Colonoscopy adverse events: are we getting the full picture?

Area of Science:

• Gastroenterology
• Clinical Epidemiology
• Patient Safety

Background:

• Colonoscopy adverse events (AEs) are frequently underreported.
• Standardized reporting systems for colonoscopy AEs are rarely implemented.
• Real-world data on colonoscopy AEs is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate colonoscopy-associated adverse events (AEs) in a real-world setting.
• To categorize and grade AEs using the American Society of Gastrointestinal Endoscopy (ASGE) lexicon.
• To assess the incidence and types of AEs following outpatient colonoscopies.

Main Methods:

• Retrospective cohort study of outpatient colonoscopies in the North Denmark Region (2015-2018).
• AEs identified via readmission within 8 days or death within 30 days.
• AEs were reviewed in electronic health records and classified using the ASGE lexicon.

Main Results:

• 1141 potentially associated AEs (23.07‰) were identified from 49,445 colonoscopies.
• 489 AEs (9.9‰) were attributed to colonoscopy after review.
• Major AE categories included instrumental (0.99‰, including perforations), bleeding (3.07‰), and pain (2.00‰). Ten fatal AEs (0.20‰) occurred, with only one procedure-related perforation.

Conclusions:

• Colonoscopy involves significant procedure and non-procedure related risks.
• Non-procedure related AEs are likely underreported, necessitating better patient monitoring.
• Standardized AE reporting and enhanced colonoscopist training are recommended to reduce AE rates.