Bleeding and Perforation Complications after Follow-Up Colonoscopies in Faecal Immunochemical Test-Based Colorectal Cancer Screening: Insights from a Retrospective Case–Control Study

Tran TN, Bouchat J., Peeters M., Berghmans B., Van Cutsem E., Van Hal G., Van Herck K., Hoeck S.
Publicatiedatum
Naam tijdschrift
Gastrointestinal Disorders
Monitoring complications of colonoscopies after a positive faecal immunochemical test (FIT-colonoscopies) is crucial in FIT-based colorectal cancer (CRC) screening. We investigated the occurrence of bleeding and perforation post FIT-colonoscopies (2013–2019) in Flanders and the contributing factors. A retrospective case–control study was conducted, including bleeding/perforation cases within 14 days after index colonoscopy, and controls without such events. Bleeding rates dropped from 0.9–1.1% (pre-2017) to 0.3% (2017–2018) and further to 0.05% (2019), while perforation rates remained at 0.05–0.11% (2014–2019). Male gender, polypectomy, general anaesthesia, and recent antiplatelet/antithrombotic drug use increased bleeding odds. Incomplete colonoscopy, polypectomy, general anaesthesia, and recent antiplatelet/antithrombotic drug use raised perforation odds. The endoscopists (n = 16) with highest bleeding rates (top 5%) performed only 6% of total FIT-colonoscopies, yet their patients experienced 45.5% of bleeding events. Similarly, for the top 5% of perforation rates, endoscopists conducting only 4.5% of total FIT-colonoscopy had 49.0% of perforation events occur in their patients. This study sheds light on FIT-colonoscopy-related complications in Flanders, their rates and risk factors. These findings can be incorporated into CRC screening materials and guide interventions to mitigate complications. A central colonoscopy register is currently lacking in Belgium, highlighting the need for its establishment to facilitate recurrent monitoring and evaluation.