Search tips
Search criteria 


Logo of gutGutView this articleSubmit a manuscriptReceive email alertsContact usBMJ
Gut. 1983 May; 24(5): 376–383.
PMCID: PMC1419999

Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies.


The diagnostic and therapeutic benefits of colonoscopy are well known but most large-scale surveys, especially those involving multiple centres, may underestimate the range and incidence of complications. The detailed records of 5000 colonoscopies in a specialist unit have been analysed and conclusions drawn which may help to make the procedure safer. The incidence of haemorrhage was 1% and bowel perforation 0.1%. All the major haemorrhages occurred during polypectomies over 2 cm in size. Secondary haemorrhage was an unpredictable occurrence, one to 14 days later. Three deaths followed colonoscopy: one cardiorespiratory death was related to oversedation; a second was due to mismanaged ischaemic colitis developing two days after traumatic instrumentation, and the third was due to peritonitis. Minor complications included thrombophlebitis, abdominal distension, and vasovagal episodes. Because of experience during the first half of the series and also due to improvements in instrumentation, the complication rate of the later part of the series was halved. Recommendations include the avoidance of oversedation, review of previous barium enema films so as to be aware of large polyps which are more likely to bleed, and the recognition of situations where perforation or septicaemia is likely to occur.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Britton DC, Tregoning D, Bone G, McKelvey ST. Colonoscopy in surgical practice. Br Med J. 1977 Jan 15;1(6054):149–151. [PMC free article] [PubMed]
  • Dagradi AE, Riff DS, Norum TM, Juler G. A complication of colonoscopic (cecal) polypectomy. Am J Gastroenterol. 1976 May;65(5):449–453. [PubMed]
  • Gordon MJ. Retroperitoneal emphysema from colonoscopy of the distal limb of a Hartmann colostomy. Gastrointest Endosc. 1975 Nov;22(2):101–102. [PubMed]
  • Jacobsohn WZ, Levy A. Colonoscopic perforation: its emergency treatment. Endoscopy. 1976 Feb;8(1):15–17. [PubMed]
  • Meyers MA, Ghahremani GG. Complications of fiberoptic Endoscopy. II. Colonoscopy. Radiology. 1975 May;115(2):301–307. [PubMed]
  • Razzak IA, Millan J, Schuster MM. Pneumatic ileal perforation: an unusual complication of colonoscopy. Gastroenterology. 1976 Feb;70(2):268–271. [PubMed]
  • Roberts R, Campbell CB, Isbister WH. Two complications of diagnostic colonoscopy. Med J Aust. 1976 Nov 20;2(21):793–794. [PubMed]
  • Taylor R, Weakley FL, Sullivan BH., Jr Non-operative management of colonoscopic perforation with pneumoperitoneum. Gastrointest Endosc. 1978 Feb;24(3):124–125. [PubMed]
  • Ecker MD, Goldstein M, Hoexter B, Hyman RA, Naidich JB, Stein HL. Benign pneumoperitoneum after fiberoptic colonoscopy. A prospective study of 100 patients. Gastroenterology. 1977 Aug;73(2):226–230. [PubMed]
  • Erdman LH, Boggs HW, Jr, Slagle GW. Electrical ileal perforation: an unusual complication of colonoscopy. Dis Colon Rectum. 1979 Oct;22(7):501–502. [PubMed]
  • Vawter M, Ruiz R, Alaama A, Aronow WS, Dagradi AE. Electrocardiographic monitoring during coloscopy. Am J Gastroenterol. 1975 Feb;63(2):155–157. [PubMed]
  • Tregoning D, Britton DC. Hazards of colonoscopy. Lancet. 1977 Mar 5;1(8010):544–544. [PubMed]
  • Rees BI, Williams LA. Incarceration of hernia after colonoscopy. Lancet. 1977 Feb 12;1(8007):371–371. [PubMed]
  • Crespon B, Housset P, Mendez J, Berman H, Debray C. Bilan de 1.000 coloscopies. Arch Fr Mal App Dig. 1975 Jun;64(4):299–308. [PubMed]
  • Frühmorgen P, Demling L. Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany. Results of an inquiry. Endoscopy. 1979 May;11(2):146–150. [PubMed]
  • Geenen JE, Schmitt MG, Jr, Wu WC, Hogan WJ. Major complications of coloscopy: bleeding and perforation. Am J Dig Dis. 1975 Mar;20(3):231–235. [PubMed]
  • Rogers BH, Silvis SE, Nebel OT, Sugawa C, Mandelstam P. Complications of flexible fiberoptic colonoscopy and polypectomy. Gastrointest Endosc. 1975 Nov;22(2):73–77. [PubMed]
  • Schwesinger WH, Levine BA, Ramos R. Complications in colonoscopy. Surg Gynecol Obstet. 1979 Feb;148(2):270–281. [PubMed]
  • Smith LE. Fiberoptic colonoscopy: complications of colonoscopy and polypectomy. Dis Colon Rectum. 1976 Jul-Aug;19(5):407–412. [PubMed]
  • Wunderlich M, Schiessel R, Wayand W. Das Risiko der chirurgischen Polypektomie am Dickdarm. Leber Magen Darm. 1980 Dec;10(6):321–324. [PubMed]
  • KLEINFELD G, GUMP FE. Complications of colotomy and polypectomy. Surg Gynecol Obstet. 1960 Dec;111:726–728. [PubMed]
  • Williams CB, Gillespie PE. Accidental removal of ureteral stoma at colonoscopy. Gastrointest Endosc. 1979 Aug;25(3):109–110. [PubMed]
  • Bigard MA, Gaucher P, Lassalle C. Fatal colonic explosion during colonoscopic polypectomy. Gastroenterology. 1979 Dec;77(6):1307–1310. [PubMed]
  • Fletcher GF, Earnest DL, Shuford WF, Wenger NK. Electrocardiographic changes during routine sigmoidoscopy. Arch Intern Med. 1968 Dec;122(6):483–486. [PubMed]
  • Darragh A, Lambe R, Scully M, Brick I, O'Boyle C, Downe WW. Investigation in man of the efficacy of a benzodiazepine antagonist, Ro 15-1788. Lancet. 1981 Jul 4;2(8236):8–10. [PubMed]
  • Axon AT, Banks J, Cockel R, Deverill CE, Newmann C. Disinfection in upper-digestive-tract endoscopy in Britain. Lancet. 1981 May 16;1(8229):1093–1094. [PubMed]
  • Carlyle DR, Goldstein HM. Angiographic management of bleeding following transcolonoscopic polypectomy. Am J Dig Dis. 1975 Dec;20(12):1196–1201. [PubMed]
  • Williams CB, Lane RH, Sakai Y. Colonoscopy: an air-pressure hazard. Lancet. 1973 Sep 29;2(7831):729–729. [PubMed]
  • Liebermann TR. Bacteremia and fiberoptic endoscopy. Gastrointest Endosc. 1976 Aug;23(1):36–37. [PubMed]
  • Meyer GW. Prophylaxis of infective endocarditis during colonoscopy: report of a survey. Gastrointest Endosc. 1981 May;27(2):58–59. [PubMed]
  • Norfleet RG, Mitchell PD, Mulholland DD, Philo J. Does bacteremia follow colonoscopy? II. Results with blood cultures obtained 5, 10, and 15 minutes after colonoscopy. Gastrointest Endosc. 1976 Aug;23(1):31–32. [PubMed]
  • Pelican G, Hentges D, Butt J, Haag T, Rolfe R, Hutcheson D. Bacteremia during colonoscopy. Gastrointest Endosc. 1976 Aug;23(1):33–35. [PubMed]
  • Norfleet RG, Mulholland DD, Mitchell PD, Philo J, Walters EW. Does bacteremia follow colonoscopy? Gastroenterology. 1976 Jan;70(1):20–21. [PubMed]
  • Graham J, Eusebio EB. Complications of colonoscopy. IMJ Ill Med J. 1977 Jul;152(1):39–42. [PubMed]
  • Knoepp LF., Jr Colonoscopy in clinical practice. South Med J. 1977 May;70(5):526–530. [PubMed]
  • Livstone EM, Cohen GM, Troncale FJ, Touloukian RJ. Diastatic serosal lacerations: an unrecognized complication of colonoscopy. Gastroenterology. 1974 Dec;67(6):1245–1247. [PubMed]
  • Livstone EM, Kerstein MD. Serosal tears following colonoscopy. Arch Surg. 1976 Jan;111(1):88–88. [PubMed]
  • Conn HO, Fessel JM. Spontaneous bacterial peritonitis in cirrhosis: variations on a theme. Medicine (Baltimore) 1971 May;50(3):161–197. [PubMed]
  • Macrae FA, St John DJ. Spontaneous bacterial peritonitis: reversible cause of deterioration in patients with cirrhosis. Med J Aust. 1980 Aug 23;2(4):209–211. [PubMed]

Articles from Gut are provided here courtesy of BMJ Publishing Group