Original Articles
Procedural success and complications of large-scale screening colonoscopy,☆☆,*

Presented at the annual meeting of the American Society for Gastrointestinal Endoscopy, May 16-19, 1999, Orlando, Florida (Gastrointest Endosc 1999;49:AB65).
https://doi.org/10.1067/mge.2002.121883Get rights and content

Abstract

Background: Indirect evidence and modeling analyses suggest that colonoscopy may be the most cost-effective way to screen the average-risk population for colorectal neoplasia. However, the success and safety of primary colonoscopic screening has not been prospectively evaluated in a multicenter trial. Methods: Asymptomatic subjects age 50 to 75 years who had not undergone examination of the colon within 10 years were recruited from the general medicine clinics of 13 Department of Veterans Affairs Medical Centers. Eligible patients underwent colonoscopy by study coinvestigators, at which time all polyps were measured, photographed, and removed. Patients were contacted at 24 hours and 1 week to track procedure-related complications. Results: Primary screening colonoscopy was performed in a cohort of 3196 asymptomatic subjects. A “good” preparation was reported in 81% of patients, and colonoscopy to the cecum was successful in 97.2% of cases. Mean insertion time to the cecum and total procedure times were 10.5 (8.7) and 30.6 (19.1) minutes, respectively. No preprocedural patient characteristics were identified that were predictive of an incomplete procedure. At least one polyp was resected in 1672 patients. There was no perforation and no death attributed to colonoscopy. Major morbidity considered to be definitely related to colonoscopy occurred in 9 of 3196 procedures (0.3%): lower GI bleeding requiring intervention (6), myocardial infarction and/or cerebrovascular accident (2), and thrombophlebitis (1). In subjects undergoing only diagnostic procedures, the major complication rate was 0.1%. Conclusions: Screening colonoscopy can be performed in multiple centers with a high degree of success and safety in large numbers of asymptomatic, average-risk men. (Gastrointest Endosc 2002;55:307-14.)

Section snippets

Patients and methods

The study protocol was approved by a central Human Rights Committee (CSPCC Perry Point, MD Department of Veterans Affairs Medical Center), and by the institutional review board of each participating center. Asymptomatic subjects age 50 to 75 years who had not undergone examination of the colon within 10 years were recruited between February 1994 and January 1997 from 13 Department of Veterans Affairs Medical Centers (VAMC) across the country. They were recruited in 1 of 3 ways: random selection

Results

Selected demographics of the subjects who underwent screening colonoscopy are presented in Table 1.

. Patient/procedure characteristics

Empty CellN = 3196
Mean age (SD)63.0 (7.1)
Gender (% male)96.8
Race (% white)83.5
Major comorbid conditions
 Coronary heart disease (%)21.1
 CVA/TIA (%)8.2
 Diabetes (%)20.8
 COPD (%)8.5
Medications (% patients receiving)
 Meperidine70.7
 Fentanyl19.1
 Midazolam71.4
 Diazepam8.5
 Atropine13.3
 Glucagon0.7

CVA/TIA, Cerebrovascular accident/transient ischemic attack; COPD, chronic obstructive pulmonary

Discussion

Indirect evidence and modeling analyses suggest that colonoscopy may be the most cost-effective way to screen the average-risk population for colorectal neoplasia.13, 14, 15 Support for colonoscopy as a primary screening modality comes from 3 lines of indirect evidence. First, the majority of colorectal cancers arise from slowly growing precancerous adenomas that occur throughout the colon. Colonoscopy is highly accurate at detecting adenomas, and their removal by colonoscopic polypectomy has

Acknowledgements

We are indebted to the members of the Data Monitoring Board of the VA Cooperative Study Group No. 380: C. Richard Boland, MD, Martin Brown, PhD, Randall Burt, MD, Ralph B. D'Agostino, PhD, Bernard Levin, MD, and Douglas K. Rex, MD for their careful oversight of the progress of the trial; the Executive Committee: David A. Lieberman, MD (Portland, OR), Dennis J. Ahnen, MD (Denver, CO), John Bond, MD (Minneapolis, MN), Greg Chejfec, MD (Hines, IL), Harinder Garewal, MD, PhD (Tucson, AZ), Sheila

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  • Cited by (0)

    Supported by the Cooperative Studies Program, Department of Veterans Affairs.

    ☆☆

    Reprint requests: Douglas B. Nelson, MD, Associate Professor of Medicine, VA Medical Center (111-D), One Veterans Drive, Minneapolis, MN 44417.

    *

    Participants from the VA Cooperative Study Group #380: William V. Harford, MD; Dennis J. Ahnen MD; Dawn Provenzale, MD, MS; Stephen J. Sontag, MD, Thomas G. Schnell, MD; Donald R. Campbell, MD; Theodore E. Durbin, MD; John G. Lee, MD; George Triadafilopoulos, MD; Francisco C. Ramirez, MD; Judith F. Collins, MD, M. Brian Fennerty, MD; Harinder Garewal, MD, PhD, Richard E. Sampliner, MD, Thomas G. Morales, MD, Ronnie Fass, MD; Robert E. Smith, MD, Yogesh Maheshwari, MD

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