title: Colonoscopy and its complications across a Canadian regional health authority.
abstract: BACKGROUND
  Defining the complication rate of endoscopy performed across an entire city will capture usual as opposed to referral center data.
  
  
  OBJECTIVE
  Our purpose was to evaluate the current practice of colonoscopy and complications associated with lower GI endoscopy in usual clinical practice.
  
  
  METHODS
  All admissions within 30 days of an outpatient lower GI endoscopy at any of the 6 adult-care Winnipeg hospitals were identified. This includes endoscopy for both complex and routine patients. A chart audit of all cases with potential complications was performed.
  
  
  RESULTS
  A total of 24,509 outpatient lower GI endoscopies for adults were performed at the 6 hospitals over the 2 study years (April 1, 2004, to March 31, 2006). There were 303 admissions with potential complications. The colonoscopy completion rate was 65% (72% for gastroenterologists vs 59% for general surgeons, P < .005). Quality of bowel preparation and nature of polyps were often not documented. The overall rate of complications was 2.9/1000 procedures; the perforation rate after polypectomy was 1.8/1000; and the postpolypectomy bleeding rate was 6.4/1000. Most (67%) complications were recognized after discharge for the index procedure. The complication rate was highest for the endoscopists performing fewer than 200 procedures per year (5.4/1000 vs 2.7/1000 for the rest, P = .02, relative risk 2 [95% CI, 1.1-3.7]).
  
  
  CONCLUSIONS
  Chart audit was limited to cases requiring admission within 30 days of the index procedure.
  
  
  CONCLUSIONS
  The overall complication rate after lower GI endoscopy in usual clinical practice in Winnipeg is comparable to that previously reported. A higher complication rate after endoscopy by low-volume endoscopists needs to be further evaluated. The reporting of endoscopy must be standardized to enhance outcomes interpretation.
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. singh@cc.umanitoba.ca
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
authors.forename: Robert B
authors.initials: RB
authors.lastname: Penfold
authors.forename: Carolyn
authors.initials: C
authors.lastname: DeCoster
authors.forename: Lisa
authors.initials: L
authors.lastname: Kaita
authors.forename: Cindy
authors.initials: C
authors.lastname: Proulx
authors.forename: Gerry
authors.initials: G
authors.lastname: Taylor
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
authors.forename: Michael
authors.initials: M
authors.lastname: Moffatt
mesh_terms: D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies