FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2976420112> ?p ?o ?g. }

• W2976420112 endingPage "876.e33" @default.
• W2976420112 startingPage "863" @default.
• W2976420112 abstract "Colonoscopy is the most commonly performed endoscopic procedure and overall is considered a low-risk procedure. However, adverse events (AEs) related to this routinely performed procedure for screening, diagnostic, or therapeutic purposes are an important clinical consideration. The purpose of this document from the American Society for Gastrointestinal Endoscopy’s Standards of Practice Committee is to provide an update on estimates of AEs related to colonoscopy in an evidence-based fashion. A systematic review and meta-analysis of population-based studies was conducted for the 3 most common and important serious AEs (bleeding, perforation, and mortality). In addition, this document includes an updated systematic review and meta-analysis of serious AEs (bleeding and perforation) related to EMR and endoscopic submucosal dissection for large colon polyps. Finally, a narrative review of other colonoscopy-related serious AEs and those related to specific colonic interventions is included. Colonoscopy is the most commonly performed endoscopic procedure and overall is considered a low-risk procedure. However, adverse events (AEs) related to this routinely performed procedure for screening, diagnostic, or therapeutic purposes are an important clinical consideration. The purpose of this document from the American Society for Gastrointestinal Endoscopy’s Standards of Practice Committee is to provide an update on estimates of AEs related to colonoscopy in an evidence-based fashion. A systematic review and meta-analysis of population-based studies was conducted for the 3 most common and important serious AEs (bleeding, perforation, and mortality). In addition, this document includes an updated systematic review and meta-analysis of serious AEs (bleeding and perforation) related to EMR and endoscopic submucosal dissection for large colon polyps. Finally, a narrative review of other colonoscopy-related serious AEs and those related to specific colonic interventions is included. Colonoscopy is a commonly performed endoscopic procedure for various GI conditions and most routinely for the screening and surveillance of colorectal neoplasia. Overall, colonoscopy is considered a safe procedure, although a number of serious adverse events (AEs) have been reported. The definition of serious AEs is variable across studies but generally includes AEs that lead to an unplanned hospitalization, unplanned procedures or interventions, prolongation of an existing hospitalization, or death. Examples include bleeding, perforation, postpolypectomy syndrome, and cardiopulmonary AEs related to moderate or deep sedation. Few population-based colonoscopy registries provide the exact magnitude of AEs associated with colonoscopy. Estimates of AEs related to colonoscopy in various studies differ by indications, patient population, asymptomatic versus symptomatic individuals, length, and completeness of follow-up after the procedure. In a 2008 systematic review of 12 studies totaling 57,742 colonoscopies performed for average-risk screening, the pooled overall AE rate was 2.8 per 1000 procedures (95% confidence interval [CI], 1.5-5.2),1Whitlock E.P. Lin J.S. Liles E. et al.Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force.Ann Intern Med. 2008; 149: 638-658Crossref PubMed Google Scholar whereas the reported incidence of AEs from mostly diagnostic colonoscopies performed in an integrated healthcare system in the United States was 5 per 1000 procedures (95% CI, 4.0-6.2).2Levin T.R. Zhao W. Conell C. et al.Complications of colonoscopy in an integrated health care delivery system.Ann Intern Med. 2006; 145: 880-886Crossref PubMed Google Scholar In a 2016 evidence synthesis report by the Agency for Healthcare Research and Policy, the authors reported a pooled rate of major bleeding (22 studies; n = 3,347,101) of .8 per 1000 procedures (95% CI, .5-1.4) and rate of perforation of .4 per 1000 procedures (95% CI, .2-.5) for screening colonoscopy.3Lin J.S. Piper M.A. Perdue L.A. et al.Screening for colorectal cancer: a systematic review for the U.S. Preventive Services Task Force.JAMA. 2016; 315: 2576-2594Crossref PubMed Google Scholar Although the risk of AEs in most studies are often not stratified by whether or not polypectomy was performed, according to 1 study, 85% of AEs are reported in patients undergoing colonoscopy with polypectomy.1Whitlock E.P. Lin J.S. Liles E. et al.Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force.Ann Intern Med. 2008; 149: 638-658Crossref PubMed Google Scholar With the widespread application of advanced endoscopic techniques for removal of colorectal polyps, including EMR and endoscopic submucosal dissection (ESD), the AEs associated with these advanced techniques are highly relevant. The aims of this document are to provide evidence-based estimates of the 3 most common and important AEs of colonoscopy (bleeding, perforation, and mortality) from population-based studies, to provide evidence-based estimates of AEs related to EMR and ESD (bleeding and perforation) for large colon polyps, and to provide a narrative-based review of aspiration, splenic injury, and less common AEs. A narrative update of the previous Standards of Practice document4Fisher D.A. Maple J.T. Ben-Menachem T. et al.ASGE Standards of Practice CommitteeComplications of colonoscopy.Gastrointest Endosc. 2011; 74: 745-752Abstract Full Text Full Text PDF PubMed Scopus (185) Google Scholar on other AEs, such as postpolypectomy syndrome, infection, and gas bloating, is addressed in this document. Risk of AEs as they relate to sedation and the pediatric population are also discussed. Details of various bowel preparations and their respective AEs are discussed in a separate American Society for Gastrointestinal Endoscopy (ASGE) document.5Saltzman J.R. Cash B.E. Pasha S.F. et al.ASGE Standards of Practice CommitteeBowel preparation before colonoscopy.Gastrointest Endosc. 2015; 81: 781-794Abstract Full Text Full Text PDF PubMed Google Scholar The panel was composed of 2 primary authors (S.T.K., R.J.H.), a content expert (A.S.), committee chair (S.W.), and members of the Standards of Practice Committee. All panel members disclosed possible intellectual and financial conflicts of interest in concordance with ASGE policies (https://www.asge.org/docs/default-source/about-asge/mission-and-governance/asge-conflict-of-interest-and-disclosure-policy.pdf). A search for population-level studies that provided estimates for the major postprocedural endpoints of perforation, bleeding, and mortality was conducted by a professional librarian using Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE 1946 to present, Embase Classic+Embase 1947 to January 2018, and Wiley Cochrane. In cases of multiple studies from the same group using the same data source (such as a conference proceeding followed by a manuscript), we included only the more recent and extensive of the studies. Only studies published in English were included for analysis. We included both retrospective and prospective cohort studies with data collected between January 2001 and March 2017 in the study. Prespecified medical subject headings, non–medical subject heading terms, and the search algorithm are shown in Appendix 1 (available online at www.giejournal.org). For estimates of perforation and bleeding after EMR and ESD, we chose case series and comparative trials published between January 2008 and January 2018; this decision was made given the rapid changes in advanced mucosal/submucosal resection techniques within the last decade. We adopted a search algorithm derived from Hassan et al,6Hassan C. Repici A. Sharma P. et al.Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis.Gut. 2016; 65: 806-820Crossref PubMed Scopus (111) Google Scholar which is available in Appendix 2 (available online at www.giejournal.org). For EMR, we restricted our analysis to polyps ≥20 mm in size. Two reviewers (S.T.K. and R.J.H.) independently screened all abstracts. Case reports, review articles, cost-effectiveness or modeling studies, and animal studies were excluded. The full text of the remaining articles was evaluated to determine if they met inclusion criteria in the study. For each study the first author, time period, and date of publication were extracted. For population-level studies mean age, percentage of females in the cohort, rates of perforation, bleeding, mortality, and percentage of colonoscopies with polypectomy were recorded. Because only a subset of population-level studies reported the indication for colonoscopy (eg, screening, surveillance, or diagnostic), this variable was not included in the meta-regression analysis. For EMR/ESD studies mean age, percentage of females in the cohort, location of the study (East Asian or Other), rate of perforation, rate of delayed bleeding, and mean polyp size (in mm) was recorded. Delayed bleeding was defined as any clinically significant bleeding that occurred after completion of the procedure up to 30 days postprocedure. Intraprocedural bleeding was not recorded as a separate outcome given the heterogeneity in definition and because almost all cases of reported intraprocedural bleeding were controlled endoscopically during the procedure. A random-effects model was used to calculate the pooled perforation and bleeding rate for both population-level and EMR/ESD studies. Pooled estimates were reported with 95% CIs. Covariates analyzed in regression analysis included mean population age, percentage of females in the cohort, and percentage of polypectomies in the cohort for population-level studies. Covariates analyzed in regression analysis included mean population age, percentage of females in cohort, and size of polyp in EMR/ESD studies. Pooled rates of perforation and bleeding were calculated and grouped by EMR or ESD status. Heterogeneity between studies was measured using the I2 statistic. Analysis was performed using Comprehensive Meta-Analysis v 3.3.070 (Englewood, NJ). Twenty-one population-level studies (11 from North America) reporting the rates of perforation, bleeding, or mortality after colonoscopy were identified (Supplementary Table 1, available online at www.giejournal.org). From these studies, data were extracted on 10,328,360 patients undergoing colonoscopy, of which 5,464,324 (54%) were women; the mean age of all patients was 62.3 years. Colonic perforation during colonoscopy may result from mechanical forces against the bowel wall, barotrauma, or a direct result of therapeutic procedures. Early symptoms include persistent abdominal pain and abdominal distention. Colonic perforation can be intraperitoneal or extraperitoneal. Intraperitoneal perforation leads to leak of air and colonic contents into the peritoneum. Plain radiographs of the chest and abdomen may demonstrate free air, although CT is superior to an upright chest film.7Stapakis J.C. Thickman D. Diagnosis of pneumoperitoneum: abdominal CT vs. upright chest film.J Comput Assist Tomogr. 1992; 16: 713-716Crossref PubMed Google Scholar Therefore, an abdominal CT should be considered for patients with an unrevealing plain film in whom there is a high suspicion of perforation.4Fisher D.A. Maple J.T. Ben-Menachem T. et al.ASGE Standards of Practice CommitteeComplications of colonoscopy.Gastrointest Endosc. 2011; 74: 745-752Abstract Full Text Full Text PDF PubMed Scopus (185) Google Scholar Rarely, colonic perforation can be extraperitoneal, leading to the passage of air into the retroperitoneal space, which can then diffuse along the fascial planes and large vessels, causing pneumo-retroperitoneum, pneumo-mediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema. Such patients can have an atypical presentation, including subcutaneous crepitus, neck swelling, chest pain, and shortness of breath after colonoscopy.8Tiwari A. Sharma H. Qamar K. et al.Recognition of extraperitoneal colonic perforation following colonoscopy: a review of the literature.Case Rep Gastroenterol. 2017; 11: 256-264Crossref PubMed Scopus (5) Google Scholar The pooled rate of perforations among 10,328,360 colonoscopies was 5.8 per 10,000 colonoscopies (95% CI, 5.7-6.0) (Fig. 1A). Reported population-level perforation rates ranged from a low of 1.6 per 10,000 to a high of 11.9 per 10,000 with significant heterogeneity between studies (I2 = 97.6%). This heterogeneity in studies may reflect differences in indication, population age, comorbidity, geographic location, and rates of polypectomy between studies. In a meta-regression analysis (Supplementary Fig. 1A, available online at www.giejournal.org), neither age nor gender was significantly associated with perforation rate. Moreover, after adjusting for differences in age and gender between different population-level studies, polypectomy was not significantly associated with risk for perforation (P = .9). A previous meta-analysis of population-level studies found a trend toward higher rate of perforation in colonoscopies with polypectomy (8 per 10,000) compared with those without polypectomy (4 per 10,000, P = .07).9Reumkens A. Rondagh E.J. Bakker C.M. et al.Post-colonoscopy complications: a systematic review, time trends, and meta-analysis of population-based studies.Am J Gastroenterol. 2016; 111: 1092-1101Crossref PubMed Google Scholar These data suggest that a substantial proportion of the risks of perforation from colonoscopy are related to procedural characteristics independent of the performance of polypectomy, such as the amount of torque or pressure applied to the bowel wall during advancement of the colonoscope or barotrauma from insufflation of the colon. Notably, as discussed later in this article, performance of advanced mucosal resection techniques (EMR and ESD) increases the risk for perforation; however, on a population level, the numbers of these advanced procedures as a percentage of all polypectomies are small. These risk estimates therefore likely accurately reflect the risk that most average-risk patients face when undergoing an examination for screening or surveillance purposes.Figure 1Pooled rates (and 95% CIs) of postcolonoscopy perforation (A), bleeding (B), and mortality (C) from population-level studies. Additional covariates included are percentage of colonoscopies with polypectomy (% polypectomy), mean age, and percentage of cohort that is female (% Female). Data analyzed with a random-effects model. Data for mortality presented as logit of event rate given low event rates. CI, Confidence interval.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Certain populations may face higher risks for perforation during colonoscopy, including patients with diverticulosis and inflammatory bowel disease (IBD).1Whitlock E.P. Lin J.S. Liles E. et al.Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force.Ann Intern Med. 2008; 149: 638-658Crossref PubMed Google Scholar, 10Bielawska B. Day A.G. Lieberman D.A. et al.Risk factors for early colonoscopic perforation include non-gastroenterologist endoscopists: a multivariable analysis.Clin Gastroenterol Hepatol. 2014; 12: 85-92Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar, 11Chukmaitov A. Bradley C.J. Dahman B. et al.Association of polypectomy techniques, endoscopist volume, and facility type with colonoscopy complications.Gastrointest Endosc. 2013; 77: 436-446Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar, 12Lohsiriwat V. Colonoscopic perforation: incidence, risk factors, management and outcome.World J Gastroenterol. 2010; 16: 425-430Crossref PubMed Scopus (114) Google Scholar, 13Rutter M.D. Nickerson C. Rees C.J. et al.Risk factors for adverse events related to polypectomy in the English Bowel Cancer Screening Programme.Endoscopy. 2014; 46: 90-97Crossref PubMed Scopus (83) Google Scholar Mukewar et al14Mukewar S. Costedio M. Wu X. et al.Severe adverse outcomes of endoscopic perforations in patients with and without IBD.Inflamm Bowel Dis. 2014; 20: 2056-2066Crossref PubMed Scopus (14) Google Scholar found that patients with IBD undergoing colonoscopy were at an 8-fold higher risk for endoscopy-associated perforations compared with patients without IBD (18.91 per 10,000 procedures vs 2.5 per 10,000 procedures). The use of corticosteroids is associated with a 13-fold greater risk for perforation associated with colonoscopy. Certain comorbid conditions also increase the risk for AEs. In a study of U.S. Medicare beneficiaries, Warren et al15Warren J.L. Klabunde C.N. Mariotto A.B. et al.Adverse events after outpatient colonoscopy in the Medicare population.Ann Intern Med. 2009; 150: 849-857Crossref PubMed Google Scholar found that the presence of stroke, chronic obstructive pulmonary disease, atrial fibrillation, and congestive heart failure all significantly increased the risk of AEs due to colonoscopy. In addition to patient factors, provider factors may also influence the procedure risk. Ranasinghe et al16Ranasinghe I. Parzynski C.S. Searfoss R. et al.Differences in colonoscopy quality among facilities: development of a post-colonoscopy risk-standardized rate of unplanned hospital visits.Gastroenterology. 2016; 150: 103-113Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar found significant variation (median, 12.3/1000; 5th to 95th percentile, 10.5 to 14.6/1000) in rates of AEs after outpatient colonoscopy between both hospital outpatient departments and free-standing ambulatory surgery centers, which could not be explained by case mix alone, raising the possibility that provider experience could be contributing to the variations in rates of AEs. Using administrative data from several large Canadian provinces, Rabeneck et al17Rabeneck L. Paszat L.F. Hilsden R.J. et al.Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice.Gastroenterology. 2008; 135: 1899-1906Abstract Full Text Full Text PDF PubMed Scopus (315) Google Scholar found that endoscopists performing at volumes in the lowest quintile (<141 colonoscopies per year) had a 2.96 increase in odds of either perforation or bleeding compared with endoscopists performing at volumes in the highest quintile (>379 colonoscopies per year). In addition, Bielawska et al10Bielawska B. Day A.G. Lieberman D.A. et al.Risk factors for early colonoscopic perforation include non-gastroenterologist endoscopists: a multivariable analysis.Clin Gastroenterol Hepatol. 2014; 12: 85-92Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar reported that colonoscopies performed by surgeons and endoscopists of unknown specialty had higher perforation rates when compared with gastroenterologists (odds ratio, 2.00; 95% CI, 1.30-3.08). Unlike perforation, risk for bleeding during colonoscopy appears to be strongly associated with the performance of polypectomy. Postpolypectomy hemorrhage may occur immediately or can be delayed for up to 4 weeks after the procedure. In our systematic review, the rate of bleeding based on 15 population-level studies, including 5,544,454 patients, was 2.4 per 1000 colonoscopies (95% CI, 2.4-2.5) (Fig. 1B). In a meta-regression analysis (Supplementary Fig. 1B, available online at www.giejournal.org), the percentage of colonoscopies involving a polypectomy strongly predicted rates of bleeding, with a 2.7% increase in risk of bleeding for every 1% increase in rate of polypectomy (P < .001). This association remained significant after adjustment for age and gender (P = .016). The association between performance of polypectomy and risk for bleeding was also observed by Reumkens et al,9Reumkens A. Rondagh E.J. Bakker C.M. et al.Post-colonoscopy complications: a systematic review, time trends, and meta-analysis of population-based studies.Am J Gastroenterol. 2016; 111: 1092-1101Crossref PubMed Google Scholar with findings of significantly more bleeding events after colonoscopies with polypectomy (9.8/1000) compared with colonoscopies without polypectomy (.6/1000, P < .001). Polyp size has been reported as a risk factor for postpolypectomy bleeding in several studies.18Consolo P. Luigiano C. Strangio G. et al.Efficacy, risk factors and complications of endoscopic polypectomy: ten year experience at a single center.World J Gastroenterol. 2008; 14: 2364-2369Crossref PubMed Scopus (69) Google Scholar, 19Dafnis G. Ekbom A. Pahlman L. et al.Complications of diagnostic and therapeutic colonoscopy within a defined population in Sweden.Gastrointest Endosc. 2001; 54: 302-309Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar, 20Kim H.S. Kim T.I. Kim W.H. et al.Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study.Am J Gastroenterol. 2006; 101: 1333-1341Crossref PubMed Scopus (179) Google Scholar Additional risk factors may include the number of polyps removed,21Singh M. Mehta N. Murthy U.K. et al.Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy.Gastrointest Endosc. 2010; 71: 998-1005Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar, 22Witt D.M. Delate T. McCool K.H. et al.Incidence and predictors of bleeding or thrombosis after polypectomy in patients receiving and not receiving anticoagulation therapy.J Thromb Haemost. 2009; 7: 1982-1989Crossref PubMed Scopus (51) Google Scholar recent warfarin therapy,20Kim H.S. Kim T.I. Kim W.H. et al.Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study.Am J Gastroenterol. 2006; 101: 1333-1341Crossref PubMed Scopus (179) Google Scholar, 23Hui A.J. Wong R.M. Ching J.Y. et al.Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases.Gastrointest Endosc. 2004; 59: 44-48Abstract Full Text Full Text PDF PubMed Scopus (247) Google Scholar, 24Sawhney M.S. Salfiti N. Nelson D.B. et al.Risk factors for severe delayed postpolypectomy bleeding.Endoscopy. 2008; 40: 115-119Crossref PubMed Scopus (186) Google Scholar right-sided colon segment location,25Buddingh K.T. Herngreen T. Haringsma J. et al.Location in the right hemi-colon is an independent risk factor for delayed post-polypectomy hemorrhage: a multi-center case-control study.Am J Gastroenterol. 2011; 106: 1119-1124Crossref PubMed Scopus (89) Google Scholar, 26Kim J.H. Lee H.J. Ahn J.W. et al.Risk factors for delayed post-polypectomy hemorrhage: a case-control study.J Gastroenterol Hepatol. 2013; 28: 645-649Crossref PubMed Scopus (37) Google Scholar and polyp histology.18Consolo P. Luigiano C. Strangio G. et al.Efficacy, risk factors and complications of endoscopic polypectomy: ten year experience at a single center.World J Gastroenterol. 2008; 14: 2364-2369Crossref PubMed Scopus (69) Google Scholar Patient comorbidities, such as cardiovascular disease,18Consolo P. Luigiano C. Strangio G. et al.Efficacy, risk factors and complications of endoscopic polypectomy: ten year experience at a single center.World J Gastroenterol. 2008; 14: 2364-2369Crossref PubMed Scopus (69) Google Scholar, 20Kim H.S. Kim T.I. Kim W.H. et al.Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study.Am J Gastroenterol. 2006; 101: 1333-1341Crossref PubMed Scopus (179) Google Scholar may increase the risk for bleeding but also may be a marker for antithrombotic use.24Sawhney M.S. Salfiti N. Nelson D.B. et al.Risk factors for severe delayed postpolypectomy bleeding.Endoscopy. 2008; 40: 115-119Crossref PubMed Scopus (186) Google Scholar Recommendations for the management of antithrombotic therapy in the periendoscopic period are discussed in detail in an ASGE guideline.27Acosta R.D. Abraham N.S. Chandrasekhara V. et al.ASGE Standards of Practice CommitteeThe management of antithrombotic agents for patients undergoing GI endoscopy.Gastrointest Endosc. 2016; 83: 3-16Abstract Full Text Full Text PDF PubMed Google Scholar The prophylactic use of mechanical methods, such as clips or detachable snares, is commonly performed in practice; however, their efficacy in preventing delayed bleeding after non-EMR polypectomies has not been confirmed. Prospective, randomized studies and a meta-analysis have shown prophylactic clipping for polyps <2 cm does not prevent delayed bleeding,28Boumitri C. Mir F.A. Ashraf I. et al.Prophylactic clipping and post-polypectomy bleeding: a meta-analysis and systematic review.Ann Gastroenterol. 2016; 29: 502-508PubMed Google Scholar, 29Matsumoto M. Kato M. Oba K. et al.Multicenter randomized controlled study to assess the effect of prophylactic clipping on post-polypectomy delayed bleeding.Dig Endosc. 2016; 28: 570-576Crossref PubMed Google Scholar, 30Shioji K. Suzuki Y. Kobayashi M. et al.Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy.Gastrointest Endosc. 2003; 57: 691-694Abstract Full Text Full Text PDF PubMed Google Scholar but in case of nonpedunculated polyps >2 cm, endoscopic clip closure of the mucosal defect has been demonstrated to reduce the incidence of delayed bleeding events in the proximal colon after resection (see Serious AEs Related to Advanced Resection Techniques, Postprocedural bleeding). Injection of epinephrine before polypectomy was reported to reduce the incidence of intraprocedural bleeding, although there was no demonstrated effect on delayed bleeding.31Di Giorgio P. De Luca L. Calcagno G. et al.Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study.Endoscopy. 2004; 36: 860-863Crossref PubMed Scopus (131) Google Scholar, 32Hsieh Y.H. Lin H.J. Tseng G.Y. et al.Is submucosal epinephrine injection necessary before polypectomy? A prospective, comparative study.Hepatogastroenterology. 2001; 48: 1379-1382PubMed Google Scholar Death after colonoscopy has been rarely reported. In a 2010 review of AEs based on prospective studies and retrospective analyses of large clinical or administrative databases, 128 deaths were reported among 371,099 colonoscopies, for an unweighted pooled death rate of .03%, or 3 in 10,000 colonoscopies33Ko C.W. Dominitz J.A. Complications of colonoscopy: magnitude and management.Gastrointest Endosc Clin North Am. 2010; 20: 659-671Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar; all-cause mortality within 30 days occurred in .07% of patients, whereas colonoscopy-specific mortality occurred in .007% of patients. Our systematic review and meta-analysis included only colonoscopy-specific mortality, which was defined as death that could be directly attributable to a postprocedural AE (such as perforation) or the management of a postprocedural AE (such as surgery for a perforation). Nine studies reported colonoscopy-associated mortality rates. Thirty-six deaths occurred among 1,152,158 colonoscopies, for a pooled death rate of .003%, or 3 in 100,000 colonoscopies (Fig. 1C). Because of the small number of population-level studies reporting mortality data, meta-regression was not performed for the endpoint of mortality. Of the studies that reported both all-cause and colonoscopy-specific mortality, most deaths within 30 days of colonoscopy were not attributable to postcolonoscopy AEs but rather to underlying comorbidities such as cardiopulmonary disease, cirrhosis, and neurologic diseases. Most causes of death directly attributable to colonoscopy were either cardiopulmonary events that occurred during or immediately after the procedure or sequelae of bowel perforation. With enhancements in endoscopic technology, the role of the endoscopist has expanded to removal of large benign polyps and polyps harboring early cancers using advanced techniques such as EMR and ESD. As with standard polypectomy, bleeding and perforation are the most common AEs with EMR and ESD, but they occur more frequently with these advanced techniques. The reported AE rates vary. Lesion size, location, and histology and operator experience may all contribute to this variability.36Bae J.H. Yang D.H. Lee J.Y. et al.Clinical outcomes of endoscopic submucosal dissection for large colorectal neoplasms: a comparison of protruding and laterally spreading tumors.Surg Endosc. 2016; 30: 1619-1628Crossref PubMed Scopus (5) Google Scholar, 37Burgess N.G. Bassan M.S. McLeod D. et al.Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors.Gut. 2017; 66: 1779-1789Crossref PubMed Scopus (32) Google Scholar, 38Swan M.P. Bourke M.J. Moss A. et al.The target sign: an endoscopic marker for the resection of the muscularis propria and potential perforation during colonic endoscopic mucosal resection.Gastrointest Endosc. 2011; 73: 79-85Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar We systematically analyzed the rates of the major endpoints of perforation and bleeding after both EMR of polyps ≥20 mm in size and ESD while also controlling for covariates of age, gender, location of the study, and polyp size. Rates of AEs were analyzed separately for EMR and ESD. Our search strategy yielded 29 studies, including 8237 unique procedures (Supplementary Table 2, available online at www.giejournal.org). Of the studies, 14 were reported from East Asia and 15 from either North America, Europe, or Oceania (Western). Twenty studies included in this analysis reported data on perforation rate after EMR. Of 6529 procedures, 59 were complicated by a perforation for a pooled rate of 1.1% (95% CI," @default.
• W2976420112 created "2019-10-03" @default.
• W2976420112 creator A5000135593 @default.
• W2976420112 creator A5004142982 @default.
• W2976420112 creator A5005538392 @default.
• W2976420112 creator A5008651395 @default.
• W2976420112 creator A5015906383 @default.
• W2976420112 creator A5016907447 @default.
• W2976420112 creator A5025657966 @default.
• W2976420112 creator A5034011079 @default.
• W2976420112 creator A5036469612 @default.
• W2976420112 creator A5038216037 @default.
• W2976420112 creator A5038992062 @default.
• W2976420112 creator A5043300874 @default.
• W2976420112 creator A5046731352 @default.
• W2976420112 creator A5047788255 @default.
• W2976420112 creator A5059348477 @default.
• W2976420112 creator A5063273969 @default.
• W2976420112 creator A5069787247 @default.
• W2976420112 creator A5072634224 @default.
• W2976420112 creator A5083731164 @default.
• W2976420112 creator A5088847915 @default.
• W2976420112 date "2019-12-01" @default.
• W2976420112 modified "2023-10-14" @default.
• W2976420112 title "ASGE review of adverse events in colonoscopy" @default.
• W2976420112 cites W1066505944 @default.
• W2976420112 cites W1590453861 @default.
• W2976420112 cites W1850633847 @default.
• W2976420112 cites W1963636754 @default.
• W2976420112 cites W1970697082 @default.
• W2976420112 cites W1972851114 @default.
• W2976420112 cites W1972983669 @default.
• W2976420112 cites W1974373698 @default.
• W2976420112 cites W1978461637 @default.
• W2976420112 cites W1981791497 @default.
• W2976420112 cites W1982188862 @default.
• W2976420112 cites W1983436619 @default.
• W2976420112 cites W1983940864 @default.
• W2976420112 cites W1985318175 @default.
• W2976420112 cites W1989139410 @default.
• W2976420112 cites W1989161368 @default.
• W2976420112 cites W1993427549 @default.
• W2976420112 cites W1998645363 @default.
• W2976420112 cites W2005019261 @default.
• W2976420112 cites W2007352645 @default.
• W2976420112 cites W2014832109 @default.
• W2976420112 cites W2015580921 @default.
• W2976420112 cites W2023222759 @default.
• W2976420112 cites W2029487819 @default.
• W2976420112 cites W2031675544 @default.
• W2976420112 cites W2036724287 @default.
• W2976420112 cites W2037379240 @default.
• W2976420112 cites W2038400317 @default.
• W2976420112 cites W2038652387 @default.
• W2976420112 cites W2038698848 @default.
• W2976420112 cites W2042021523 @default.
• W2976420112 cites W2043866790 @default.
• W2976420112 cites W2045123221 @default.
• W2976420112 cites W2046823108 @default.
• W2976420112 cites W2047410124 @default.
• W2976420112 cites W2051066205 @default.
• W2976420112 cites W2055706594 @default.
• W2976420112 cites W2058845634 @default.
• W2976420112 cites W2062552339 @default.
• W2976420112 cites W2063508899 @default.
• W2976420112 cites W2066275551 @default.
• W2976420112 cites W2066671801 @default.
• W2976420112 cites W2067795345 @default.
• W2976420112 cites W2068771825 @default.
• W2976420112 cites W2071007161 @default.
• W2976420112 cites W2071305868 @default.
• W2976420112 cites W2072053952 @default.
• W2976420112 cites W2072384642 @default.
• W2976420112 cites W2077431179 @default.
• W2976420112 cites W2082636434 @default.
• W2976420112 cites W2086022929 @default.
• W2976420112 cites W2087337636 @default.
• W2976420112 cites W2088184346 @default.
• W2976420112 cites W2090099198 @default.
• W2976420112 cites W2093977495 @default.
• W2976420112 cites W2096279874 @default.
• W2976420112 cites W2099383744 @default.
• W2976420112 cites W2101113958 @default.
• W2976420112 cites W2101229651 @default.
• W2976420112 cites W2105961063 @default.
• W2976420112 cites W2108619504 @default.
• W2976420112 cites W2136864841 @default.
• W2976420112 cites W2141131256 @default.
• W2976420112 cites W2148769961 @default.
• W2976420112 cites W2160711732 @default.
• W2976420112 cites W2162308634 @default.
• W2976420112 cites W2162484946 @default.
• W2976420112 cites W2163026705 @default.
• W2976420112 cites W2163352040 @default.
• W2976420112 cites W2166774534 @default.
• W2976420112 cites W2201074817 @default.
• W2976420112 cites W2207024246 @default.
• W2976420112 cites W2239511536 @default.

• next