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. 1983 May;24(5):376–383. doi: 10.1136/gut.24.5.376

Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies.

F A Macrae, K G Tan, C B Williams
PMCID: PMC1419999  PMID: 6601604

Abstract

The diagnostic and therapeutic benefits of colonoscopy are well known but most large-scale surveys, especially those involving multiple centres, may underestimate the range and incidence of complications. The detailed records of 5000 colonoscopies in a specialist unit have been analysed and conclusions drawn which may help to make the procedure safer. The incidence of haemorrhage was 1% and bowel perforation 0.1%. All the major haemorrhages occurred during polypectomies over 2 cm in size. Secondary haemorrhage was an unpredictable occurrence, one to 14 days later. Three deaths followed colonoscopy: one cardiorespiratory death was related to oversedation; a second was due to mismanaged ischaemic colitis developing two days after traumatic instrumentation, and the third was due to peritonitis. Minor complications included thrombophlebitis, abdominal distension, and vasovagal episodes. Because of experience during the first half of the series and also due to improvements in instrumentation, the complication rate of the later part of the series was halved. Recommendations include the avoidance of oversedation, review of previous barium enema films so as to be aware of large polyps which are more likely to bleed, and the recognition of situations where perforation or septicaemia is likely to occur.

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Selected References

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  1. Axon A. T., Banks J., Cockel R., Deverill C. E., Newmann C. Disinfection in upper-digestive-tract endoscopy in Britain. Lancet. 1981 May 16;1(8229):1093–1094. doi: 10.1016/s0140-6736(81)92252-2. [DOI] [PubMed] [Google Scholar]
  2. Bigard M. A., Gaucher P., Lassalle C. Fatal colonic explosion during colonoscopic polypectomy. Gastroenterology. 1979 Dec;77(6):1307–1310. [PubMed] [Google Scholar]
  3. Britton D. C., Tregoning D., Bone G., McKelvey S. T. Colonoscopy in surgical practice. Br Med J. 1977 Jan 15;1(6054):149–151. doi: 10.1136/bmj.1.6054.149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Carlyle D. R., Goldstein H. M. Angiographic management of bleeding following transcolonoscopic polypectomy. Am J Dig Dis. 1975 Dec;20(12):1196–1201. doi: 10.1007/BF01070763. [DOI] [PubMed] [Google Scholar]
  5. Conn H. O., Fessel J. M. Spontaneous bacterial peritonitis in cirrhosis: variations on a theme. Medicine (Baltimore) 1971 May;50(3):161–197. doi: 10.1097/00005792-197105000-00002. [DOI] [PubMed] [Google Scholar]
  6. Crespon B., Housset P., Mendez J., Berman H., Debray C. Bilan de 1.000 coloscopies. Arch Fr Mal App Dig. 1975 Jun;64(4):299–308. [PubMed] [Google Scholar]
  7. Dagradi A. E., Riff D. S., Norum T. M., Juler G. A complication of colonoscopic (cecal) polypectomy. Am J Gastroenterol. 1976 May;65(5):449–453. [PubMed] [Google Scholar]
  8. Darragh A., Lambe R., Scully M., Brick I., O'Boyle C., Downe W. W. Investigation in man of the efficacy of a benzodiazepine antagonist, Ro 15-1788. Lancet. 1981 Jul 4;2(8236):8–10. doi: 10.1016/s0140-6736(81)90251-8. [DOI] [PubMed] [Google Scholar]
  9. Ecker M. D., Goldstein M., Hoexter B., Hyman R. A., Naidich J. B., Stein H. L. Benign pneumoperitoneum after fiberoptic colonoscopy. A prospective study of 100 patients. Gastroenterology. 1977 Aug;73(2):226–230. [PubMed] [Google Scholar]
  10. Erdman L. H., Boggs H. W., Jr, Slagle G. W. Electrical ileal perforation: an unusual complication of colonoscopy. Dis Colon Rectum. 1979 Oct;22(7):501–502. doi: 10.1007/BF02586942. [DOI] [PubMed] [Google Scholar]
  11. Fletcher G. F., Earnest D. L., Shuford W. F., Wenger N. K. Electrocardiographic changes during routine sigmoidoscopy. Arch Intern Med. 1968 Dec;122(6):483–486. [PubMed] [Google Scholar]
  12. Frühmorgen P., Demling L. Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany. Results of an inquiry. Endoscopy. 1979 May;11(2):146–150. doi: 10.1055/s-0028-1098341. [DOI] [PubMed] [Google Scholar]
  13. Geenen J. E., Schmitt M. G., Jr, Wu W. C., Hogan W. J. Major complications of coloscopy: bleeding and perforation. Am J Dig Dis. 1975 Mar;20(3):231–235. doi: 10.1007/BF01070726. [DOI] [PubMed] [Google Scholar]
  14. Gordon M. J. Retroperitoneal emphysema from colonoscopy of the distal limb of a Hartmann colostomy. Gastrointest Endosc. 1975 Nov;22(2):101–102. doi: 10.1016/s0016-5107(75)73716-1. [DOI] [PubMed] [Google Scholar]
  15. Graham J., Eusebio E. B. Complications of colonoscopy. IMJ Ill Med J. 1977 Jul;152(1):39–42. [PubMed] [Google Scholar]
  16. Jacobsohn W. Z., Levy A. Colonoscopic perforation: its emergency treatment. Endoscopy. 1976 Feb;8(1):15–17. doi: 10.1055/s-0028-1098368. [DOI] [PubMed] [Google Scholar]
  17. KLEINFELD G., GUMP F. E. Complications of colotomy and polypectomy. Surg Gynecol Obstet. 1960 Dec;111:726–728. [PubMed] [Google Scholar]
  18. Knoepp L. F., Jr Colonoscopy in clinical practice. South Med J. 1977 May;70(5):526–530. doi: 10.1097/00007611-197705000-00006. [DOI] [PubMed] [Google Scholar]
  19. Liebermann T. R. Bacteremia and fiberoptic endoscopy. Gastrointest Endosc. 1976 Aug;23(1):36–37. doi: 10.1016/s0016-5107(76)73575-2. [DOI] [PubMed] [Google Scholar]
  20. Livstone E. M., Cohen G. M., Troncale F. J., Touloukian R. J. Diastatic serosal lacerations: an unrecognized complication of colonoscopy. Gastroenterology. 1974 Dec;67(6):1245–1247. [PubMed] [Google Scholar]
  21. Livstone E. M., Kerstein M. D. Serosal tears following colonoscopy. Arch Surg. 1976 Jan;111(1):88–88. doi: 10.1001/archsurg.1976.01360190090020. [DOI] [PubMed] [Google Scholar]
  22. Macrae F. A., St John D. J. Spontaneous bacterial peritonitis: reversible cause of deterioration in patients with cirrhosis. Med J Aust. 1980 Aug 23;2(4):209–211. [PubMed] [Google Scholar]
  23. Meyer G. W. Prophylaxis of infective endocarditis during colonoscopy: report of a survey. Gastrointest Endosc. 1981 May;27(2):58–59. doi: 10.1016/s0016-5107(81)73149-3. [DOI] [PubMed] [Google Scholar]
  24. Meyers M. A., Ghahremani G. G. Complications of fiberoptic Endoscopy. II. Colonoscopy. Radiology. 1975 May;115(2):301–307. doi: 10.1148/115.2.301. [DOI] [PubMed] [Google Scholar]
  25. Norfleet R. G., Mitchell P. D., Mulholland D. D., Philo J. Does bacteremia follow colonoscopy? II. Results with blood cultures obtained 5, 10, and 15 minutes after colonoscopy. Gastrointest Endosc. 1976 Aug;23(1):31–32. doi: 10.1016/s0016-5107(76)73573-9. [DOI] [PubMed] [Google Scholar]
  26. Norfleet R. G., Mulholland D. D., Mitchell P. D., Philo J., Walters E. W. Does bacteremia follow colonoscopy? Gastroenterology. 1976 Jan;70(1):20–21. [PubMed] [Google Scholar]
  27. Pelican G., Hentges D., Butt J., Haag T., Rolfe R., Hutcheson D. Bacteremia during colonoscopy. Gastrointest Endosc. 1976 Aug;23(1):33–35. doi: 10.1016/s0016-5107(76)73574-0. [DOI] [PubMed] [Google Scholar]
  28. Razzak I. A., Millan J., Schuster M. M. Pneumatic ileal perforation: an unusual complication of colonoscopy. Gastroenterology. 1976 Feb;70(2):268–271. [PubMed] [Google Scholar]
  29. Rees B. I., Williams L. A. Incarceration of hernia after colonoscopy. Lancet. 1977 Feb 12;1(8007):371–371. doi: 10.1016/s0140-6736(77)91178-3. [DOI] [PubMed] [Google Scholar]
  30. Roberts R., Campbell C. B., Isbister W. H. Two complications of diagnostic colonoscopy. Med J Aust. 1976 Nov 20;2(21):793–794. doi: 10.5694/j.1326-5377.1976.tb115358.x. [DOI] [PubMed] [Google Scholar]
  31. Rogers B. H., Silvis S. E., Nebel O. T., Sugawa C., Mandelstam P. Complications of flexible fiberoptic colonoscopy and polypectomy. Gastrointest Endosc. 1975 Nov;22(2):73–77. doi: 10.1016/s0016-5107(75)73705-7. [DOI] [PubMed] [Google Scholar]
  32. Schwesinger W. H., Levine B. A., Ramos R. Complications in colonoscopy. Surg Gynecol Obstet. 1979 Feb;148(2):270–281. [PubMed] [Google Scholar]
  33. Smith L. E. Fiberoptic colonoscopy: complications of colonoscopy and polypectomy. Dis Colon Rectum. 1976 Jul-Aug;19(5):407–412. doi: 10.1007/BF02590825. [DOI] [PubMed] [Google Scholar]
  34. Taylor R., Weakley F. L., Sullivan B. H., Jr Non-operative management of colonoscopic perforation with pneumoperitoneum. Gastrointest Endosc. 1978 Feb;24(3):124–125. doi: 10.1016/s0016-5107(78)73481-4. [DOI] [PubMed] [Google Scholar]
  35. Tregoning D., Britton D. C. Hazards of colonoscopy. Lancet. 1977 Mar 5;1(8010):544–544. doi: 10.1016/s0140-6736(77)91402-7. [DOI] [PubMed] [Google Scholar]
  36. Vawter M., Ruiz R., Alaama A., Aronow W. S., Dagradi A. E. Electrocardiographic monitoring during coloscopy. Am J Gastroenterol. 1975 Feb;63(2):155–157. [PubMed] [Google Scholar]
  37. Williams C. B., Gillespie P. E. Accidental removal of ureteral stoma at colonoscopy. Gastrointest Endosc. 1979 Aug;25(3):109–110. doi: 10.1016/s0016-5107(79)73389-x. [DOI] [PubMed] [Google Scholar]
  38. Williams C. B., Lane R. H., Sakai Y. Colonoscopy: an air-pressure hazard. Lancet. 1973 Sep 29;2(7831):729–729. doi: 10.1016/s0140-6736(73)92554-3. [DOI] [PubMed] [Google Scholar]
  39. Wunderlich M., Schiessel R., Wayand W. Das Risiko der chirurgischen Polypektomie am Dickdarm. Leber Magen Darm. 1980 Dec;10(6):321–324. [PubMed] [Google Scholar]

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