2.7）和出血（n = 31，3.2‰，95%CI 2.1 - 4.4）。尽管并发症的几个风险因素显著增加，但gFOBT和FIT项目之间的不良事件发生率保持稳定。总体而言，我们观察到1例死亡（1/27,000例结肠镜检查）和3例脾损伤。在采用FIT的结直肠癌筛查项目中，结肠镜检查的危害比通常估计的更为频繁。本研究显示，每1000例结肠镜检查中有6例不良事件需要住院时间超过24小时（3例出血、2例穿孔），1例需要手术治疗，以及50例轻微并发症。
