Risk of Death From Colonoscopy in a FIT-Positive Program

In any screening program, it is important to know the benefits and harms of screening. Patients who have a positive fecal immunochemical test (FIT) result have a high yield of colonoscopy. The death rate from colonoscopy in FIT-positive patients is uncertain. 

In a study of the Netherlands' national FIT screening program, 172,797 persons underwent colonoscopy, of whom 13,848 (8%) had colorectal cancer (CRC) identified. 

Fatalities from colonoscopy were measured in 3 ways. First, compulsory reporting of fatal colonoscopy-related complications identified 4 deaths, or 0.23 per 10,000 participants, or 1 per 43,199 colonoscopy patients. 

Second, to understand excess all-cause mortality, the death rate from national registries in the FIT-positive patients undergoing colonoscopy who did not have CRC identified was compared to the FIT-negative patients in the program. The excess all-cause mortality in the patients undergoing colonoscopy was 0.91 per 10,000 participants, for an excess death rate of 1 per 10,961 colonoscopy patients.

Third, the authors evaluated cause of death in a segment of 112,634 FIT-positive patients who had colonoscopy, of whom 48 died within 30 days after colonoscopy. Of these 48 patient deaths, 10 (20.8%) appeared likely to be related to the colonoscopy, 3 were caused by sepsis, 5 resulted from cardiovascular events within 6 days of colonoscopy, and 2 occurred from an endoscopic intervention between 8 and 30 days. This led to a calculation of 0.89 deaths per 10,000 FIT-positive persons, or 1 per 11,236 FIT-positive patients undergoing colonoscopy.