Risk of colonoscopy-related complications in a fecal immunochemical test-based population colorectal cancer screening program

Wen-Feng Hsu; Chi-Yang Chang; Chun-Chao Chang; Li-Chun Chang; Chien-Hua Chen; Chun-Che Lin; Yu-Min Lin; Chia-Long Lee; Hong-Yuan Wu; Hsin-Chung Lee; Yi-Chia Lee; Ming-Yao Su; Li-Ju Lin; Shu-Li Chia; Ming-Shiang Wu; Han-Mo Chiu; for the Colonoscopy Quality Assurance Joint Working Group of Taiwan Colorectal Cancer Screening Program and Digestive Endoscopy Society of Taiwan

doi:10.1055/a-1328-5126

Endoscopy, Inhaltsverzeichnis

Endoscopy 2022; 54(03): 290-298
DOI: 10.1055/a-1328-5126

Original article

Risk of colonoscopy-related complications in a fecal immunochemical test-based population colorectal cancer screening program

Authors

Wen-Feng Hsu

¹Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan

²College of Medicine, National Taiwan University, Taipei, Taiwan
Chi-Yang Chang

³School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan

⁴Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
Chun-Chao Chang

⁵Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

⁶Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Li-Chun Chang

²College of Medicine, National Taiwan University, Taipei, Taiwan

⁷Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Chien-Hua Chen

⁸Digestive Disease Center, Chang-Bing Show-Chwan Memorial Hospital, Changhua, Taiwan
Chun-Che Lin

⁹Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
Yu-Min Lin

¹⁰Department of Internal Medicine, Shin Kong Wu Ho‐Su Memorial Hospital, Taipei, Taiwan
Chia-Long Lee

¹¹Department of Internal Medicine, Cathay General Hospital Medical Center, Taipei, Taiwan
Hong-Yuan Wu

²College of Medicine, National Taiwan University, Taipei, Taiwan
Hsin-Chung Lee

³School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan

¹²Department of Surgery, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
Yi-Chia Lee

²College of Medicine, National Taiwan University, Taipei, Taiwan

⁷Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Ming-Yao Su

¹³Department of Medicine, Division of Gastroenterology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
Li-Ju Lin

¹⁴Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
Shu-Li Chia

¹⁴Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
Ming-Shiang Wu

²College of Medicine, National Taiwan University, Taipei, Taiwan

⁷Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Han-Mo Chiu

²College of Medicine, National Taiwan University, Taipei, Taiwan

⁷Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

for the Colonoscopy Quality Assurance Joint Working Group of Taiwan Colorectal Cancer Screening Program and Digestive Endoscopy Society of Taiwan

Abstract

Background The likelihood of advanced or synchronous neoplasms is significantly higher in fecal immunochemical test (FIT)-positive individuals than in the general population. The magnitude of the colonoscopy-related complication rate in FIT-positive individuals remains unknown. This study aimed to elucidate the colonoscopy-related complication rate after a positive FIT result and compare it with the rate when colonoscopy was performed for other purposes.

Methods Information regarding colonoscopy-related severe complications after a positive FIT result (FIT-colonoscopy) and ordinary colonoscopy during 2010–2014 was collected from the Taiwanese Colorectal Cancer Screening Program Database and National Health Insurance Research Database. Severe complications included significant bleeding, perforation, and cardiopulmonary events ≤ 14 days after colonoscopy. The number of events per 1000 procedures was used to quantify complication rates. Multivariate analysis was conducted to assess the association of various factors with severe complications associated with FIT-colonoscopy compared with ordinary colonoscopy.

Results 319 114 FIT-colonoscopies (214 955 patients) were identified, 51 242 (16.1 %) of which included biopsy and 94 172 (29.5 %) included polypectomy. Overall, 2125 significant bleedings (6.7 ‰) and 277 perforations (0.9 ‰) occurred ≤ 14 days after FIT-colonoscopy. Polypectomy, antiplatelet use, and anticoagulant use were associated with higher risk of complications (adjusted odds ratio [aOR] 4.41, 95 % confidence interval [CI] 4.05–4.81); aOR 1.35, 95 %CI 1.12–1.53; aOR 1.88, 95 %CI 0.61–5.84, respectively). Compared with ordinary colonoscopy, FIT-colonoscopy involved significantly higher risk of significant bleeding (aOR 3.10, 95 %CI 2.90–3.32).

Conclusions FIT-colonoscopy was associated with a more than two-fold risk of significant bleeding, especially when polypectomy was performed.

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Referenzen

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