Outpatient colonoscopy safe; risk of complications low

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NEW YORK (Reuters Health), Jan 1 - Outpatient colonoscopy is a safe procedure with a low risk of acute complications, according to an analysis of a large series performed in practices throughout Bavaria, Germany, in 2006.

"Our results indicate a high level of process quality and safety of outpatient colonoscopies," Dr. Alexander Crispin, from Ludwig Maximilians University Munich, noted in an email to Reuters Health.

As reported in the December issue of Endoscopy, Dr. Crispin and colleagues reviewed a total of 236,087 colonoscopies. Overall, 55,933 (24%) were screening colonoscopies, while the remainder had specific indications: 60% were performed for clinical signs and symptoms, 11% for adenoma surveillance, and 5% for cancer aftercare.

Bowel preparation achieved a clear bowel in roughly 76% of cases, whereas liquid residues were present in roughly 22%. Less than 2% of bowels (1.47%) were too dirty to allow mucosa assessment. Altogether, 93% of colonoscopies were performed under sedation/analgesia and 97% were complete.

"Improving bowel preparation enhances completeness," Dr. Crispin commented to Reuters Health, "and sedation/analgesia is conducive to both completeness and lowering the risk of acute complications."

Acute complications occurred in 735 patients (0.31%). There were 520 bleeding episodes (0.22% of colonoscopies); 69 perforations (0.03%), 50 of which required surgery; and 152 cardiorespiratory complications (0.06%), of which at least 3 were fatal.

"On a patient level, the most important risk factor for bleeding was intervention, with polypectomy patients being at a particularly high risk," the investigators note.

Older age, biopsy, and polypectomy increased the risk of perforations, while higher age was the only discernible risk indicator for cardiorespiratory events.

In this series of outpatient colonoscopies, Dr. Crispin noted, "detection rates of histologically verified adenoma and carcinoma were high overall, 19.99% and 1.35%, respectively (24.26% and 1.14% in the screening group)."

This analysis, the investigators conclude, suggests that colonoscopies can be safely and effectively performed on an outpatient basis.

By Megan Brooks

Endoscopy 2009;41:1018-1025.

Last Updated: 2009-12-31 14:20:04 -0400 (Reuters Health)

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