Bowel perforation is a rare but serious complication of colonoscopy.
Its prevalence is increasing with the rapidly growing volume of procedures performed.
Although colonoscopies have been performed for decades, the risk factors for perforation are not completely understood.
Dr Lawrence Hookey and colleagues from Canada investigated risk factors for perforation during colonoscopy by assessing variables that included sedation type and endoscopist specialty and level of training.
The researchers performed a retrospective multivariate analysis of risk factors for early perforation (occurring at any point during the colonoscopy but recognized during or immediately after the procedure) in adult patients by using the Clinical Outcomes Research Initiative National Endoscopic Database.
Risk factors were determined from published articles.
|Propofol sedation did not significantly affect risk for perforation|
|Clinical Gastroenterology & Hepatology|
The team assessed additional variables including endoscopist specialty and years of experience, trainee involvement, and sedation with propofol.
The researchers identified 192 perforation events during 1,144,900 colonoscopies from 85 centers entered into the database from 2000 to 2011.
On further analysis, the team found that increasing age, American Society of Anesthesia class, female sex, hospital setting, any therapy, and polyps >10 mm were significantly associated with increased risk of early perforation.
Colonoscopies performed by surgeons and endoscopists of unknown specialty had higher rates of perforation than those performed by gastroenterologists.
The research team observed that propofol sedation did not significantly affect risk for perforation.
Dr Hookey's team concludes, "In addition to previously established risk factors, non-gastroenterologist specialty was found to affect risk for perforations detected during or immediately after colonoscopy."
"This finding could result from differences in volume and style of endoscopy training. Further investigation into these observed associations is warranted."