T. Tran, Joanna Bouchat, Marc Peeters, B. Berghmans, Eric Van Cutsem, G. Van Hal, Koen Van Herck, S. Hoeck
{"title":"基于粪便免疫化学检验的结直肠癌筛查中随访结肠镜检查后的出血和穿孔并发症:一项回顾性病例对照研究的启示","authors":"T. Tran, Joanna Bouchat, Marc Peeters, B. Berghmans, Eric Van Cutsem, G. Van Hal, Koen Van Herck, S. Hoeck","doi":"10.3390/gidisord6010003","DOIUrl":null,"url":null,"abstract":"Monitoring complications of colonoscopies after a positive faecal immunochemical test (FIT-colonoscopies) is crucial in FIT-based colorectal cancer (CRC) screening. We investigated the occurrence of bleeding and perforation post FIT-colonoscopies (2013–2019) in Flanders and the contributing factors. A retrospective case–control study was conducted, including bleeding/perforation cases within 14 days after index colonoscopy, and controls without such events. Bleeding rates dropped from 0.9–1.1% (pre-2017) to 0.3% (2017–2018) and further to 0.05% (2019), while perforation rates remained at 0.05–0.11% (2014–2019). Male gender, polypectomy, general anaesthesia, and recent antiplatelet/antithrombotic drug use increased bleeding odds. Incomplete colonoscopy, polypectomy, general anaesthesia, and recent antiplatelet/antithrombotic drug use raised perforation odds. The endoscopists (n = 16) with highest bleeding rates (top 5%) performed only 6% of total FIT-colonoscopies, yet their patients experienced 45.5% of bleeding events. Similarly, for the top 5% of perforation rates, endoscopists conducting only 4.5% of total FIT-colonoscopy had 49.0% of perforation events occur in their patients. This study sheds light on FIT-colonoscopy-related complications in Flanders, their rates and risk factors. These findings can be incorporated into CRC screening materials and guide interventions to mitigate complications. 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引用次数: 0
摘要
监测粪便免疫化学检验(FIT-结肠镜检查)阳性后结肠镜检查的并发症对于基于 FIT 的结肠直肠癌 (CRC) 筛查至关重要。我们调查了佛兰德地区(2013-2019 年)FIT 结肠镜检查后出血和穿孔的发生率及其诱因。我们进行了一项回顾性病例对照研究,其中包括结肠镜检查后 14 天内的出血/穿孔病例,以及未发生此类事件的对照组。出血率从0.9%-1.1%(2017年以前)降至0.3%(2017-2018年),并进一步降至0.05%(2019年),而穿孔率保持在0.05%-0.11%(2014-2019年)。男性性别、息肉切除术、全身麻醉和近期使用抗血小板/抗血栓药物会增加出血几率。不完全结肠镜检查、息肉切除术、全身麻醉和近期使用抗血小板/抗血栓药物会增加穿孔几率。出血率最高的内镜医师(n = 16)(前 5%)仅完成了 6% 的 FIT 结肠镜检查,但他们的患者却发生了 45.5% 的出血事件。同样,对于穿孔率最高的 5%,内镜医师只进行了 4.5% 的 FIT 结肠镜检查,但他们的患者却发生了 49.0% 的穿孔事件。这项研究揭示了佛兰德地区与 FIT 结肠镜检查相关的并发症及其发生率和风险因素。这些发现可纳入 CRC 筛查材料,并指导减少并发症的干预措施。比利时目前缺乏中央结肠镜检查登记册,因此有必要建立该登记册,以便于进行经常性监测和评估。
Bleeding and Perforation Complications after Follow-Up Colonoscopies in Faecal Immunochemical Test-Based Colorectal Cancer Screening: Insights from a Retrospective Case–Control Study
Monitoring complications of colonoscopies after a positive faecal immunochemical test (FIT-colonoscopies) is crucial in FIT-based colorectal cancer (CRC) screening. We investigated the occurrence of bleeding and perforation post FIT-colonoscopies (2013–2019) in Flanders and the contributing factors. A retrospective case–control study was conducted, including bleeding/perforation cases within 14 days after index colonoscopy, and controls without such events. Bleeding rates dropped from 0.9–1.1% (pre-2017) to 0.3% (2017–2018) and further to 0.05% (2019), while perforation rates remained at 0.05–0.11% (2014–2019). Male gender, polypectomy, general anaesthesia, and recent antiplatelet/antithrombotic drug use increased bleeding odds. Incomplete colonoscopy, polypectomy, general anaesthesia, and recent antiplatelet/antithrombotic drug use raised perforation odds. The endoscopists (n = 16) with highest bleeding rates (top 5%) performed only 6% of total FIT-colonoscopies, yet their patients experienced 45.5% of bleeding events. Similarly, for the top 5% of perforation rates, endoscopists conducting only 4.5% of total FIT-colonoscopy had 49.0% of perforation events occur in their patients. This study sheds light on FIT-colonoscopy-related complications in Flanders, their rates and risk factors. These findings can be incorporated into CRC screening materials and guide interventions to mitigate complications. A central colonoscopy register is currently lacking in Belgium, highlighting the need for its establishment to facilitate recurrent monitoring and evaluation.