Outpatient Colonoscopy Complications in CDCʼs Colorectal Cancer Screening Demonstration Program: A Prospective Analysis: 1491

Purpose: To report colonoscopy complications rate in the Centers for Disease Control and Prevention's (CDC) federally funded Colorectal Cancer Screening Demonstration Program (CRCSDP), conducted from 2005-2009. Methods: Clinical data were collected prospectively from five community-based, colorectal cancer screening programs in five CRCSDP sites (Baltimore, Maryland; Suffolk County, New York; Nebraska; King, Jefferson, and Clallam Counties, Washington; and St. Louis, Missouri). Individuals underwent colonoscopy for colorectal cancer screening (CRC), diagnostic follow-up after positive stool blood tests, and surveillance. Persons screened were 50-64 years of age at average-risk for CRC with a household income equal or less to 250% of the federal poverty level, and had no or inadequate health insurance. Individuals excluded were those with symptoms of CRC, a history of inflammatory bowel disease, or a history of genetic syndromes that predispose to CRC. Programs were required to provide a follow-up call to patients after endoscopic tests were performed and to report unintended medical complications to CDC. Complications were identified by reviewing the standardized reporting form to determine if the event was related to colonoscopy. Serious complications were defined as conditions or symptoms that resulted in an emergency room visit or hospital admission and were associated with the colonoscopy, including gastrointestinal bleeding that required hospital admission or blood transfusion; perforation; post-polypectomy syndrome or excessive abdominal pain; or death. An incidence rate per 1000 colonoscopies was calculated. Results: A total of 3215 individuals underwent 3355 colonoscopies. Of these, 89% were conducted for screening, 9% for diagnostic follow-up and 2% for surveillance purposes. The mean age was 55.9, 26% male and 74% females. The serious complications rate was low (n= 2, or 0.6/1000) and no deaths were observed. Two patients had bowel perforations (0.6/1000) and both required surgery. These two procedures were performed for screening and were without intervention (biopsy or polypectomy). One person developed a self-limited supraventricular tachycardia following completion of the bowel preparation. There were no events of serious gastrointestinal bleeding reported in this cohort. Two patients had self-limited bleeding that did not require transfusion or hospital admission. Conclusion: In the first federally funded colorectal cancer screening demonstration program, which provided screening to an underserved population, the overall incidence of serious complications from colonoscopy was low.