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Colonoscopy Carries Risks of Bleeding, Perforation, Death

Risk factors for complications include polypectomy, older age, low-volume provider

TUESDAY, Dec. 23 (HealthDay News) -- Factors associated with bleeding and perforation from colonoscopy include older age, undergoing a polypectomy, and using a low-volume endoscopist, according to research published in the December issue of Gastroenterology.

Linda Rabeneck, M.D., of the University of Toronto in Ontario, Canada, and colleagues analyzed data on individuals aged 50 to 75 in Ontario, British Columbia, Alberta and Nova Scotia, who underwent outpatient colonoscopy during a one-year period. The authors established exclusion criteria to focus on screening colonoscopy.

The researchers identified 97,091 patients who had a colonoscopy. The pooled rate of colonoscopy-related bleeding in the four provinces was 1.64 per 1,000 and the pooled rate of perforation was 0.85 per 1,000, they report. Three deaths within 30 days of the procedure were colonoscopy-related, and two were possibly related, for a death rate of 0.074 per 1,000, the report indicates. Those who had the procedure done by the lowest-volume endoscopists had higher odds of bleeding or perforation (odds ratio, 2.96), the authors note.

"Clearly, patients need to be informed of the risks of the procedure, including the risk of death. Endoscopists need to be especially careful in performing polypectomies and in performing colonoscopy in those who are older. The increased use of colonoscopy has been accompanied by a marked increase in the number of polypectomies performed. Given the central role of polypectomy in colorectal cancer prevention and its strong association with bleeding and perforation, we need to define best practice in terms of polypectomy technique," the authors conclude.

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