Risk factors for adverse events related to polypectomy in the English Bowel Cancer Screening Programme.
OBJECTIVE
The English National Health Service Bowel Cancer Screening Programme (NHSBCSP) is one of the world's largest organized screening programs. Minimizing adverse events is essential for any screening program. Study aims were to determine rates and to examine risk factors for adverse events.


METHODS
Bleeding and perforations in NHSBCSP colonoscopies between August 2006 and January 2012 were examined. Logistic regression was used to examine risk factors for adverse events, including age, gender, polyp size, morphology, and location. For accurate attribution of adverse events, procedures with resection of only one polyp ("single-polypectomy") were analyzed in detail.


RESULTS
130 831 colonoscopies (167 208 polypectomies) were analyzed, including 30 881 single-polypectomies. Overall bleeding rate was 0.65 %, rate of bleeding requiring transfusion was 0.04 % and perforation rate was 0.06 %. Polypectomy increased bleeding risk 11.14-fold and perforation risk 2.97-fold. Cecal location (but not elsewhere in the proximal colon) and increasing polyp size were the two most important risk factors for bleeding and perforation. After adjustment for polyp size, the odds ratio (OR) relative to the distal colon for bleeding requiring transfusion after cecal snare polypectomy was 13.5 (95 %CI 3.9 - 46.4) and for perforation after cecal nonpedunculated polypectomy it was 12.2 (95 %CI 1.2 - 119.5).


CONCLUSIONS
This is the largest study focusing on polyp-specific risk factors. We have confirmed that the greatest risk factor for both post-polypectomy bleeding and perforation is polyp size. This is the first demonstration of substantial and significantly increased risk for both noteworthy bleeding (requiring transfusion) and perforation from cecal polypectomy for a given polyp size, compared with elsewhere in the colon.
Gastroenterology, University Hospital of North Tees, Stockton on Tees, UK.
Matthew D
MD
Rutter
NHS Cancer Screening Programmes, Sheffield, UK.
Claire
C
Nickerson
Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK.
Colin J
CJ
Rees
NHS Cancer Screening Programmes, Sheffield, UK.
Julietta
J
Patnick
Cancer Epidemiology Unit, Oxford University, Oxford, UK.
Roger G
RG
Blanks
D000368:Aged; D000369:Aged, 80 and over; D002429:Cecal Diseases / Q000453:epidemiology / Q000209:etiology; D003108:Colonic Diseases / Q000453:epidemiology / Q000209:etiology; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy; D055088:Early Detection of Cancer; D004739:England; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors