Saturday, February 28, 2009
colonoscopy
Summary and Comment
Colonoscopy-Related Bleeding and Perforation
Older age, male sex, polypectomy, and performance by a low-volume endoscopist were risk factors for bleeding or perforation in a population-based study in Canada.
Data on perforation rates in clinical practice are limited because most reports of such complications come from individual centers. Now, researchers in Canada have conducted a population-based study to determine the rates of — and risk factors for — colonoscopy-related bleeding and perforation. Using physician claims databases, they identified all individuals aged 50 to 75 who underwent outpatient colonoscopy in British Columbia, Alberta, Ontario, or Nova Scotia between April 1, 2002, and March 31, 2003 (n=97,091). Then, they used administrative data to identify people who were admitted to the hospital with colonoscopy-related bleeding or perforation within 30 days after the procedure.
Pooled rates of bleeding and perforation were 1.64 per 1000 procedures and 0.85 per 1000 procedures, respectively; the death rate — determined only for Ontario — was 0.074 per 1000 procedures (approximately 1 per 13,500). Predictors of having either bleeding or perforation were older age, male sex, polypectomy, and completion of the colonoscopy by an individual with a low annual colonoscopy volume (<300 per year). When the analysis was limited to colonoscopies performed by gastroenterologists, only polypectomy was associated with bleeding or perforation.
Comment: In general, these data are in line with single-center reports and with the few available population-based studies. Clearly, older age and polypectomy are risk factors for perforation, and polypectomy is the major risk factor for bleeding. Whether male sex is actually a risk factor is uncertain; this study could not account for the number of polyps removed per colonoscopy, and men are more likely than women both to have multiple polyps and to have more large polyps. Based on findings from other investigations, large polyp size is definitely a risk factor for bleeding. Of considerable importance is the observation that lower annual colonoscopy volumes are associated with higher complication rates. This effect disappeared when investigators considered only procedures done by gastroenterologists, suggesting that the more extensive training received by these specialists eliminates the volume effect. If this finding is corroborated by further study, it could have important implications — perhaps for training and perhaps for the appropriate volume of colonoscopy needed to maintain adequate skills.
— Douglas K. Rex, MD
Published in Journal Watch Gastroenterology February 27, 2009
Citation(s):
Rabeneck L et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 2008 Dec; 135:1899.
Medline abstract (Free)
Colonoscopy-Related Bleeding and Perforation
Older age, male sex, polypectomy, and performance by a low-volume endoscopist were risk factors for bleeding or perforation in a population-based study in Canada.
Data on perforation rates in clinical practice are limited because most reports of such complications come from individual centers. Now, researchers in Canada have conducted a population-based study to determine the rates of — and risk factors for — colonoscopy-related bleeding and perforation. Using physician claims databases, they identified all individuals aged 50 to 75 who underwent outpatient colonoscopy in British Columbia, Alberta, Ontario, or Nova Scotia between April 1, 2002, and March 31, 2003 (n=97,091). Then, they used administrative data to identify people who were admitted to the hospital with colonoscopy-related bleeding or perforation within 30 days after the procedure.
Pooled rates of bleeding and perforation were 1.64 per 1000 procedures and 0.85 per 1000 procedures, respectively; the death rate — determined only for Ontario — was 0.074 per 1000 procedures (approximately 1 per 13,500). Predictors of having either bleeding or perforation were older age, male sex, polypectomy, and completion of the colonoscopy by an individual with a low annual colonoscopy volume (<300 per year). When the analysis was limited to colonoscopies performed by gastroenterologists, only polypectomy was associated with bleeding or perforation.
Comment: In general, these data are in line with single-center reports and with the few available population-based studies. Clearly, older age and polypectomy are risk factors for perforation, and polypectomy is the major risk factor for bleeding. Whether male sex is actually a risk factor is uncertain; this study could not account for the number of polyps removed per colonoscopy, and men are more likely than women both to have multiple polyps and to have more large polyps. Based on findings from other investigations, large polyp size is definitely a risk factor for bleeding. Of considerable importance is the observation that lower annual colonoscopy volumes are associated with higher complication rates. This effect disappeared when investigators considered only procedures done by gastroenterologists, suggesting that the more extensive training received by these specialists eliminates the volume effect. If this finding is corroborated by further study, it could have important implications — perhaps for training and perhaps for the appropriate volume of colonoscopy needed to maintain adequate skills.
— Douglas K. Rex, MD
Published in Journal Watch Gastroenterology February 27, 2009
Citation(s):
Rabeneck L et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 2008 Dec; 135:1899.
Medline abstract (Free)
# posted by roodbont @ 1:24 AM 
