Endoscopy 2009; 41(12): 1018-1025
DOI: 10.1055/s-0029-1215214
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Process quality and incidence of acute complications in a series of more than 230 000 outpatient colonoscopies

A.  Crispin1 , B.  Birkner2 , A.  Munte2 , G.  Nusko3 , U.  Mansmann1
  • 1Department of Medical Informatics, Biometry, and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
  • 2Bavarian Association of Compulsory Health Insurance Physicians, Munich, Germany
  • 3Internal Medicine, Klinik Bad Windsheim, Bad Windsheim, Germany
Further Information

Publication History

submitted 22 October 2008

accepted after revision 5 August 2009

Publication Date:
23 October 2009 (online)

Background and study aims: Data on process quality and complications of colonoscopies are sparse, especially for the screening setting. We describe process quality in routine care, estimate the incidence of acute complications, and identify risk indicators for substandard care and complications.

Patients and methods: We analyzed data from 236 087 compulsory health insurance (CHI) members who underwent colonoscopies in 2006. Data were documented prospectively in the Electronic Colonoscopy Documentation of the Bavarian Association of CHI Physicians, a registry of outpatient colonoscopies performed in practices throughout Bavaria, Germany. It covers demographic characteristics, indications, quality indicators, macroscopic and histological findings, diagnoses, and acute complications.

Results: Colon preparation resulted in clear bowels in 76.31 % of patients, liquid residues in 22.22 %, and dirty bowels in 1.47 %. In total, 92.85 % of the examinations were performed with patients under sedation/analgesia and 97.43 % of colonoscopies were complete. Photodocumentation was present for 98.87 %. Male sex, middle age, screening, satisfactory bowel preparation, and sedation/analgesia were associated with completeness. A total of 735 patients (0.31 %) suffered complications, among them 520 bleedings (0.22 %), 69 perforations (0.03 %), and 152 cardiorespiratory complications (0.06 %). Male sex, higher age, nonscreening indication, biopsies, polypectomies, and absence of sedation/analgesia were indicative of a higher bleeding risk. Perforations were also related to biopsies and polypectomies. Higher age was the only discernible risk indicator for cardiorespiratory events.

Conclusions: Outpatient colonoscopy is a safe procedure with a low risk of acute complications. Improving bowel preparation enhances completeness. Sedation/analgesia is conducive to both completeness and the lowering of the risk of acute complications.


A. CrispinMD 

Department of Medical Informatics, Biometry, and Epidemiology
Ludwig Maximilians University Munich

Marchioninistrasse 15
D-81377 Munich

Fax: +49-89-70957491

Email: cri@ibe.med.uni-muenchen.de