Rates of minor adverse events and health resource utilization postcolonoscopy

Utilization of Probiotics in Relieving Post-Colonoscopy Gastrointestinal Symptoms: A Systematic Review and Meta-Analysis

INTRODUCTION

Colonoscopy is regarded as a safe diagnostic and therapeutic procedure, nevertheless, some patients may still encounter post-colonoscopy gastrointestinal symptoms. This study aimed to evaluate the utilization of probiotics before and after colonoscopy to relieve those symptoms.

METHODOLOGY

This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. Included studies were all interventional studies examining the effects of probiotics use before and after colonoscopy. Articles were retrieved from MEDLINE, EBSCO-Host, Cochrane, ProQuest, and Google Scholar electronic databases, utilized specific keywords ( " Probiotic " OR " Probiotics ") AND (" Colonoscopy " OR " Colonoscopies "). The Cochrane Risk of Bias (RoB) 2 and Joanna Briggs Institute (JBI) Critical Appraisal tools were used for study quality assessment, as well as Review Manager (RevMan) 5.4 to perform the meta-analysis.

RESULTS

A total of ten studies were included in this systematic review. Six studies assessed the effect of probiotics consumption after colonoscopy, three examined the impact before colonoscopy, and one study assessed both. The most common type of probiotics used were Lactobacillus and Bifidobacterium. Quantitative synthesis of probiotics before colonoscopy showed no significant differences among bloating, abdominal pain, nausea, and vomiting symptoms (p=0.49, p=0.14, p=0.30, and p=0.42, respectively). Similarly, quantitative synthesis of probiotics after colonoscopy showed no significant differences in bloating and abdominal pain (p=0.16 and p=0.63, respectively).

CONCLUSIONS

Probiotic administration pre- and post-colonoscopy exhibited preliminary evidence for reducing gastrointestinal symptoms, but a quantitative synthesis revealed non-significant findings, necessitating further investigations.

Splenic Laceration Post Colonoscopy: A Rare Complication

BACKGROUND

The number of colonoscopies performed in the United States is increasing each year. Although the procedure is generally safe and effective, complications can arise. Splenic laceration is an extremely rare complication of colonoscopy.

CASE REPORT

A 71-year-old woman presented to the Emergency Department with abdominal pain and left shoulder pain accompanied by nausea within 24 h of undergoing a colonoscopy. A computed tomography scan showed hemoperitoneum, with findings suggestive of a splenic laceration. Upon laparoscopy, the patient was found to have a splenic laceration with active bleeding. She was treated with splenectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Colonoscopy is one of the most commonly performed outpatient procedures in the United States. As such, being able to recognize potential complications of the procedure is essential. With the number of colonoscopies being performed each year increasing, the emergency physician should be aware of the remote possibility of splenic injury as a cause of abdominal pain whenever a history of recent colonoscopy is elicited from the patient.

What Patients Want in a Smartphone App That Supports Colonoscopy Preparation: Qualitative Study to Inform a User-Centered Smartphone App

Background

The preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11% of patients do not keep their colonoscopy appointments and up to 33% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy.

Objective

The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments.

Methods

We conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy.

Results

A total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use.

Conclusions

Participants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app.

Standards of diagnostic colonoscopy for early-stage neoplasia: Recommendations by an Asian private group

BACKGROUND AND AIM

In recent years, the incidence of colorectal cancer has been increasing, and it is now becoming the major cause of cancer death in Asian countries. The aim of the present study was to develop Asian expert-based consensus to standardize the preparation, detection and characterization for the diagnosis of early-stage colorectal neoplasia.

METHODS

A professional group was formed by 36 experts of the Asian Novel Bio-Imaging and Intervention Group (ANBI² G) members. Representatives from 12 Asia-Pacific countries participated in the meeting. The group organized three consensus meetings focusing on diagnostic endoscopy for gastrointestinal neoplasia. The Delphi method was used to develop the consensus statements.

RESULTS

Through the three consensus meetings with debating, reviewing the literature and regional data, a consensus was reached at third meeting in 2016. The consensus was reached on a total of 10 statements. Summary of statements is as follows: (i) Adequate bowel preparation for high-quality colonoscopy; (ii) Antispasmodic agents for lesion detection; (iii) Image-enhanced endoscopy (IEE) for polyp detection; (iv) Adenoma detection rate for quality indicators; (v) Good documentation of colonoscopy findings; (vi) Complication rates; (vii) Cecal intubation rate; (viii) Cap-assisted colonoscopy (CAC) for polyp detection; (ix) Macroscopic classification using indigocarmine spray for characterization of colorectal lesions; and (x) IEE and/or magnifying endoscopy for prediction of histology.

CONCLUSION

This consensus provides guidance for carrying out endoscopic diagnosis and characterization for early-stage colorectal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early-stage colorectal neoplasia.

Patient-reported minor adverse events after colonoscopy: a systematic review

OBJECTIVE

The purpose of this systematic review was to investigate the incidence and nature of minor adverse events (MAEs) after colonoscopy, and response rates to questionnaires concerning MAEs in patients undergoing colonoscopy.

MATERIALS AND METHODS

A systematic literature search was conducted in the databases PubMed and Embase. Predictor variables were patient-reported MAEs after colonoscopy. The outcome was frequency and types of MAEs and the patients' response rate to questionnaires after colonoscopy. Quality assessment for potential risk of bias and level of evidence was evaluated using the National Health and Medical Research Council guidelines.

RESULTS

Seven prospective cohorts were included with a pooled total of 6172 participants. Patients undergoing colonoscopy had a response rate to questionnaires ranging from 64% to 100%, with a mean of 81%. One-third of the patients experienced MAEs, most prominently in the first 1-2 weeks after colonoscopy, and less common at 30 days post colonoscopy. The most frequently reported MAEs were abdominal pain, bloating and abdominal discomfort.

CONCLUSIONS

In general, patients undergoing colonoscopy have a high response rate to questionnaires about MAEs. MAEs after colonoscopy are commonly seen. High age and score of American Society of Anesthesiologists (ASA) classification, female gender and duration of procedure seem to be associated with a higher risk of MAEs, whereas adequate sedation seems to decreases the risk. MAEs after colonoscopy seems to be underreported in the current literature and the existing evidence is based on inhomogeneous reports. In the current study, it was not possible to conduct a meta-analysis. There is a need for larger scale studies addressing the MAEs patients experience in conjunction with a colonoscopy. Furthermore, the assessment of the MAEs should rely on questionnaires tested for validity, comprehensibility and reliability, to reflect the patient-reported experience of a colonoscopy as precise as possible.

Patient-reported complications related to colonoscopy: a prospective feasibility study of an email-based survey

OBJECTIVE

This prospective pilot study assessed the feasibility of electronic email-based questionnaires about patient-reported complications after colonoscopy.

MATERIAL AND METHODS

A newly internally validated questionnaire on patient-reported complications related to colonoscopy was conducted as an online survey.

RESULTS

Out of 200 patients (mean age 65 years), 83% completed the first questionnaire immediately after the procedure, 77% completed the second follow-up questionnaire after 24 h at home, and 70% the third one after 30 d. Forty-four percent of the patients reported minor adverse events after 24 h, and 23% at the follow-up after 30 d. The rate of sick leave in the 30-d period after the colonoscopy was 6%.

CONCLUSIONS

This study shows that email-based questionnaires give a high response rate independent of age or gender, but that the response rate declines with time after colonoscopy. Minor adverse events are underestimated, and colonoscopy could lead to sick leave in a minor subgroup of patients.

Alberta Family Physician Electronic Endoscopy study: Quality of 1769 colonoscopies performed by rural Canadian family physicians

OBJECTIVE

To determine whether rural FP colonoscopists in Alberta are achieving benchmarks in colonoscopy quality.

DESIGN

Prospective, multicentre observational study.

SETTING

Alberta.

PARTICIPANTS

Nine FP colonoscopists.

MAIN OUTCOME MEASURES

Proportion of successful cecal intubations; proportion of patients aged 50 and older with pathologically confirmed adenomas; mean number of adenomas per colonoscopy; and serious adverse events related to colonoscopy.

RESULTS

In this 6-month study, 9 rural FPs in Alberta performed 1769 colonoscopies. Overall, all key colonoscopy quality benchmarks were met or exceeded. The proportion of successful cecal intubations was 97.9% (95% CI 97.2% to 98.6%). The proportion of male and female patients aged 50 and older whose first-time colonoscopy results revealed an adenoma was 67.4% (95% CI 62.4% to 72.7%) and 51.1% (95% CI 45.5% to 56.7%), respectively. There were 120 adenomas, 36 advanced adenomas, and 1 colon cancer case per 100 colonoscopies. There were 2 postpolypectomy bleeds and no other serious complications.

CONCLUSION

Alberta rural FP colonoscopists are meeting benchmarks in colonoscopy quality. Ongoing electronic collection of endoscopy quality markers should be encouraged. Supporting and training rural FPs who perform endoscopy might help alleviate current wait times and improve access for rural Canadian patients.

Colonoscopy complications: experience with 8968 consecutive patients in a single institution

OBJECTIVE

to evaluate the incidence, epidemiological characteristics, diagnosis and evolution of patients who returned to the emergency care units of the Albert Einstein Hospital in São Paulo/SP with signs and symptoms suggestive of colonoscopy complications up to 30 days after the procedure.

METHODS

we conducted a retrospective, uni-institutional study of patients submitted to colonoscopy in 2014 who returned to the Emergency department (ED) within 30 days after the procedure.

RESULTS

8968 patients underwent colonoscopies, 95 (1.06%) of whom had complaints related to possible complications. Most of the procedures were elective ones. Minor complications (nonspecific abdominal pain/distension) were frequent (0.49%) and most of the patients were discharged after consultation at the ED. Severe complications were less frequent: perforation (0.033%), lower gastrointestinal bleeding (0.044%), and intestinal obstruction (0.044%). ED consultations in less than 24 hours after the procedure was associated with a higher index of normal colonoscopies (p=0.006), more diagnosis of fever (p=0.0003) and dyspeptic syndrome (p=0.043), and less diagnosis of colitis/ileitis (p=0.015). The observation of fever in patients treated at the ED was associated with the diagnosis of polyps at colonoscopy (p=0.030).

CONCLUSION

the data corroborate the safety of the colonoscopy exam and points to a reduction in major complications rates.

Screening Indication Associated With Lower Likelihood of Minor Adverse Events in Patients Undergoing Outpatient Colonoscopy

We sought to determine, among outpatients at one university hospital endoscopy center, rates of self-reported minor adverse events (MAEs) at 2, 14, and 30 days postcolonoscopy and to identify predictors of MAEs at Day 2 postcolonoscopy. A single-center longitudinal cohort study with follow-ups at Days 2, 14, and 30 postcolonoscopy was conducted in Montreal, Canada. Baseline self-report data included patient age, gender, gastrointestinal discomforts and other discomforts in the preceding month, and comorbidity. Intracolonoscopy procedures and the method of insufflation were obtained from endoscopy reports. Minor adverse event data were obtained by either phone or Internet survey. Multivariate logistic regression was used to identify predictors of MAEs at Day 2. Of 705 individuals approached, 420 (mean age = 58.7 years; SD = 8.4, 45.7% female) were eligible and consented to study participation, and 378 (90%) participated in at least one follow-up. At Days 2, 14, and 30, 86 (25.1%), 46 (13.7%), and 13 (3.1%) patients, respectively, experienced at least one MAE. At the Day 30 follow-up, 2 (0.53%) patients reported having experienced a serious adverse event. The multivariable analysis results showed that screening compared with nonscreening colonoscopy was protective for MAEs at 2 days (OR = 0.5, 95% CI [0.3, 0.9]). We found that 25% of patients experienced at least one MAE at 2 days postcolonoscopy, and screening compared with nonscreening colonoscopy patients were half as likely to experience these early MAEs. Nurses may use these findings to educate and reassure patients about colonoscopy risks. Large, longitudinal multicenter studies are needed to corroborate our findings.

Prospective Analysis of Minor Adverse Events After Colon Polypectomy

BACKGROUND

The risks of minor adverse events (MAEs) such as abdominal pain and bloating after colon polypectomy (CP) are less clearly documented than major adverse events. However, these complications may cause significant discomfort during the performance of normal activities. We aimed to estimate the incidence of MAE, associated risk factors, and healthcare resource utilization after CP.

METHODS

Patients who underwent CP were prospectively enrolled in this study. Trained nurses contacted patients by telephone at 7 and 30 days after the CP and administered a standardized questionnaire to obtain information regarding the development of complications. MAEs were defined as any discomfort the patient experienced after CP excluding major bleeding, perforation, and post-polypectomy coagulation syndrome.

RESULTS

Among a total of 2716 patients, 2253 patients completed the interview at 7 and 30 days. MAEs occurred in 263 patients (11.7%) before day 7, among which the most common were abdominal pain (4.5%), rectal bleeding (2.8%), and bloating (2.6%). Cumulative incidence of MAEs was in 267 patients (11.9%) at 30 days. On multivariate analysis, female sex (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.58-3.18) and use of meperidine (OR 1.54, 95% CI 1.04-2.27) were risk factors for the occurrence of MAEs. Two patients (0.7%) required hospital admission, 117 patients (43.8%) were treated medically in the outpatient clinic, and the majority at 148 patients (55.4%) experienced resolution of symptoms after observation.

CONCLUSIONS

The post-CP MAE rate was as low as 11.8%. The MAEs occurred mainly in the first seven postoperative days and resulted in little use of healthcare resources.

Canadian Association of Gastroenterology Indicators of Safety Compromise following Colonoscopy in Clinical Practice

In 2012 the Canadian Association of Gastroenterology published 19 indicators of safety compromise. We studied the incidence of these indicators by reviewing all colonoscopies performed in St. John's, NL, between January 1, 2012, and June 30, 2012. Results. A total of 3235 colonoscopies were included. Adverse events are as follows. Medication-related includes use of reversal agents 0.1%, hypoxia 9.9%, hypotension 15.4%, and hypertension 0.9%. No patients required CPR or experienced allergic reactions or laryngospasm/bronchospasm. The indicator, "sedation dosages in patients older than 70," showed lower usage of fentanyl and midazolam in elderly patients. Procedure-related immediate includes perforation 0.2%, immediate postpolypectomy bleeding 0.3%, need for hospital admission or transfer to the emergency department 0.1%, and severe persistent abdominal pain proven not to be perforation 0.4%. Instrument impaction was not seen. Procedure-related delayed includes death within 14 days 0.1%, unplanned health care visit within 14 days of the colonoscopy 1.8%, unplanned hospitalization within 14 days of the colonoscopy 0.6%, bleeding within 14 days of colonoscopy 0.2%, infection 0.03%, and metabolic complication 0.03%. Conclusions. The most common adverse events were mild and sedation related. Rates of serious adverse events were in keeping with published reports.