Age-Specific Rates and Time-Courses of Gastrointestinal and Nongastrointestinal Complications Associated With Screening/Surveillance Colonoscopy

• Published in: The American journal of gastroenterology Vol. 116; no. 12; pp. 2430 - 2445
• Main Authors: Ladabaum, Uri, Mannalithara, Ajitha, Desai, Manisha, Sehgal, Maanek, Singh, Gurkirpal
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer 01.12.2021; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Age; Age Distribution; Age Factors; Aged; Aged, 80 and over; Colonoscopy; Colonoscopy - adverse effects; Emergency medical care; Female; Gastroenterology; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - etiology; Health surveillance; Heart attacks; Human subjects; Humans; Incidence; Inpatients - statistics & numerical data; Intestinal Perforation - epidemiology; Intestinal Perforation - etiology; Male; Mass Screening - methods; Medical screening; Medicare; Middle Aged; Population; Population Surveillance; Quality control; Retrospective Studies; Risk Factors; Stroke; United States > US; California
• ISSN: 0002-9270; 1572-0241; 1572-0241
• DOI: 10.14309/ajg.0000000000001531

The rates of serious cardiac, neurologic, and pulmonary events attributable to colonoscopy are poorly characterized, and background event rates are usually not accounted for. We performed a multistate population-based study using changepoint analysis to determine the rates and timing of serious gastrointestinal and nongastrointestinal adverse events associated with screening/surveillance colonoscopy, including analyses by age (45 to <55, 55 to <65, 65 to <75, and ≥75 years). Among 4.5 million persons in the Ambulatory Surgery and Services Databases of California, Florida, and New York who underwent screening/surveillance colonoscopy in 2005-2015, we ascertained serious postcolonoscopy events in excess of background rates in Emergency Department (SEDD) and Inpatient Databases (SID). Most serious nongastrointestinal postcolonoscopy events were expected based on the background rate and not associated with colonoscopy itself. However, associated nongastrointestinal events predominated over gastrointestinal events at ages ≥65 years, including more myocardial infarctions plus ischemic strokes than perforations at ages ≥75 years (361 [95% confidence intervals {CI} 312-419] plus 1,279 [95% CI 1,182-1,384] vs 912 [95% CI 831-1,002] per million). At all ages, the observed-to-expected ratios for days 0-7, 0-30, and 0-60 after colonoscopy were substantially >1 for gastrointestinal bleeding and perforation, but minimally >1 for most nongastrointestinal complications. Risk periods ranged from 1 to 125 days depending on complication type and age. No excess postcolonoscopy in-hospital deaths were observed. Although crude counts substantially overestimate nongastrointestinal events associated with colonoscopy, nongastrointestinal complications exceed bleeding and perforation risk in older persons. The inability to ascertain modifications to antiplatelet therapy was a study limitation. Our results can inform benefit-to-risk determinations for preventive colonoscopy.