Colonoscopy-Related Mortality in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program

Abstract

172,797 participants underwent colonoscopy after a positive result from a FIT in the Dutch national CRC screening program; 13,848 participants received a diagnosis of CRC. The reported fatal complication rate was 0.23 per 10,000 FITpositive participants (or 1 per 43,199; 95% CI, 0.090 -0.60) undergoing colonoscopy, whereas this was 0.91 per 10,000 FIT-positive participants (or 1 per 10,961; 95% CI, 0.44 -1.38) according to the excess death rate. Likely colonoscopy-related causes of death were reported in 0.86 per 10,000 FIT-positive participants (or 1 per 11,236; 95% CI, 0.48 -1.63) who underwent colonoscopy, of which 50% considered cardiovascular events. CONCLUSIONS:Colonoscopy-related mortality within the Dutch FIT-based CRC screening program was estimated to range from 0.23 to 0.91 per 10,000 FIT-positive participants undergoing colonoscopy. These findings indicate underreporting of fatal complications in registries and a noteworthy incidence of fatal cardiovascular adverse events that requires further investigation. Nevertheless, the harm of FIT-based CRC screening is vastly outweighed by the benefits.

Mortality Rates of Colorectal Cancer Screening Programs: Differing Methodologies, Complimentary Results

“…First, Kooyker et al 1 suggest that because of the compliance to invitation for colonoscopy at the level of around 16% we were not powered to detect significant shift in mortality. This is not fully accurate; our primary goal was to assess the impact of a screening program as a populational intervention.…”

“…In a recently published study Kooyker et al 1 analyze postcolonoscopy 30-day mortality facilitating data from a 2-step Dutch colorectal cancer (CRC) screening program. On a substantial study sample of more than 3.7 million persons the authors compare fecal immunochemical test (FIT)-positive screenees undergoing screening colonoscopy with FIT-negative control subjects that did not undergo colonoscopy.…”

“…On a substantial study sample of more than 3.7 million persons the authors compare fecal immunochemical test (FIT)-positive screenees undergoing screening colonoscopy with FIT-negative control subjects that did not undergo colonoscopy. 1 In the discussion the authors mention a study published by our team in Clinical Gastroenterology and Hepatology on this subject. 2 In that study our team has, among other analyses, compared 30-day postcolonoscopy mortality of individuals undergoing screening colonoscopy with individuals that were not undergoing any screening (see the Supplementary materials published online alongside the mentioned article).…”

Gender-specific cut-off levels in colorectal cancer screening with fecal immunochemical test: A population-based study of colonoscopy findings and costs

“…37 The Dutch screening program estimated the colonoscopy-related mortality to be 0.23-0.91 per 10,000 colonoscopies. 38 In an evaluation of the Stockholm-Gotland gFOBT screening program, there were no deaths related to colonoscopy, and all complications of bleeding and perforation were related to polypectomy. 39 Complications are rare, especially after a diagnostic colonoscopy, and the benefit of screening seems to outweigh them.…”

Continuous monitoring of colonoscopy performance in the Netherlands: first results of a nationwide registry

“…Mortality after colonoscopy has been rarely reported in literature and is expected to be underreported in adverse event registries. [22] A recent ASGE review reported a range of colonoscopy-related death rates from 0.002% to 0.011%. [20] To fully appreciate our findings, some limitations need to be addressed.…”