Adverse events after colonoscopy in a randomised colorectal cancer screening trial.

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY BMJ Open Gastroenterology Pub Date : 2024-10-07 DOI:10.1136/bmjgast-2024-001471
Øyvind Bakken Rognstad, Edoardo Botteri, Geir Hoff, Michael Bretthauer, Elisabeth Gulichsen, Svein Oskar Frigstad, Øyvind Holme, Kristin Ranheim Randel
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Abstract

Objective: Colonoscopy-related adverse events increase the burden of colorectal cancer (CRC) screening. This cross-sectional study evaluates adverse events during and after colonoscopy in a large, randomised CRC screening trial in Norway comparing sigmoidoscopy to immunochemical testing for faecal blood.

Methods: We included all individuals who underwent colonoscopy at two screening centres between 2012 and 2020. From medical records, we retrieved data on adverse events during and within 30 days after colonoscopy and classified them according to the American Society for Gastrointestinal Endoscopy lexicon for endoscopic adverse events. Multivariable logistic regression models were fitted to identify risk factors for adverse events.

Results: Of the 10 244 included individuals, 242 (2.4%) had at least one adverse event that was possibly, probably, or definitively related to the colonoscopy. 188 (1.8%) had mild adverse events, 50 (0.49%) had moderate, 3 (0.03%) had severe, and 1 had a fatal adverse event. The most frequent adverse events were lower gastrointestinal bleeding (0.86%), abdominal pain (0.48%), vasovagal reaction (0.39%), postpolypectomy syndrome (0.20%), and perforation (0.08%). 23 (0.22%) individuals had non-gastrointestinal adverse events. Risk factors associated with adverse events were older age, female sex, screening centre, anticoagulant therapy, number of polypectomies, size of lesion removed, presence of proximal lesion, and adenocarcinoma. Adverse event rates per endoscopist ranged from 0% to 4.9%.

Conclusion: Adverse events after colonoscopy of screening positives occurred in about 2 out of 100 procedures. Three-quarters of events were mild. Awareness of risk factors may help endoscopists to mitigate the risk.

Trial registration number: NCT01538550.

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随机大肠癌筛查试验中结肠镜检查后的不良事件。
目的:结肠镜检查相关不良事件增加了结肠直肠癌(CRC)筛查的负担。这项横断面研究评估了挪威一项大型随机 CRC 筛查试验中结肠镜检查期间和之后发生的不良事件,该试验比较了乙状结肠镜检查和粪血免疫化学检测:我们纳入了 2012 年至 2020 年期间在两个筛查中心接受结肠镜检查的所有患者。我们从医疗记录中检索了结肠镜检查期间和检查后 30 天内的不良事件数据,并根据美国消化内镜学会的内镜不良事件词典进行了分类。多变量逻辑回归模型用于确定不良事件的风险因素:在纳入的 10 244 人中,242 人(2.4%)至少有一次不良事件可能、可能或确定与结肠镜检查有关。188人(1.8%)有轻度不良反应,50人(0.49%)有中度不良反应,3人(0.03%)有重度不良反应,1人有致命不良反应。最常见的不良事件是下消化道出血(0.86%)、腹痛(0.48%)、血管迷走神经反应(0.39%)、息肉切除术后综合征(0.20%)和穿孔(0.08%)。23人(0.22%)发生了非胃肠道不良反应。与不良事件相关的风险因素有:年龄较大、女性、筛查中心、抗凝治疗、息肉切除次数、切除病灶的大小、近端病灶的存在以及腺癌。每位内镜医师的不良事件发生率从 0% 到 4.9% 不等:结肠镜检查筛查阳性患者后的不良事件发生率约为 2/100。四分之三的事件是轻微的。对风险因素的认识有助于内镜医师降低风险:NCT01538550.
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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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