MORE THINKING ABOUT SCREENING COLONOSCOPIES
Colonoscopy is the preferred and most effective strategy for colorectal cancer screening. However, the benefit of any procedure must be weighed against the potential risks. This is particularly important as it relates to screening exams, which for the most part are done in otherwise healthy individuals.
A retrospective study was conducted via a review of electronic records involving approximately 36,000 colonoscopies performed at Kaiser Permanente, an integrated healthcare delivery system. Of the 16,318 eligible colonoscopies, the incidence of serious complications was 5/1000 procedures. The 82 cases of serious complications that occurred involved 15 perforations, 53 cases of bleeding requiring hospitalization, 38 cases of bleeding requiring inpatient observation, 6 cases of diverticulitis. There were 10 deaths (0.6/1000) within 30 days of the procedure, but only 1 of these was directly related to colonoscopy.
A significant discovery from this study is the importance of recognizing the consequences of removing small lesions that otherwise might not have needed removal. It is recognized by experts that the prime risk in removal of many of these smaller lesions actually derives from the use of cautery. Therefore, many experts have switched to a “cold snare” guillotine-type removal approach for these smaller lesions.