Adverse Events Occurring Frequently Following Colonoscopy

Moussa Laanani, MD, MPH

Patients who undergo a colonoscopy are at an increased risk of several different serious adverse events.

A team, led by Moussa Laanani, MD, MPH, Department of Public Health Studies, French National Health Insurance, estimated the systemic serious adverse event rates following a colonoscopy and identified the risk factors for these events.

The nationwide cohort study was conducted using comprehensive French claims databases for patients at least 30-years old who underwent a first screening or diagnostic colonoscopy between 2010-2015. The investigators estimated the rates of cardiovascular and renal serious adverse events within 5 days of the colonoscopy.

The standardized incidence ratios were then calculated to compare the incidence rates with those of the same events within the general population. Laanani and colleagues assessed associated risk factors using multilevel logistic regression.

The study included 4.1 million patients with a median age of 59 years old. The study population was 55.2% women, while 30.1% of the patients had a Charlson index score ≤1. The five-day serious adverse events incidence rate was 2.8 per 10,000 procedures for shock, 0.87 per 10,000 procedures for myocardial infarction, and 1.9 per 10,000 procedures for stroke.

The serious adverse event incidence rates were also 2.9 per 10,000 procedures for pulmonary embolism, 5.5 per 10,000 procedures for acute renal failure, and 3.3 per 10,000 procedures for urolithiasis.

These serious adverse events occurred 3.3-5.8 times more often during the first 5 days following a colonoscopy than what is expected in the general population. The 30-day mortality rates ranged from 2.2 per 1000 cases of urolithiasis to 268.1 per 1000 cases of shock.

Increasing age was also linked to an increase in the incidence of serious adverse events and risks of shock and acute renal failure was associated with a greater number of comorbidities than the other serious adverse events.

Colonoscopies in university hospitals were also associated with higher risks, which reflects patient selection processes. Institutions, such as Northwell Health, are leveraging artificial intelligence chatbots to reduce no-shows for patients with colonoscopy appointments.

Patients at Long Island Jewish Medical Center and Southside Hospital will have access to the personalized text- or email-based program to improve colonoscopy procedure rates. Investigators at the health system will track whether the technology impacts patient satisfaction, cancellations and no-shows, and successful completion of the procedure.

Chatbots allow health systems and providers to deliver more personalized health education and information, Sabina Zak, MBA, vice president of community health and health services research at Northwell Health, said in an interview with HCPLive®. The technology could reduce no-shows because it has the potential to improve health literacy so both patients and caregivers make more informed decisions and adhere to treatment.

The platform applies animated videos to improve learning and comprehension, Zak added.

Many patients are intimidated by colonoscopy procedures or think it will be much more unpleasant that it actually is. But the exam is potentially lifesaving. However, identifying potential adverse events is crucial for patient care.

“The systemic [serious adverse events] can be associated with a substantial mortality,” the authors wrote. “They should be taken into account when deciding colonoscopy, in addition to perforation and bleeding, particularly in elderly patients with multiple comorbidities.”

The study, “Incidence of and Risk Factors for Systemic Adverse Events After Screening or Primary Diagnostic Colonoscopy,” was published online in The American Journal of Gastroenterology.