Frequency of Splenic Injury in U.S. Inpatients

Frequency of Splenic Injury in U.S. Inpatients

Douglas K. Rex, MD, MASGE, reviewing Cortes P, et al. Endosc Int Open 2022 Feb 15.

A previous study of U.S. inpatients suggested that the frequency of splenic injury was about 1 in 6000. 

The current study utilized 2012-2018 data from the National Inpatient Sample, which uses diagnostic and procedural codes to match colonoscopy with splenic injury. 

Among 2.26 million inpatient colonoscopies, 240 had splenic injury recognized and, of these, 10.4% required splenectomy. Over the time period, the incidence of splenic injury remained stable. Patients with a colonoscopy-related splenic injury had a 14.45 times adjusted odds ratio for mortality and 10.11 times higher risk of stay in an intensive care unit.

Douglas K. Rex, MD, FASGE


This study found a risk of 1 splenic injury per 9400 inpatient colonoscopies, slightly lower than previous estimates. Certainly, these reports are important for demonstrating the continued occurrence of this uncommon but potentially serious complication of colonoscopy. We still lack a good rule for colonoscopy performance to reliably prevent splenic injury. My sense is that the risk probably surrounds torque movements to reduce loops when the colonoscope tip is proximal to the splenic flexure.

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.


Cortes P, Corral JE, Umar S, et al. Splenic injury is an under-recognized adverse event of in-patient colonoscopy: a nationwide analysis. Endosc Int Open 2022;10:E178-E182. (

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