Tu1056 COLONOSCOPY RELATED ADVERSE EVENTS IN A POPULATION-BASED COLON SCREENING PROGRAM

Abstract

The British Columbia Colon Screening Program (BCCSP) is a population-based program enrolling 50-74 year old average-risk adults for biennial FIT (cut-off 10 mcg/g) with follow-up colonoscopy for positive FIT. The neoplasia detection rate is 50-55% and over 75% of colonoscopies have a specimen taken. Previously reported colonoscopy adverse event rates for FIT based screening programs vary: 0.03-6.2% and 0-2.7% for bleeding and perforation, respectively with mortality reported to be between 0.0004% and 0.0074%. To determine the rate of colonoscopy related serious adverse events within the BCCSP. This is a cohort study with prospective data collection of all participants undergoing colonoscopy in BCCSP from November 15, 2013 to December 31, 2017. Colonoscopies were performed at 50 sites by 308 physicians (63% surgeons, 20% GI, 14% internists, 3% family practice). BCCSP contacts all screening participants 14 days post colonoscopy to determine unplanned medical visits prior (during bowel preparation) or following the colonoscopy. Unplanned events underwent BCCSP Quality Committee review if the event was a perforation, cardiovascular/respiratory event, or resulted in death, hospitalization, or significant intervention including repeat colonoscopy, interventional radiology, surgery, blood transfusion, or cardioversion. Unplanned events were defined as serious adverse events (SAE) if they resulted in death, hospitalization or significant intervention and sub-classified as probably, possibly, or unlikely related to the colonoscopy. A total of 108,004 colonoscopies were performed. Unplanned events were reported in 1753 participants, of which 586 met criteria for review. Of these, 578 were confirmed unplanned events and 409 were SAEs of which 367 (89.7%) were probably, 22 (5.4%) possibly and 20 (4.9%) unlikely associated with colonoscopy. 36/10,000 colonoscopies were associated with a SAE that was probably or possibly related: perforation in 5/10,000, bleeding 22/10,000. Three deaths occurred following colonoscopy that were probably (2 perforations) or possibly related to the colonoscopy (0.3/10,000). The BCCSP has a colonoscopy SAE rate in keeping with previous publications, particularly in the context of the high proportion of colonoscopies with polypectomy, a known risk factor for perforation and bleeding. The BCCSP includes physicians from diverse educational and training backgrounds with varying levels of experience and different practice settings; the results should be generalizable to other screening programs. This study will help inform screening participants about the risks of colonoscopy in a FIT-based colon screening program.