Complications Following Colonoscopy in a Nationwide Standard Cohort: A Retrospective Case-control Study

Ji Woo Kim; Su Young Kim; Jung Hye Choi; Hyun-Soo Kim; Jung Kuk Lee; Yun Tae Kim; Geunu Park; Dae Ryong Kang

doi:10.4166/kjg.2019.73.3.152

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Kim, Kim, Choi, Kim, Lee, Kim, Park, and Kang: Complications Following Colonoscopy in a Nationwide Standard Cohort: A Retrospective Case-control Study

Original Article

The Korean Journal of Gastroenterology 2019; 73(3): 152-158.

Published online: 27 March 2019

DOI: https://doi.org/10.4166/kjg.2019.73.3.152

Complications Following Colonoscopy in a Nationwide Standard Cohort: A Retrospective Case-control Study

Ji Woo Kim¹, Su Young Kim², Jung Hye Choi², Hyun-Soo Kim²

, Jung Kuk Lee³, Yun Tae Kim³, Geunu Park⁴, Dae Ryong Kang³

¹Department of Medicine, Yonsei University Wonju College of Medicine Wonju, Korea.

²Department of Internal Medicine, Yonsei University Wonju College of Medicine Wonju, Korea.

³Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Korea.

⁴Department of Biostatistics, Yonsei University, Seoul, Korea.

Correspondence to: Hyun-Soo Kim, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea. Tel: +82-33-741-1229, Fax: +82-33-741-1228, hyskim@yonsei.ac.kr

Received 20 December 2018 Revised 15 January 2019 Accepted 2 February 2019

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Despite the many reports of colonoscopy complications worldwide, few studies have been performed at the population level in Korea. In this study, a population-based study was performed to evaluate the incidence of post-colonoscopy perforations compared to a control group.

Methods

Between January 2011 and December 2011, data for all cases (age over 45) who underwent a colonoscopy were collected from National Health Insurance Service using a random sampling method. The clinical characteristics and perforation incidence (within 30 days after the colonoscopy) of cases were identified, and cases were then compared with controls who had not undergone a colonoscopy.

Results

Among 1,380,000 subjects, 31,177 cases and 62,354 controls were identified. Perforation occurred in 14 patients (0.04%) in the case group and one patient (<0.01%) in the control group (RR, 28.0; 95% CI 3.7–212.9, p<0.001). Subgroup analysis was followed according to the endoscopic procedure, gender and age. In subgroup analysis, colonoscopy-associated perforations occurred more in the therapeutic procedure (RR, 26; 95% CI 1.46–461.46), male (RR, 50; 95% CI 2.96–844.41), and age of 45–60 years (RR, 30; 95% CI 1.71–525.23).

Conclusions

A colonoscopy procedure is related to an increased risk of perforation at the population level. In addition, the therapeutic procedure, male, and age of 45-60 years appeared to be associated with an increased risk of perforation.

Keywords: Colonoscopy, Complications, Intestinal perforation

Figures and Tables

Table 1

Baseline Characteristics

Values are presented as mean±standard deviation or n (%).

CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease.

Table 2

Incidence Rate per 1,000 Persons (Events, n) and Relative Risk for Perforation within 30 Days of the Colonoscopy

Table 3

Summary Table of Perforation from Recent Large Studies with a Similar Sample Size to the Present Study

Notes

^{Financial support} This study was supported by grants from the Korean National Health Clinical Research (NHCR) project (HC16C2320) and the National R&D Program for Cancer Control(HA17C0046), Ministry of Health & Welfare, Republic of Korea.

^{Conflict of interest} None.

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SUPPLEMENTARY MATERIAL

Supplementary Table 1

National Health Insurance Service Codes in Our Study

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ORCID iDs: Hyun-Soo Kim
https://orcid.org/0000-0001-7190-0362
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