COLOGNE. During colonoscopy screening for bowel cancer and in the four weeks after the procedure, the risk for complications to develop is low. This is the finding of a prospective cohort study conducted in the Saarland region, whose results Nadine Zwink and coauthors report in the current issue of Deutsches Ärzteblatt International (Dtsch Aerztebl Int 2017; 114: 321-7).
Worldwide, bowel cancer is the most common cancer and the fourth most common cause of death in men and women. In Germany, colonoscopy screening as a service covered by the statutory health insurance schemes was introduced in October 2002. However, the associated routine documentation has registered only those complications that occurred immediately after the procedure (2.8/1000 colonoscopies). This may lead to an underestimation of the complications -- ie, perforations and bleeds/hemorrhages -- with delayed manifestation of symptoms.
In order to put a stop to the collection of such possibly unsatisfactory data, the authors from the German Cancer Research Center and from the Saarland cancer registry collected data in 26 practices of 5527 men (48%) and women (52%) who had undergone colonoscopy screening in 2010-13. They were asked to report on complications during and within 4 weeks after the colonoscopy at a follow-up examination, using a questionnaire. 5252 participants completed the questionnaire and were included in the study.
43 participants reported experiencing complications. However, only a small proportion of self-reported complications was confirmed medically; on the other hand, most of those affected were not aware of the bleeds/hemorrhages reported by their doctor. In total, 10 cases of bleeding/hemorrhage were confirmed by doctors, as were two cases of perforation during the colonoscopy, which in total equates to a medically confirmed complication rate of 20/5252=0.38%. Complications affected almost exclusively participants in whom neoplasms had been detected and removed.
For the authors, the study results showed that the complication rate is low, even when carefully considering a 4-week period after the colonoscopy. Especially in participants without colorectal neoplasms, who do not immediately benefit from colonoscopy screening, the rate of complications was found to be extremely low.