Chubak Jessica, Ichikawa Laura E, Merchant Sophie A, Dalmat Ronit R, Ziebell Rebecca A, Jensen Christopher D, Lee Jeffrey K, Corley Douglas A, Ghai Nirupa R, Green Beverly B, Skinner Celette Sugg, Schottinger Joanne E, Breslau Erica S, Levin Theodore R
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Cancer Epidemiol Biomarkers Prev. 2025 Feb 6;34(2):281-289. doi: 10.1158/1055-9965.EPI-24-0551.
Screening colonoscopy harm data are limited for adults ages 76 to 85 years.
We conducted a retrospective cohort study of screening colonoscopies versus fecal immunochemical tests (FIT) and general population matched comparators ages 76 to 85 years within three integrated healthcare systems (2010-2019). The primary outcome was death or overnight hospitalization within 30 days. A secondary outcome also included nine harm diagnoses. Adjusted risk estimates and risk differences (RD) were obtained using Poisson regression. Narrow analyses excluded outcomes after the next lower endoscopy or colorectal procedure, whereas broad analyses included them.
Patients undergoing screening colonoscopy (N = 4,435) had a higher 10-day cumulative incidence of gastrointestinal bleeding {0.18% [95% confidence interval (CI), 0.09%-0.35%]} and perforation [0.09% (95% CI, 0.03%-0.23%)] than those with FIT (N = 17,740) and the general population (N = 44,350) in the narrow analysis. Screening colonoscopy patients had a 1.04% (95% CI, 0.74%-1.34%) risk of death or hospitalization within 30 days in the narrow analysis, similar to those with FIT [RD = 0% (95% CI, -0.36% to 0.35%)] and the general population [RD = -0.07% (95% CI, -0.39% to 0.25%)]. In the broad analysis, risk following colonoscopy was 2.30% (95% CI, 1.85%-2.75%) with RD = 1.13% (95% CI, 0.67%-1.60%) versus general population [ages 76-80 years: RD = 0.93% (95% CI, 0.45%-1.41%) and ages 81-85 years: RD = 2.14% (95% CI, 0.74%-3.54%)]. Secondary outcomes followed a similar pattern by age.
At ages 76 to 85 years, screening colonoscopies including downstream procedures are associated with an increased short-term risk of death or hospitalization.
Harm data can be combined with benefit data to guide screening colonoscopy decisions among older adults.
关于76至85岁成年人结肠镜筛查危害的数据有限。
我们在三个综合医疗系统内（2010 - 2019年）进行了一项回顾性队列研究，比较了76至85岁人群的结肠镜筛查与粪便免疫化学检测（FIT）以及一般人群匹配对照者的情况。主要结局是30天内死亡或过夜住院。次要结局还包括九种危害诊断。使用泊松回归获得调整后的风险估计值和风险差异（RD）。狭义分析排除了下一次较低级别的内镜检查或结直肠手术后的结局，而广义分析则包括这些结局。
在狭义分析中，接受结肠镜筛查的患者（N = 4435）胃肠道出血的10天累积发生率{0.18%[95%置信区间（CI），0.09% - 0.
