A Woman With Dizziness and Shoulder Pain After Colonoscopy

Saad A. Shebrain, MD; Patrick Knight, MD

Disclosures

July 31, 2020

Discussion

The United States Preventive Services Task Force recommendations for routine screening for colorectal cancer in average-risk patients has further reinforced the significant benefit of screening patients aged 50 to 75 years.[1] The guidelines support several screening algorithms that can be used on a case-by-case basis. These screening modalities include annual fecal immunochemical testing, annual high-sensitivity fecal occult blood testing (FOBT), flexible sigmoidoscopy every 5 years in addition to high-sensitivity FOBT every 3 years, or colonoscopy every 10 years. Screening colonoscopy remains the criterion standard diagnostic study for identifying cancerous and precancerous lesions. The sensitivity and specificity of screening colonoscopy in identifying these lesions is widely used as a comparison when evaluating the effectiveness of other potential screening methods.

According to estimations calculated, approximately 14 million colonoscopies were performed in the United States in 2012; 3.3 million were performed for diagnostic and surveillance purposes and 10.7 million were performed for routine screening.[2] With an ongoing national initiative to increase the percentage of eligible patients being screened, a simulated analysis was used to evaluate the effect of the implementation of a national colonoscopy program that involved 80% of eligible screening candidates. This revealed that the estimated number of colonoscopies performed per year would initially increase to 16.2 million and would stabilize at 12-13 million per year, following 10 years of program implementation.[2]

Studies such as the one described have not only revealed a large number of screening colonoscopies performed each year in the United States but have also demonstrated that this figure is likely increasing from year to year due to an effort to increase the percentage of eligible patients that undergo screening.[2] This increase in colonoscopies represents a potential triumph for preventative medicine. With that being said, this increase further highlights the importance of practitioners encompassing a broad range of specialties and practice settings being able to recognize and differentiate the potential complications involved with this invasive procedure.

Complication types and rates from colonoscopies have repeatedly been shown to be relatively low. For example, a retrospective database analysis of 2.3 million patients who underwent colonoscopies in the outpatient setting revealed that only 1.98 in 1000 developed a complication that required hospitalization.[3] Further analysis by several other studies revealed that the overall risk for mortality secondary to complications arising from colonoscopy was between 0.0000029% and 0.007%.[4,5] Although these figures are encouragingly low, prompt recognition of potential complications, such as those seen in this case, in combination with the ability to differentiate between less serious and potentially life-threatening events is paramount to maintaining these low rates.

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