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Colonoscopy-related complications in a nationwide immunochemical fecal occult blood test-based colorectal cancer screening program

Authors Mikkelsen EM, Thomsen MK, Tybjerg J, Friis-Hansen L, Andersen B, Jørgensen JC, Baatrup G, Njor SH, Mehnert F, Rasmussen M

Received 23 July 2018

Accepted for publication 11 September 2018

Published 13 November 2018 Volume 2018:10 Pages 1649—1655


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Irene Petersen

Ellen M Mikkelsen,1 Mette Kielsholm Thomsen,1 Julie Tybjerg,2 Lennart Friis-Hansen,3 Berit Andersen,4,5 Jens Christian Riis Jørgensen,6 Gunnar Baatrup,7,8 Sisse H Njor,2,4,5 Frank Mehnert,1 Morten Rasmussen9

1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2RKKP, The Danish Clinical Registries, A National Quality Improvement Programme, Aarhus, Denmark; 3Department of Clinical Biochemistry, Nordsjællands Hospital, Hillerød, Denmark; 4Department of Public Health Programmes, Randers Regional Hospital, The Central Denmark Region, Randers, Denmark; 5Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 6Department of Surgery, Vejle Hospital, Vejle, Denmark; 7Department of Surgery, Odense University Hospital, Odense, Denmark; 8Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 9Department of Digestive Diseases K, Bispebjerg Hospital, Copenhagen, Denmark

Background: The Danish national screening program for colorectal cancer (CRC) consists of an immunochemical fecal occult blood test (iFOBT) followed by colonoscopy. The Danish Colorectal Cancer Screening Database (DCCSD) records data on the incidence of hospital-registered complications after colonoscopy. However, the validity of these data is unknown, and the incidence of complications is potentially underreported.
Objective: To evaluate the validity of the colonoscopy complications registered in the DCCSD by using medical records as the reference. Further, to evaluate the incidence of complications leading to hospital contact.
Methods: Among 14,671 individuals with a positive iFOBT result and a colonoscopy procedure performed from March 3, 2014 to December 31, 2014, we selected 295 individuals for medical record review. We calculated sensitivity as the proportion of true complications registered in the DCCSD out of all complications found in the medical records, and the positive predictive value (PPV) as the number of true complications in the DCCSD out of all DCCSD-registered complications. On the basis of the medical record data, we calculated the incidence proportion of hospital-registered complications overall and by subtype.
Results: In total, we reviewed 286 records and found 102 individuals with at least one complication. The sensitivity of the DCCSD for any complication was 29.4% (95% CI: 20.8–39.3) and the PPV was 88.2% (95% CI: 72.6–96.7). On the basis of the medical record data, the incidence proportion of any complication after colonoscopy was 0.70% (95% CI: 0.57–0.84) and that of perforation or lesion was 0.10% (95% CI: 0.06–0.17); bleeding, 0.41% (95% CI: 0.31–0.53); post-polypectomy syndrome, 0.16% (95% CI: 0.10–0.24); and other medical complications, 0.04 (95% CI: 0.02–0.09).
Conclusion: The DCCSD has low sensitivity for complications, and improvements in data registration are warranted. The incidence proportion of any hospital-treated post-colonoscopy complication was 0.70% in 2014, which was the first year of the Danish national CRC screening program. This is within the range of complications reported by other studies.

Keywords: prevention, public health, harms

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