S1228 Safety of Screening Colonoscopy in Patients With Cirrhosis: A Real-World Analysis From the TriNetX Database

Introduction: Patients with cirrhosis often require colonoscopy for various indications, however, the safety of screening colonoscopy in cirrhosis patients remains poorly defined. We aimed to evaluate post-screening colonoscopy complications in patients with compensated versus decompensated cirrhosis using a large, multicenter database. Methods: We queried the TriNetX database to identify adult cirrhotic patients (≥18 years) who underwent screening colonoscopy (identified by current procedural terminology codes) between 2010 and 2025. Patients were stratified into compensated, decompensated cirrhosis, and controls. Individuals with high risk for colorectal cancer or prior total abdominal colectomy were excluded. Propensity score matching (1:1) was used to adjust for baseline demographics, comorbidities, and laboratory values. Post-colonoscopy outcomes were assessed within 30 days after colonoscopy using hazard ratios (HR) with 95% confidence intervals (CI). Results: We identified 18,862 patients with compensated cirrhosis, 51,945 with decompensated cirrhosis, and 1,257,361 control patients who underwent screening colonoscopy. After matching, when compared to non-cirrhotic controls (N = 48,171 per group), patients with decompensated cirrhosis had significantly higher odds of post-colonoscopy bleeding (1.5% vs 1.0%; HR 1.52, 95% CI 1.34–1.74, P < 0.001), perforation (0.3% vs 0.1%; HR 2.70, 95% CI 2.14–3.43, P < 0.001), and infection (3.1% vs 1.5%; HR 2.02, 95% CI 1.85–2.21, P < 0.001). Decompensated cirrhosis was also associated with increased 30-day overall mortality (2.0% vs 1.3%; HR 1.46, 95% CI 1.32–1.61, P < 0.001, which could be related to cirrhosis. When compared to non-cirrhotic controls, patients with compensated cirrhosis (N = 18,861 per group) had non-significant differences in post-colonoscopy bleeding (HR 0.9, 95% CI 0.69–1.18, P = 0.5), perforation (HR 1.62, 95% CI 0.39-6.76, P < 0.8), and infection (HR 0.97, 95% CI 0.76-1.23, P = 0.07). Conclusion: In this large, real-world cohort, screening colonoscopy was safe in patients with compensated cirrhosis. In contrast, there was a significant increased risk of bleeding, perforation, and infection in decompensated cirrhosis patients compared to non-cirrhotic controls. These findings suggest that the severity of liver disease should be a critical consideration when assessing the risks and benefits of surveillance colonoscopy.