Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Clinical Drug Informatics, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan.
J Gastroenterol Hepatol. 2021 Oct;36(10):2745-2753. doi: 10.1111/jgh.15531. Epub 2021 May 5.
In Japan, screening colonoscopy for colorectal cancer is expected to reduce colorectal cancer mortality, although its complication rate has not been sufficiently examined. The aim of this study is to analyze severe complications due to colonoscopy.
As a study population, we retrospectively used commercially anonymized health insurance claims data covering 5.71 million patients from January 2005 to August 2018. We extracted patients who received colonoscopy with lesions resection or without treatment. Main outcomes were rates of hemorrhage, perforation, fatal events, and their risk factors.
Among 341 852 colonoscopy without treatment in 260 128 patients (mean age: 49.6 ± 11.7 years), the rates of hemorrhage, perforation, and fatal events were 0.0059% (95% confidence interval [CI] 0.0031-0.0085), 0.0032% (95% CI 0.0011-0.0052), and 0.00029% (95% CI 0-0.0012), respectively. Regarding hemorrhage, compared with the rate for patients <50 years old (0.0050%), the rates for those 50-59, 60-69, and ≥70 years old were 0.0095% (P = 0.17), 0.0031% (P = 0.17), and 0%, respectively. Regarding perforation, compared with patients <50 years old (0.0056%), the rates for those 50-59, 60-69, and ≥70 years old were 0%, 0.0015% (P = 0.99), and 0.0102% (P = 0.99), respectively. A multivariate analysis for risk factors showed no significant findings for hemorrhage and perforation without treatment. Among 123 087 colonoscopy with lesions resection in 102 058 patients (mean age: 53.7 ± 9.3 years), the rates of hemorrhage, perforation, and fatal events were 0.136% (95% CI 0.1157-0.1572), 0.033% (95% CI 0.0228-0.0437), and 0.00081% (95% CI 0-0.0035), respectively.
The analysis using health insurance claims data demonstrated the safety of colonoscopy.
在日本，筛查结直肠癌的结肠镜检查有望降低结直肠癌死亡率，尽管其并发症发生率尚未得到充分检查。本研究旨在分析结肠镜检查的严重并发症。
作为研究人群，我们回顾性地使用了涵盖 2005 年 1 月至 2018 年 8 月的 571 万患者的商业匿名健康保险索赔数据。我们提取了接受有或无病变切除术的结肠镜检查的患者。主要结局为出血、穿孔、致命事件的发生率及其危险因素。
在 260128 例患者（平均年龄：49.6±11.7 岁）的 341852 例无治疗的结肠镜检查中，出血、穿孔和致命事件的发生率分别为 0.0059%（95%置信区间：0.0031-0.0085）、0.0032%（95%置信区间：0.0011-0.0052）和 0.00029%（95%置信区间：0-0.0012）。关于出血，与<50 岁患者的发生率（0.0050%）相比，50-59 岁、60-69 岁和≥70 岁患者的发生率分别为 0.0095%（P=0.17）、0.0031%（P=0.17）和 0%。关于穿孔，与<50 岁患者（0.0056%）相比，50-59 岁、60-69 岁和≥70 岁患者的发生率分别为 0%、0.0015%（P=0.99）和 0.0102%（P=0.99）。多变量分析危险因素显示，无治疗的出血和穿孔无显著发现。在 102058 例有病变切除术的 123087 例结肠镜检查中（平均年龄：53.7±9.3 岁），出血、穿孔和致命事件的发生率分别为 0.136%（95%置信区间：0.1157-0.1572）、0.033%（95%置信区间：0.0228-0.0437）和 0.00081%（95%置信区间：0-0.0035）。
使用健康保险索赔数据进行的分析表明结肠镜检查是安全的。
