Colonoscopies are widely used clinical procedures that enable physicians to look inside the large intestine, and helps with patient diagnoses. A recently conducted meta-analysis, published in The American Journal of Gastroenterology, investigated the prevalence and rate of post-colonoscopy complications.
A colonoscopy is a clinical procedure that enables a physician to look inside the large intestine (commonly referred to as the colon). Colonoscopies are practiced worldwide, and used frequently in diagnosing ulcerative colitis, Crohn’s disease, polyps, and colorectal cancers. During the procedure, a colonoscope (thin, flexible tube with a camera attached to the end) is inserted into the anus to take pictures or videos of the colon. Several complications can arise after the procedure including perforations (a small hole in the colon), bleeding, and/or mortality. Worldwide efforts, by the American Society of Gastrointestinal Endoscopy (ASGE) and the European Society of Gastrointestinal Endoscopy (ESGE), aim to continuously improve the safety standards and protocols for colonoscopies, in hopes of reducing post-colonoscopy complications.
A recent meta-analysis, published in The American Journal of Gastroenterology, investigated the prevalence and rate of post-colonoscopy complications. The authors defined complications as perforation or bleeding with 30-days post-colonoscopy, or mortality within the first 3-months after colonoscopy. The authors began by conducting a comprehensive literature search of Pubmed, the Cochrane library, and Ovid EMbase for population-based studies on post-colonoscopy complications, between January 2001 and December 2015. After careful consideration and exclusion of certain studies, 21 studies (14 retrospective and 7 prospective) were included, representing a total of 1,966,340 colonoscopies.
The meta-analysis revealed that for all colonoscopies (irrespective of indication), the perforation rate was 0.5/1,000 colonoscopies, bleeding rate was 2.6/1,000 colonoscopies, and the mortality rate was 2.9/1,000 colonoscopies. When considering colonoscopies performed for screening or surveillance purposes only, the perforation and bleeding rates decreased slightly to 0.3/1,000 and 2.4/1,000 colonoscopies, respectively. In contrast, perforation (1.3/1,000 colonoscopies) and bleeding (4.6/1,000 colonoscopies) rates were significantly higher in symptomatic patients. The authors also discovered that perforation and bleeding complications were significantly higher in patients undergoing polypectomy, the removal of polyps from the colon to prevent them from turning cancerous. The analysis also revealed that over the last 15 years, the prevalence of post-colonoscopy bleeding has steadily declined, whereas perforation and mortality rates have remained stable.
The meta-analysis reaffirmed the notion that colonoscopies are an overall safe procedure, that can be vital in patient diagnoses. However, complications can occur, and therefore it is important to monitor patient safety and improve protocols whenever possible. The study demonstrates that post-colonoscopy complications vary depending on the colonoscopy indication. For instance, colonoscopies for screening/surveillance purposes come with less risk than colonoscopies for patients with symptoms or those that have undergone polypectomy procedures. Additionally, trends from the last 15 years show that despite rigorous efforts in improving safety standards and protocols, only bleeding rates have decreased, whereas perforation and mortality rates remain the same. This, however, is misleading. With increasing volumes of colonoscopies and increased complexity of procedures, including polypectomies, one would expect complications to have increased over the years. Instead, with continuous improvements in colonoscopy equipment, techniques, and training, complications have remained steady or decreased. In conclusion, the meta-analysis is reassuring, and highlights how efforts to achieve and maintain safe colonoscopy practices have allowed complication rates to remain low. It further encourages healthcare providers and researchers to continue developing even safer standards and protocol for colonoscopies.
Written By: Haisam Shah, BSc