OBJECTIVES To estimate the systemic serious adverse event (SAE) rates after colonoscopy and to identify their risk factors. METHODS A nationwide cohort study was conducted using the comprehensive French claims databases SNDS (National Health Data System). Patients aged 30 years and over who underwent a first screening or diagnostic colonoscopy in 2010-2015 were included. The rates of cardiovascular and renal SAEs were estimated within 5 days after colonoscopy. The standardized incidence ratios were calculated to compare these incidence rates with those of the same events in the general population, and the associated risk factors were assessed by multilevel logistic regression. RESULTS Among the 4,088,799 included patients (median age, 59 years [interquartile range = 50-67]; 55.2% women; 30.1% with a Charlson index score ≤1), the 5-day SAE incidence rate was 2.8/10,000 procedures for shock, 0.87/10,000 for myocardial infarction, 1.9/10,000 for stroke, 2.9/10,000 for pulmonary embolism, 5.5/10,000 for acute renal failure, and 3.3/10,000 for urolithiasis. These SAEs occurred 3.3 to 15.8 times more often during the first 5 days after colonoscopy than expected in the general population. Thirty-day mortality rates ranged from 2.2/1,000 cases of urolithiasis to 268.1/1,000 cases of shock. Increasing age was associated with an increasing incidence of SAEs. Risks of shock and acute renal failure were associated with a greater number of comorbidities than the other SAEs. Colonoscopies in university hospitals were associated with higher risks, reflecting patient selection processes. DISCUSSION The systemic SAEs can be associated with a substantial mortality. They should be taken into account when deciding colonoscopy, in addition to perforation and bleeding, particularly in elderly patients with multiple comorbidities.

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筛查或初步诊断性结肠镜检查后全身不良事件的发生率和危险因素

目的 评估结肠镜检查后的全身严重不良事件 (SAE) 发生率并确定其危险因素。方法 使用法国综合索赔数据库 SNDS（国家健康数据系统）进行了一项全国性队列研究。纳入 2010-2015 年接受首次筛查或诊断性结肠镜检查的 30 岁及以上患者。在结肠镜检查后 5 天内估计心血管和肾脏 SAE 的发生率。计算标准化发生率以将这些发生率与一般人群中相同事件的发生率进行比较，并通过多级逻辑回归评估相关危险因素。结果 在纳入的 4,088,799 名患者中（中位年龄，59 岁 [四分位距 = 50-67]；55.2% 的女性；30.1% 的 Charlson 指数评分≤1），5 天 SAE 发生率为休克 2.8/10,000 次手术、心肌梗塞 0.87/10,000 次、中风 1.9/10,000 次、肺栓塞 2.9/10,000 次、急性肾功能衰竭 5.5/10,000 次和 1003 尿石症。在结肠镜检查后的前 5 天内，这些 SAE 的发生频率是一般人群的 3.3 至 15.8 倍。30 天死亡率范围从 2.2/1,000 例尿石症到 268.1/1,000 例休克。年龄增加与 SAE 发生率增加有关。与其他严重不良事件相比，休克和急性肾功能衰竭的风险与更多的合并症相关。大学医院的结肠镜检查与较高的风险相关，反映了患者选择过程。讨论 全身性 SAE 可能与大量死亡率相关。