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Original article
Severe complications in colorectal cancer screening colonoscopies in the Valencian Community
Complicaciones graves en las colonoscopias de cribado del cáncer colorrectal en la Comunidad Valenciana
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Josefa Ibáñeza,b,
Corresponding author
Ibanyez_jos@gva.es

Corresponding author.
, Mercedes Vanaclocha-Espíb, Elena Pérez-Sanza,b, María José Valverdea,b, Isabel Sáez-Lloretc, Ana Molina-Barcelób, Dolores Salasa,b,d, Working Group of the Colorectal Cancer Prevention Program of the Comunitat Valenciana
a Dirección General de Salud Pública, Conselleria de Sanidad Universal y Salud Pública. Generalitat Valenciana, Valencia, Spain
b Área de Cáncer y Salud Pública, FISABIO-Salud Pública, Valencia, Spain
c Centro de Salud Pública de Benidorm, Conselleria de Sanidad Universal y Salud Pública. Generalitat Valenciana, Valencia, Spain
d CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Tables (4)
Table 1. Identification and rate of severe complications of screening colonoscopies performed in the period 2005–2012.
Table 2. Rate of severe complications by timing and gender.
Table 3. Rate of severe complications by timing and age.
Table 4. Severe complications of screening colonoscopies according to timing of complication, type of severe complication (perforation, haemorrhage) and type of colonoscopy (diagnostic or therapeutic).
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Abstract
Objective

To identify and characterise the severe complications of diagnostic confirmation colonoscopies carried out as part of the Colorectal Cancer Screening Programme of the Valencian Community (CCSP-VC).

Method

A retrospective observational study from 2005 to 2012. To identify complications, the CCSP-VC information system was used, as well as Spanish Minimum Basic Data Set hospital discharge summaries and medical records. Cumulative incidence rates were estimated for all complications, immediate complications (occurring the same day as the colonoscopy) and delayed complications (occurring 1–30 days after the colonoscopy) for the 1000 colonoscopies performed. A bivariate analysis using the Chi-square test was performed for the onset of complications, according to gender, age and type of test (guaiac/immunological), as well as for the complication onset time (immediate/delayed) based on the type of colonoscopy (diagnostic/therapeutic) and type of complication (haemorrhage/perforation).

Results

Of the total 8831 screening colonoscopies performed, 23 severe complications were observed, 13 of which were perforations (56.5%) and 10 haemorrhages (43.5%). No serious vagal syndrome, peritonitis or deaths were recorded. The cumulative incidence rate was 2.60‰; 2.85‰ for the guaiac test and 2.56‰ for the immunological test. The incidence rate was higher in men (2.93‰) than in women (2.16‰), as well as in older groups (3.02‰ versus 1.98‰). Of the total complications, 61% (n=14) were immediate.

Conclusions

The severe complication rates of screening colonoscopies are a quality indicator for population-based colorectal cancer screening programmes that require extensive research in order to maintain the appropriate risk/benefit ratio of such programmes.

Keywords:
Colonoscopy
Complications
Colorectal cancer
Adverse effects
Population-based screening
Resumen
Objetivo

Identificar y caracterizar las complicaciones graves de las colonoscopias de confirmación diagnóstica del Programa de Prevención de Cáncer Colorrectal de la Comunitat Valenciana (PPCCR-CV).

Método

Estudio observacional retrospectivo (2005-2012). Para identificar las complicaciones se utilizó el sistema de información del PPCCR-CV, las altas hospitalarias del conjunto mínimo básico de datos (CMBD) y la historia clínica. Se estimaron tasas de incidencia acumulada para el total de complicaciones, para inmediatas (mismo día de la colonoscopia) y tardías (1-30 días desde la colonoscopia) por 1.000 colonoscopias. Análisis bivariado con la prueba Chi cuadrado para la aparición de complicación según sexo, edad y tipo de test (guayaco/inmunológico) y para el tiempo de aparición de la complicación (inmediata/tardía) según el tipo de colonoscopia (diagnóstica/terapéutica) y el tipo de complicación (hemorragia/perforación).

Resultados

De las 8.831 colonoscopias del estudio se detectaron 23 complicaciones graves de las cuales 13 fueron perforaciones (56,5%) y 10 hemorragias (43,5%) y ningún síndrome vagal grave, peritonitis o fallecimiento. La tasa de incidencia acumulada fue del 2,60‰, para el test de guayaco del 2,85‰ y del 2,56‰ para el inmunológico. La tasa de incidencia fue mayor en hombres (2,93‰) que en mujeres (2,16‰) y en grupos de mayor edad (3,02‰ vs. 1,98‰). El 61% (n=14) de las complicaciones fueron inmediatas.

Conclusiones

Las tasas de complicaciones de las colonoscopias de cribado graves son un indicador de calidad de los programas poblacionales de cribado de cáncer colorrectal y requieren una investigación exhaustiva para mantener el balance adecuado de beneficios y efectos adversos de estos programas.

Palabras clave:
Colonoscopia
Complicaciones
Cáncer colorrectal
Efectos adversos
Cribado poblacional

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