Adverse events requiring hospitalization within 30 days after outpatient screening and nonscreening colonoscopies

Gastrointest Endosc. 2013 Mar;77(3):419-29. doi: 10.1016/j.gie.2012.10.028.


Background: The incidence of adverse events (AEs) is a crucial factor when colonoscopy is considered for mass screening, but few studies have addressed delayed and non-GI AEs.

Objectives: To investigate the risk of AEs requiring hospitalization after screening and nonscreening colonoscopies compared with control subjects who did not undergo colonoscopy.

Design: Retrospective matched cohort.

Setting: Statutory health insurance fund in Germany.

Patients: A total of 33,086 individuals who underwent colonoscopy as an outpatient (8658 screening, 24,428 nonscreening) and 33,086 matched controls who did not undergo colonoscopy.

Interventions: Outpatient screening and nonscreening colonoscopies.

Main outcomes measurements: Risk of AEs (perforation, bleeding, myocardial infarction, stroke, splenic injury, and others) requiring hospitalization within 30 days after colonoscopy/index date and risk differences between the group that underwent colonoscopy and the group that did not.

Results: The incidence of perforation was 0.8 (95% confidence interval [CI], 0.3-1.7) and 0.7 (95% CI, 0.4-1.1) per 1000 screening and nonscreening colonoscopies, respectively. Hospitalizations because of bleeding occurred in 0.5 (95% CI, 0.1-1.2) and 1.1 (95% CI, 0.8-1.7) per 1000 screening and nonscreening colonoscopies, respectively. The incidence of myocardial infarction, stroke, and other non-GI AEs was similar in colonoscopy and control groups. No splenic injury was observed. Those with AEs generally had a higher mean age and comorbidity rate than the overall study population.

Limitations: The analysis relies on health insurance claims data.

Conclusions: This study provides further evidence of the safety of colonoscopy in routine practice with regard to delayed and non-GI AEs. Hospitalizations because of the investigated AEs were uncommon or rare for both screening and nonscreening colonoscopies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Care / statistics & numerical data
  • Case-Control Studies
  • Colonoscopy / adverse effects*
  • Colonoscopy / statistics & numerical data
  • Female
  • Germany / epidemiology
  • Hospitalization / statistics & numerical data*
  • Humans
  • Incidence
  • Intestinal Perforation / epidemiology*
  • Intestinal Perforation / etiology
  • Male
  • Mass Screening / adverse effects*
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Postoperative Hemorrhage / epidemiology*
  • Postoperative Hemorrhage / etiology
  • Retrospective Studies
  • Risk Assessment
  • Stroke / epidemiology
  • Time Factors
  • Young Adult