Complications of Colonoscopy Remain Stable During Surveillance in VA Cooperative Study 380

Complications of Colonoscopy Remain Stable During Surveillance in VA Cooperative Study 380

Douglas K. Rex, MD, MASGE, reviewing Kobe EA, et al. Gastrointest Endosc 2022 May 6.

Most studies of colonoscopy complications examine adverse event rates at a single time point. The Department of Veterans Affairs Cooperative Study #380 was one of the original screening colonoscopy studies leading to federal reimbursement of screening colonoscopy for Medicare patients. This study examined complication rates over time in patients who had screening and subsequent surveillance colonoscopies. 

The overall rates of major adverse events per 1000 examinations were 6.1 events at examination 2, 4.8 events at examination 3, and 7.2 events at examination 4. Of 21 major events, there was 1 perforation and 3 GI bleeds requiring hospitalization, all related to polypectomy. Most major events (n=17) at follow-up were cardiopulmonary-related, but even these were generally transient, with 10 hypotension events requiring intervention, 1 periprocedural apnea incident, 6 cardiac arrhythmias, with 3 being bradycardia requiring atropine, and 1 vasovagal event. One patient had recurrent major events; this patient developed bradycardia, which responded to atropine, during 3 different colonoscopies.

Douglas K. Rex, MD, FASGE

COMMENT

These results indicate that rates of major complications during surveillance colonoscopy remain stable over time, which is important for understanding the safety of surveillance programs. Patients who experience bradycardia associated with colonic looping or distention often demonstrate the same event in subsequent examinations, as occurred with 1 patient here. This study is a reminder that cardiopulmonary events are often the most common adverse event of sedated colonoscopy, and this study did not track the all-important events of stroke and myocardial infarction that occurred within 30 days after the procedure.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Kobe EA, Sullivan BA, Qin X, et al. Longitudinal assessment of colonoscopy adverse events in the prospective Cooperative Studies Program no. 380 colorectal cancer screening and surveillance cohort. Gastrointest Endosc 2022 May 6. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.04.1343)

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