© 2003 by Oxford University Press
Journal of the National Cancer Institute, Vol. 95, No. 3, 230-236,
February 5, 2003
© 2003 Oxford University Press
ARTICLE |
Risk of Perforation After Colonoscopy and Sigmoidoscopy: A Population-Based Study
Affiliations of authors: N. M. Gatto, J. S. Jacobson, Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY; H. Frucht, Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University: V. Sundararajan, Department of Epidemiology and Preventive Medicine, Monash Medical School, Melbourne, Australia; V. R. Grann, A. I. Neugut, Department of Epidemiology, Joseph L. Mailman School of Public Health, and Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University.
Correspondence to: Alfred I. Neugut, M.D., Ph.D., Division of Medical Oncology, New York-Presbyterian Hospital, 630 West 168th St., PH 18-127, New York, NY 10032 (e-mail: ain1{at}columbia.edu).
Background: Although the risk of bowel perforation is often cited as a major factor in the choice between colonoscopy and sigmoidoscopy for colorectal screening, good estimates of the absolute and relative risks of perforation are lacking. Methods: We used a large population-based cohort that consisted of a random sample of 5% of Medicare beneficiaries living in regions of the United States covered by the Surveillance, Epidemiology, and End Results (SEER) Program registries to determine rates of perforation in people aged 65 years and older. We identified individuals who were cancer-free and had undergone colonoscopy or sigmoidoscopy between 1991 and 1998, calculated both the incidence and risk of perforation within 7 days of the procedure, and explored the impact on incidence and risk of perforation of age, race/ethnicity, sex, comorbidities, and indication for the procedure. We also estimated the risk of death after perforation. Risks were calculated with odds ratios (ORs) and 95% confidence intervals (CIs). All statistical tests were two-sided. Results: There were 77 perforations after 39 286 colonoscopies (incidence = 1.96/1000 procedures) and 31 perforations after 35 298 sigmoidoscopies (incidence = 0.88/1000 procedures). After adjustment, the OR for perforation from colonoscopy relative to perforation from sigmoidoscopy was 1.8 (95% CI = 1.2 to 2.8). Risk of perforation from either procedure increased in association with increasing age (Ptrend<.001 for both procedures) and the presence of two or more comorbidities (Ptrend<.001 for colonoscopy and Ptrend = .03 for sigmoidoscopy). Compared with those who were endoscopied and did not have a perforation, the risk of death was statistically significantly increased for those who had a perforation after either colonoscopy (OR = 9.0, 95% CI = 3.0 to 27.3) or sigmoidoscopy (OR = 8.8, 95% CI = 1.6 to 48.5). The risk of perforation after colonoscopy, especially for screening procedures, declined during the 8-year study period. Conclusions: The risk of perforation after colonoscopy is approximately double that after sigmoidoscopy, but this difference appears to be decreasing. These observations should be useful to clinicians making screening and diagnostic decisions for individual patients and to policy officials setting guidelines for colorectal cancer screening programs.
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