Complications of colonoscopy in an integrated health care delivery system
Complications of colonoscopy in an integrated health care delivery system
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DOI：
10.7326/0003-4819-145-12-200612190-00004
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发表时间：
2006-12-19
影响因子：
39.2
通讯作者：
Schulman, Jane
中科院分区：
文献类型：
--
作者：
Levin, Theodore R.;Zhao, Wei;Schulman, Jane
背景资料：关于结肠镜检查并发症，特别是息肉切除术后出血的信息是有限的。目的：量化结肠镜检查并发症的程度和严重性。设计：回顾性队列。设置：北方加州的Kaiser Permanente。患者：16318名40岁或以上的成员在1994年1月至2002年7月期间接受结肠镜检查。测量：审查电子记录中的严重并发症，包括结肠镜检查后30天内因结肠穿孔、结肠出血、憩室炎、息肉切除术后综合征或其他与结肠镜检查直接相关的严重疾病而入院。发生82例严重并发症（5.0/1000次结肠镜检查[95%CI，4.0 - 6.2/1000次结肠镜检查]）。无活检或息肉切除术的结肠镜检查中，每1000例中有0.8例发生严重并发症，而有活检或息肉切除术的结肠镜检查中，每1000例中有7.0例发生严重并发症。穿孔发生率为0.9/1000例结肠镜检查（CI，0.5 - 1.5/1000例结肠镜检查）（0.6/1000例无活检或息肉切除术，1.1/1000例有活检或息肉切除术）。每1000例结肠镜活检或息肉切除术后出血发生率为4.8例（CI，每1000例结肠镜活检3.6 ~ 6.2例）。活检或息肉切除术与任何严重并发症的风险增加相关（率比，9.2 [CI，2.9 - 29.01 vs.结肠镜检查无活检）。10例死亡（1例归因于结肠镜检查）发生在结肠镜检查后30天内。局限性：99.3%（16204例）的结肠镜检查为非筛选性检查。初级筛查样本中并发症的发生率可能较低。少数观察到的不良事件限制了检测并发症风险因素的能力。结论：结肠镜活检或息肉切除术与并发症风险增加相关。穿孔也可能发生在没有活检的结肠镜检查期间。
Background: Information about colonoscopy complications, particularly postpolypectomy bleeding, is limited.Objective: To quantify the magnitude and severity of colonoscopy complications.Design: Retrospective cohort.Setting: Kaiser Permanente of Northern California.Patients: 16 318 members 40 years of age or older undergoing colonoscopy between January 1994 and July 2002.Measurements: Electronic records reviewed for serious complications, including hospital admission within 30 days of colonoscopy for colonic perforation, colonic bleeding, diverticulitis, the postpolypectomy syndrome, or other serious illnesses directly related to colonoscopy.Results: 82 serious complications occurred (5.0 per 1000 colonescopies [95% Cl, 4.0 to 6.2 per 1000 colonoscopies]). Serious complications occurred in 0.8 per 1000 colonoscopies without biopsy or polypectomy and in 7.0 per 1000 colonoscopies with biopsy or polypectomy. Perforations occurred in 0.9 per 1000 colonoscopies (Cl, 0.5 to 1.5 per 1000 colonoscopies) (0.6 per 1000 without biopsy or polypectomy and 1.1 per 1000 with biopsy or polypectomy). Postbiopsy or postpolypectomy bleeding occurred in 4.8 per 1000 colonoscopies with biopsy (Cl, 3.6 to 6.2 per 1000 colonescopies). Biopsy or polypectomy was associated with an increased risk for any serious complication (rate ratio, 9.2 [Cl, 2.9 to 29.01 vs. colonoscopy without biopsy). Ten deaths (1 attributable to colonoscopy) occurred within 30 days of the colonoscopy.Limitations: 99.3% (16 204) of colonoscopies were nonscreening examinations. The rate of complications may be lower in a primary screening sample. The small number of observed adverse events limited power to detect risk factors for complications.Conclusions: Colonoscopy with biopsy or polypectomy is associated with increased risk for complications. Perforation may also occur during colonoscopies without biopsies.