Tadano Toshihiro, Abe Koichiro, Sasaki Seiju, Terasawa Teruhiko, Hosono Satoyo, Katayama Takafumi, Hoshi Keika, Nakayama Tomio, Hamashima Chisato
Cancer Detection Center, Miyagi Cancer Society, Miyagi, Japan.
Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Dig Endosc. 2025 Sep;37(9):905-918. doi: 10.1111/den.15055. Epub 2025 Jun 5.
Bowel preparation for colonoscopy can lead to serious adverse events (AEs), raising significant safety concerns in colorectal cancer (CRC) screening. A systematic review of these serious AEs in Japan was performed to explore potential management strategies.
The Ovid-MEDLINE and Ichushi databases were searched from inception to March 2024. Domestic studies that reported serious AEs in adults aged 18 years and older who were administered bowel cleansing agents or laxatives for a scheduled colonoscopy, regardless of its purpose, were extracted. Serious AEs were defined as those requiring hospitalization or extended hospital stays. Selected studies were assessed for quality verification using the established checklist.
A total of 5049 articles were identified through database searches, and 54 articles were extracted based on selection criteria. Reports of the frequency of serious AEs were based on one case series study, which found 13.9 cases of bowel obstruction and 2.3 cases of bowel perforation per 100,000 colonoscopies. Multiple serious AEs caused by different agents were identified in 78 cases across 54 articles. These AEs were predominantly observed in elderly individuals and those with comorbidities. Though most cases were associated with diagnostic tests for symptomatic patients, some were also observed in primary screening or fecal test-positive individuals. The most common AE was induced by bowel obstruction, primarily in abdominally symptomatic patients, including one fatality.
The frequency and characteristics of serious AEs associated with bowel preparation for colonoscopy in Japan were presented. These findings may contribute to managing these AEs, specifically in CRC screening.
结肠镜检查的肠道准备可能导致严重不良事件（AE），这在结直肠癌（CRC）筛查中引发了重大安全问题。本研究对日本这些严重不良事件进行了系统评价，以探索潜在的管理策略。
检索Ovid-MEDLINE和Ichushi数据库，检索时间从建库至2024年3月。提取国内关于18岁及以上成年人接受肠道清洁剂或泻药进行结肠镜检查（无论目的如何）后发生严重不良事件的研究。严重不良事件定义为需要住院或延长住院时间的事件。使用既定清单对选定研究进行质量验证评估。
通过数据库检索共识别出5049篇文章，根据入选标准提取了54篇文章。严重不良事件发生率的报告基于一项病例系列研究，该研究发现每10万例结肠镜检查中有13.9例肠梗阻和2.3例肠穿孔。在54篇文章中的78例中发现了由不同药物引起的多种严重不良事件。这些不良事件主要在老年人和患有合并症的个体中观察到。虽然大多数病例与有症状患者的诊断检查相关，但在初筛或粪便检测呈阳性的个体中也观察到了一些病例。最常见的不良事件是由肠梗阻引起的，主要发生在有腹部症状的患者中，包括1例死亡。
本研究呈现了日本结肠镜检查肠道准备相关严重不良事件的发生率和特征。这些发现可能有助于管理这些不良事件，尤其是在CRC筛查中。
