The risk of bleeding and perforation from sigmoidoscopy or colonoscopy in colorectal cancer screening: A systematic review and meta-analyses.

Autor: Kindt IS; The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Martiny FHJ; The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.; Department of Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark., Gram EG; The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.; The Research Unit for General Practice in Region Zealand, Region Zealand, Denmark., Bie AKL; The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Jauernik CP; The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Rahbek OJ; The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Nielsen SB; The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Siersma V; The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Bang CW; The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Brodersen JB; The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.; The Research Unit for General Practice in Region Zealand, Region Zealand, Denmark.; The Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Oct 31; Vol. 18 (10), pp. e0292797. Date of Electronic Publication: 2023 Oct 31 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0292797
Abstrakt: Introduction: Physical harm from Colorectal Cancer Screening tends to be inadequately measured and reported in clinical trials. Also, studies of ongoing Colorectal Cancer Screening programs have found more frequent and severe physical harm from screening procedures, e.g., bleeding and perforation, than reported in previous trials. Therefore, the objectives of the study were to systematically review the evidence on the risk of bleeding and perforation in Colorectal Cancer Screening.
Design: Systematic review with descriptive statistics and random-effects meta-analyses.
Methods: We systematically searched five databases for studies investigating physical harms related to Colorectal Cancer Screening. We assessed the internal and the external validity using the ROBINS-I tool and the GRADE approach. Harm estimates was calculated using mixed Poisson regression models in random-effect meta-analyses.
Results: We included 89 studies. Reporting and measurement of harms was inadequate in most studies. In effect, the risk of bias was critical in 97.3% and serious in 98.3% of studies. All GRADE ratings were very low. Based on severe findings with not-critical risk of bias and 30 days follow-up, the risk of bleedings per 100,000 people screened were 8 [2;24] for sigmoidoscopy, 229 [129;408] for colonoscopy following fecal immunochemical test, 68 [39;118] for once-only colonoscopy, and 698 [443;1045] for colonoscopy following any screening tests. The risk of perforations was 88 [56;138] for colonoscopy following fecal immunochemical test and 53 [25;112] for once-only colonoscopy. There were no findings within the subcategory severe perforation with long-term follow-up for colonoscopy following any screening tests and sigmoidoscopy.
Discussion: Harm estimates varied widely across studies, reporting and measurement of harms was mostly inadequate, and the risk of bias and GRADE ratings were very poor, collectively leading to underestimation of harm. In effect, we consider our estimates of perforation and bleeding as conservative, highlighting the need for better reporting and measurement in future studies.
Trial Registration: PROSPERO registration number: CRD42017058844.
Competing Interests: We have no conflicts of interest to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
(Copyright: © 2023 Kindt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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