Bleeding and Perforation After Outpatient Colonoscopy and Their Risk Factors in Usual Clinical Practice
Bleeding and Perforation After Outpatient Colonoscopy and Their Risk Factors in Usual Clinical Practice
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DOI：
10.1053/j.gastro.2008.08.058
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发表时间：
2008-12-01
期刊：
影响因子：
29.4
通讯作者：
Stukeli, Therese A.
中科院分区：
文献类型：
--
作者：
Rabeneck, Linda;Paszat, Lawrence F.;Stukeli, Therese A.
背景与目的：最广泛引用的结肠镜检查并发症发生率来自于内镜专家的病例系列研究。我们的目的是在一项基于人群的研究中评估与门诊结肠镜检查相关的出血、穿孔和死亡的发生率及其危险因素。研究方法：我们确定了2002年4月1日至2003年3月31日期间在加拿大不列颠哥伦比亚省、阿尔伯塔、安大略和新斯科舍省接受门诊结肠镜检查的所有50 - 75岁的个体。使用行政数据，我们确定了每个省在结肠镜检查后30天内因出血或穿孔住院的所有个人。我们计算了4个省的合并出血和穿孔率。在安大略，我们提取了手术后30天内发生的所有死亡的医院图表。我们使用广义估计方程模型来评估与出血和穿孔相关的因素。结果：我们确定了97，091名接受门诊结肠镜检查的患者。结肠镜检查相关出血和穿孔的合并发生率分别为1.64/1000和0.85/1000。死亡率为0.074/1000或约1/14，000。年龄较大、男性、接受息肉切除术以及由低容量内窥镜医生进行结肠镜检查与出血或穿孔的可能性增加有关。结论：虽然结肠镜检查已经确定了检测结直肠癌和腺瘤性息肉的好处，但该程序与严重并发症的风险有关，包括死亡。年龄较大、男性、息肉切除术和由低容量内镜医师完成的手术与结肠镜检查相关出血和穿孔独立相关。
Background & Aims: The most widely quoted complication rates for colonoscopy are from case series performed by expert endoscopists. Our objectives were to evaluate the rates of bleeding, perforation, and death associated with outpatient colonoscopy and their risk factors in a population-based study. Methods: We identified all individuals 50 to 75 years old who underwent an outpatient colonoscopy during April 1, 2002, to March 31, 2003, in British Columbia, Alberta, Ontario, and Nova Scotia, Canada. Using administrative data, we identified all individuals who were admitted to hospital with bleeding or perforation within 30 days following the colonoscopy in each province. We calculated the pooled rates of bleeding and perforation from the 4 provinces. In Ontario, we abstracted the hospital charts of all deaths that occurred within 30 days following the procedure. We used generalized estimating equations models to evaluate factors associated with bleeding and perforation. Results: We identified 97,091 persons who had an outpatient colonoscopy. The pooled rates of colonoscopy-related bleeding and perforation were 1.64/1000 and 0.85/1000, respectively. The death rate was 0.074/1000 or approximately 1/14,000. Older age, male sex, having a polypectomy, and having the colonoscopy performed by a low-volume endoscopist were associated with increased odds of bleeding or perforation. Conclusions: Although colonoscopy has established benefits for the detection of colorectal cancer and adenomatous polyps, the procedure is associated with risks of serious complications, including death. Older age, male sex, having a polypectomy, and having the procedure done by a low-volume endoscopist were independently associated with colonoscopy-related bleeding and perforation.