Background

The full spectrum of serious non-gastrointestinal post-colonoscopy complications has not been well characterized. We analyzed rates of and factors associated with adverse post-colonoscopy gastrointestinal (GI) and non-gastrointestinal events (cardiovascular, pulmonary, or infectious) attributable to screening or surveillance colonoscopy (S-colo) and non-screening or non-surveillance colonoscopy (NS-colo).

Methods

We performed a population-based study of colonoscopy complications using databases from California hospital-owned and nonhospital-owned ambulatory facilities, emergency departments, and hospitals from January 1, 2005 through December 31, 2011. We identified patients who underwent S-colo (1.58 million), NS-colo (1.22 million), or low-risk comparator procedures (joint injection, aspiration, lithotripsy; arthroscopy, carpal tunnel; or cataract; 2.02 million) in California’s Ambulatory Services Databases. We identified patients who developed adverse events within 30 days, and factors associated with these events, through patient-level linkage to California’s Emergency Department and Inpatient Databases.

Results

After S-colo, the numbers of lower GI bleeding, perforation, myocardial infarction, and ischemic stroke per 10,000-persons were 5.3 (95% confidence interval [CI], 4.8–5.9), 2.9 (95% CI, 2.5–3.3), 2.5 (95% CI, 2.1–2.9), and 4.7 (95% CI, 4.1–5.2) without biopsy or intervention; with biopsy or intervention, numbers per 10,000-persons were 36.4 (95% CI, 35.1–37.6), 6.3 (95% CI, 5.8–6.8), 4.2 (95% CI, 3.8–4.7), and 9.1 (95% CI, 8.5–9.7). Rates of dysrhythmia were higher. After NS-colo, event rates were substantially higher. Most serious complications led to hospitalization, and most GI complications occurred within 14 days of colonoscopy. Ranges of adjusted odds ratios for serious GI complications, myocardial infarction, ischemic stroke, and serious pulmonary events after S-colo vs comparator procedures were 2.18 (95% CI, 2.02–2.36) to 5.13 (95% CI, 4.81–5.47), 0.67 (95% CI, 0.56–0.81) to 0.99 (95% CI, 0.83–1.19), 0.66 (95% CI, 0.59–0.75) to 1.13 (95% CI, 0.99–1.29), and 0.64 (95% CI, 0.61–0.68) to 1.05 (95% CI, 0.98–1.11). Biopsy or intervention, comorbidity, black race, low income, public insurance, and NS-colo were associated with post-colonoscopy adverse events.

Conclusions

In a population-based study in California, we found that following S-colo, rates of serious GI adverse events were low but clinically relevant, and that rates of myocardial infarction, stroke, and serious pulmonary events were no higher than after low-risk comparator procedures. Rates of myocardial infarction are similar to, but rates of stroke are higher than, those reported for the general population.

中文翻译：

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在基于人群的研究中筛查或监测结肠镜检查的胃肠道和非胃肠道并发症的发生率低

背景

严重的非胃肠道结肠镜检查后并发症的全部光谱尚未得到很好的表征。我们分析了结肠镜检查后胃肠道（GI）和非胃肠道事件（心血管，肺或感染性）不良反应的发生率和相关因素，这些事件归因于筛查或监测结肠镜检查（S-colo）和非筛查或非监测结肠镜检查（ NS-colo）。

方法

我们从2005年1月1日至2011年12月31日使用加利福尼亚州医院拥有和非医院拥有的门诊设施，急诊室和医院的数据库对结肠镜检查并发症进行了基于人群的研究。我们确定接受了S-colo的患者（1.58百万），NS-colo（122万）或加利福尼亚州门诊服务数据库中的低风险比较程序（联合注射，抽吸，碎石术；关节镜检查，腕管或白内障； 202万）。我们通过与加利福尼亚州急诊部门和住院数据库的患者级联系，确定了30天内发生不良事件的患者以及与这些事件相关的因素。

结果

S-colo后，每10,000人的下消化道出血，穿孔，心肌梗塞和缺血性卒中的发生率分别为5.3（95％置信区间[CI]，4.8-5.9），2.9（95％CI，2.5-3.3） ，2.5（95％CI，2.1-2.9）和4.7（95％CI，4.1-5.2），无需活检或干预；进行活检或干预后，每10,000人的人数分别为36.4（95％CI，35.1–37.6），6.3（95％CI，5.8–6.8），4.2（95％CI，3.8–4.7）和9.1（95％CI ，8.5–9.7）。心律失常的发生率较高。NS-colo后，事件发生率明显更高。最严重的并发症导致住院，大多数胃肠道并发症发生在结肠镜检查后的14天内。严重胃肠道并发症，心肌梗塞，缺血性卒中和严重肺事件发生的校正比值比范围为2.18（95％CI，2.02–2.36）至5.13（95％CI，4。81–5.47），0.67（95％CI，0.56–0.81）至0.99（95％CI，0.83–1.19），0.66（95％CI，0.59–0.75）至1.13（95％CI，0.99–1.29）和0.64（95％CI，0.61-0.68）至1.05（95％CI，0.98-1.11）。结肠镜检查后的不良事件与活检或干预，合并症，黑人种族，低收入，公共保险和NS-colo有关。

结论

在加利福尼亚的一项基于人群的研究中，我们发现在进行S-colo后，严重的胃肠道不良事件发生率较低，但在临床上相关，并且心肌梗塞，中风和严重的肺部事件发生率不低于低风险后比较器程序。心肌梗死的发生率与普通人群相似，但中风发生率高于报告的人群。