Original articleClinical endoscopyOnset and clinical course of bleeding and perforation after outpatient colonoscopy: a population-based study
Section snippets
Study cohort
The current study makes use of data from a population-based cohort of patients who underwent outpatient colonoscopy in 4 Canadian provinces during the period from April 1, 2002 to March 31, 2003, which we previously reported.6 The objective of that report was to estimate the rates of colonoscopy-related bleeding, perforation, and death. As previously described, data were obtained from the Canadian Institute for Health Information Discharge Abstract Database, which contains information on every
Study cohort
Between April 1, 2002 and March 31, 2003, we identified 67,632 patients aged 50 to 75 years in Ontario who had an outpatient colonoscopy. Perforation and bleeding requiring admission to the hospital occurred in 37 and 83 patients, respectively. One patient had both perforation and bleeding on admission; this patient is included in the perforation category.
Onset of perforation and bleeding
Figure 1 depicts time to hospital admission after undergoing an outpatient colonoscopy. For those patients with a perforation, 21 of 37 (57%)
Discussion
We report here that, based on a population-based study of 67,632 outpatient colonoscopies, the majority (92%) of hospitalizations for perforation occurred within 2 days and all within 5 days. Hospitalizations for bleeding were delayed, with 39% occurring within 2 days. Three patients (3.6%) with a bleed were admitted after 14 days.
Few large-scale (>10,000) reports of perforation and bleeding associated with outpatient colonoscopy have reported on the timing of hospital admission for patients
References (13)
- et al.
Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology
Gastroenterology
(2008) - et al.
Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer
Am J Gastroenterol
(2002) - et al.
A lexicon for endoscopic adverse events: report of an ASGE workshop
Gastrointest Endosc
(2010) - et al.
Colonoscopy and its complications across a Canadian regional health authority
Gastrointest Endosc
(2009) - et al.
Endoscopic perforation of the colon: lessons from a 10-year study
Am J Gastroenterol
(2000) - et al.
Colonoscopy completion and complication rates in a community gastroenterology practice
Gastrointest Endosc
(2006)
Cited by (44)
Differences in patient outcomes after outpatient GI endoscopy across settings: a statewide matched cohort study
2022, Gastrointestinal EndoscopyCitation Excerpt :To focus on general acute care hospitals, procedures performed in Veterans Affairs, single specialty, or other nonacute care hospitals were also excluded, as were those delivered to non-Massachusetts residents, in out-of-state facilities, and with missing covariates (Supplementary Fig. 1). Following prior research,4,6,20,23-26 the primary outcomes were all-cause unplanned hospital visits occurring within 7 and 30 days after the index GI endoscopic procedure. This measure captured a range of postprocedure adverse events associated with GI endoscopies, including GI bleeding, perforation, abdominal pain, and cardiopulmonary adverse events.4,23,27,28
Medico-legal implications for the colon perforation during colonoscopy
2021, Journal of Forensic and Legal MedicineCitation Excerpt :In this study, there were nine cases of delayed perforation, and symptoms of suspected perforation appeared up to 57 h after colonoscopy. Because perforation can occur at any time in up to seven days after colonoscopy,21–23 delayed perforation may not be noticed with only a short hospitalization. Therefore, thorough patient education for the possible symptoms of colon perforation after procedure may be the best way to detect a missed perforation.
Seven-day postcolonoscopy emergency department visits: What do they really measure?
2018, Gastrointestinal EndoscopyPredictors of post-colonoscopy emergency department use
2018, Gastrointestinal EndoscopyDistance from hospital impacts adverse event detection after outpatient endoscopy
2017, Gastrointestinal EndoscopyEndoscopic "rescue" treatment for gastrointestinal perforations, anastomotic dehiscence and fistula
2016, Clinics and Research in Hepatology and Gastroenterology
DISCLOSURE: This study was supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Grant support also received from the Canadian Institutes of Health Research to L. Rabeneck (Principle Investigator). The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. All authors disclosed no financial relationships relevant to this publication.
See CME section; page 575.