Colonoscopy related adverse events and mortality in an Italian organized colorectal cancer screening program

Colorectal Cancer

Endoscopy. 2020 Jul 28. doi: 10.1055/a-1228-9225. Online ahead of print.


Background and Aims Post-colonoscopy adverse events (AE) are a key quality indicator in population-based colorectal cancer screening programs, affecting safety and costs. Aim of this study was to assess colonoscopy-related AE and mortality in a screening setting. Methods We retrieved data from a cohort of patients undergoing colonoscopy within a screening program (Faecal Immunochemical Test every 2 years, 50 to 69 years old, or post-polypectomy surveillance) in Italy between 2002 and 2014, to

assess the rate of post-colonoscopy related AE and mortality. Any admission within 30 days of a screening colonoscopy was reviewed to capture any possible AE. Mortality registries were also matched with endoscopy database to investigate 30-day post colonoscopy mortality rate. Association of each outcome with patient/procedure related variables was assessed with multivariable analysis. Results Overall, 117,881 screening colonoscopies (66,584, 56.5%, with polypectomy) were included. Overall, 497/117,881 (0.42%) post-colonoscopy AE occurred: 281 (0.24%) bleedings and 65 (0.05%) perforations (3.7‰/0.7‰, operative/diagnostic procedures, p<0.001). At multivariable analysis, bleeding was associated to polyp size (≥20mm: OR 16.29, 95%CI: 9.39-28.29), proximal location (OR 1.46, 95%CI: 1.14-1.87), and histology severity (high-risk adenoma, OR 5.6, 95%CI: 2.43-12.91), while perforation was associated to endoscopic resection (OR 2.91, 95%CI: 1.62-5.22), polyp size (OR 4.34, 95%CI: 1.46-12.92) and proximal location (OR 1.94, 95%CI: 1.12-3.37). Post-colonoscopy death occurred in 15/117,881 (1.27x10,000) cases. Conclusions In an organised screening program, post-colonoscopy AE are a rare but not negligible eventuality. The most frequent is post-polypectomy bleeding, especially after resection of large (≥20mm) and proximal lesions.