《Table 5 Bleeding rates per colonoscopy indication and procedure type from recent studies with sampl

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《Adverse events related to colonoscopy: Global trends and future challenges》

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Large-scale studies about colonoscopy perforations were less reported before 2000.Araghizadeh et al[25]showed that 31 perforations occurred in 34，620 colonoscopies（0.09%）over 30 years.Two other studies also showed that the overall rate of perforation is<0.1%[26，27].However，another large population-based cohort study demonstrated 108 perforations after 39，286 colonoscopies（0.20%），and reported that the risk of perforation during a colonoscopy is roughly double compared with sigmoidoscopy[28].Many large-scale studies on colonoscopy perforations have been published since 2000.In particular，recent studies have assessed the occurrence of colonoscopy perforations using big data analyses[16，29，30].A large study based on comprehensive French health insurance data，which included nearly one million colonoscopies，suggested that the estimated perforation rate was 0.04%（424/947，061）[29].That study indicated that a patient’s elderly status，resecting a large polyp（>10 mm），and emergency colonoscopy are associated with a risk of perforation.Another study also reported similar perforation rates，such as 0.02%（192/1，144，900）[16].Pox et al[30]stated the results of 2，821，392 colonoscopies conducted over 6 years in Germany.To date，this cohort is the largest database of screening colonoscopies worldwide.The overall perforation rate in that cohort was 0.016%（439/2，821，392），including 279（0.46/1000）patients with polypectomy and 160 patients without polypectomy（0.12/1000）[30].The most significant risk factor for adverse events was a polypectomy.The frequencies of colon perforations in some larger studies（sample sizes>50，000 cases）published since 2000 are shown in Table 1.The perforation rate tends to remain stable and not to change（Figure 1）.The results of our review are consistent with a recent large-scale meta-analysis by Reumkens et al[5]showing that the overall perforation rate was 0.05%and the trends in the past 15 years did not show any significant change.