Estimates of complications and clinically significant findings in screening and surveillance colonoscopy

Colorectal cancer is the third most common cancer and second leading cause of cancer-related death in the U.S. Colonoscopic screening can reduce mortality but carries risks of complications. This study analyzed 21,302 patients undergoing screening or surveillance colonoscopy to identify predictors of serious complications and clinically significant neoplasia (>9 mm). Multivariate logistic regression assessed risk factors and estimated the number needed to endoscope (NNE) for each outcome. Serious complications occurred in 0.31% of patients, while 8.76% had large neoplasia. Anticoagulation therapy significantly increased complication risk without improving yield. Predictors of neoplasia included male sex, older age, ASA class ≥II, and prior positive screening. Aspirin/NSAID use appeared protective. Findings suggest screening benefits may diminish at older ages as complication risk rises, and anticoagulation markedly elevates risk without added benefit.