Endoscopic and surgical complications of work-up in screening for colorectal cancer

BACKGROUND AND PURPOSE: In a ongoing randomized screening study of 68,306 patients for early detection of colorectal neoplasm, those with positive Hemoccult II(R) tests (Smith Kline Diagnostic, Sunnyvale, CA) were examined with a flexible sigmoidoscope (FS; 60 cm) and double-contrast barium enema (DCE). The aim of this study was to determine the rate of complications to the work-up. METHODS: A total of 2,108 FS, 1,987 DCE, 190 colonoscopies, and Hemoccult(R). RESULTS: One patient's large bowel was perforated during diagnostic endoscopy. Four perforations of the large bowel occurred during endoscopic polypectomy (0.8 percent of 513 adenomas removed), and one case of bleeding occurred 12 days after polypectomy. No complications occurred in connection with the 1,987 DCE. Five of 104 laparotomized patients underwent relaparotomy, 3 after removal of a colorectal carcinoma, and 2 of 4 patients with diverticular disease. All five patients healed but required a longer stay at the hospital. CONCLUSIONS: Complications occurred in 0.3 percent of the endoscopies, and 5 percent of patients had to undergo laparotomy again. No mortality occurred. If mortality attributable to colorectal cancer will decrease because of screening, we find the complication rate is acceptable.