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World J Gastroenterol. Jan 14, 2019; 25(2): 190-204
Published online Jan 14, 2019. doi: 10.3748/wjg.v25.i2.190
Adverse events related to colonoscopy: Global trends and future challenges
Su Young Kim, Hyun-Soo Kim, Hong Jun Park
Su Young Kim, Hyun-Soo Kim, Hong Jun Park, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, South Korea
Author contributions: Kim SY and Kim HS contributed equally to this paper with conception of the study and wrote the manuscript; Park HJ collected the data for our study.
Supported by the National R&D Program for Cancer Control, No. HA17C0046, and the Korean National Health Clinical Research (NHCR) Project, No. HC16C2320.
Conflict-of-interest statement: No author has any personal or financial conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hyun-Soo Kim, MD, PhD, Professor, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, South Korea. hyskim@yonsei.ac.kr
Telephone: +82-33-7410505 Fax: +82-33-7473538
Received: September 28, 2018
Peer-review started: September 28, 2018
First decision: October 26, 2018
Revised: November 22, 2018
Accepted: November 30, 2018
Article in press: November 30, 2018
Published online: January 14, 2019
Abstract

Colonoscopy is a widely used method for diagnosing and treating colonic disease. The number of colonoscopies is increasing worldwide, and concerns about associated adverse events are growing. Large-scale studies using big data for post-colonoscopy complications have been reported. A colon perforation is a severe complication with a relatively high mortality rate. The perforation rate, as reported in large studies (≥ 50,000 colonoscopies) published since 2000, ranges from 0.005-0.085%. The trend in the overall perforation rate in the past 15 years has not changed significantly. Bleeding is a more common adverse event than perforation. Recent large studies (≥ 50,000 colonoscopies) have reported post-colonoscopy bleeding occurring in 0.001-0.687% of cases. Most studies about adverse events related to colonoscopy were performed in the West, and relatively few studies have been conducted in the East. The incidence of post-colonoscopy complications increases in elderly patients or patients with inflammatory bowel diseases. It is important to use a unified definition and refined data to overcome the limitations of previous studies. In addition, a structured training program for endoscopists and a systematic national management program are needed to reduce post-colonoscopy complications. In this review, we discuss the current trends in colonoscopy related to adverse events, as well as the challenges to be addressed through future research.

Keywords: Colonoscopy, Adverse events, Perforation, Bleeding, Post-colonoscopy

Core tip: Although colonoscopy-related adverse events rarely occur and the need for colonoscopy is increasing, the proportion of subjects with risk factors is increasing. Recently, the perforation rate, as reported in large studies, ranges from 0.005-0.085%. The perforation probability after colonoscopy does not decrease over time in either the West or the East. Other studies have reported post-colonoscopy bleeding occurring in 0.001-0.687% of cases. In this review article, we discuss the current trends in post-colonoscopy complications, as well as the challenges to be addressed through future research.