Factors predicting adverse events associated with therapeutic colonoscopy for colorectal neoplasia: a retrospective nationwide study in Japan - 20/04/17

Doi : 10.1016/j.gie.2016.05.013

Ryota Niikura, MD, PhD ¹, Hideo Yasunaga, MD, PhD ², Atsuo Yamada, MD, PhD ^1,^⁎, Hiroki Matsui, PhD ², Kiyohide Fushimi, MD, PhD ³, Yoshihiro Hirata, MD, PhD ¹, Kazuhiko Koike, MD, PhD ¹
¹ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
² Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
³ Department of Health Care Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

^∗Reprint requests: Atsuo Yamada, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1138655, Japan.Department of GastroenterologyGraduate School of MedicineThe University of Tokyo7-3-1 HongoBunkyo-kuTokyo 1138655Japan

Abstract

Background and Aims

Few large studies have evaluated the adverse events associated with therapeutic colonoscopy for colorectal neoplasia, including bleeding and bowel perforation. Our aim was to investigate factors associated with these events, using a Japanese national inpatient database.

Methods

We extracted data from the nationwide Japan Diagnosis Procedure Combination database for patients who underwent therapeutic colonoscopy for colorectal neoplasia between 2013 and 2014. Therapeutic colonoscopy included endoscopic submucosal dissection (ESD), EMR, and polypectomy. Outcomes included bleeding, perforation, cerebro-cardiovascular events, and in-hospital death. A multivariable logistic regression model was used to evaluate factors associated with bleeding and bowel perforation.

Results

We analyzed 345,546 patients, including 16,812 (4.9%) who underwent ESD, 219,848 (63.6%) who underwent EMR, and 108,886 (31.5%) who underwent polypectomy. The rates of bleeding, bowel perforation, cardiovascular events, cerebrovascular events, and death were 32.5, 0.47, 0.05, 0.88, and 1.32 per 1000 patients, respectively. In the multivariate analysis, a higher bleeding rate was associated with being male, comorbid diseases, ESD, tumor size ≥2 cm, and use of drugs including low-dose aspirin, thienopyridines, non-aspirin antiplatelet drugs, novel oral anticoagulants, warfarin, non-steroidal anti-inflammatory drugs (NSAIDs), and steroids. A higher bowel perforation rate was associated with being male, renal disease, ESD, tumor size ≥2 cm, and drugs including warfarin, NSAIDs, and steroids.

Conclusions

Although the incidence of adverse events after therapeutic colonoscopy was low, several patient-related factors were significantly associated with bleeding and bowel perforation.

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Abbreviations : ESD, DPC, NSAID, NOAC, LDA, ICD-10

Plan

Outcomes and variables

Statistics

Results

Patient characteristics

Adverse events after therapeutic colonoscopy

Univariate and multivariate analyses for bleeding

Univariate and multivariate analyses for bowel perforation

Discussion

	DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
	This work was supported by grants for Research on Policy Planning and Evaluation from the Ministry of Health, Labour, and Welfare, Japan (grant numbers: H27-Policy-Designated-009 and H27-Policy-Strategy-011). The funders played no role in the study design, data collection or analysis, the decision to publish, or preparation of the manuscript.
	See CME section; p. 1021.