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Risk of Death From Colonoscopy in a FIT-Positive Program

Douglas K. Rex, MD, MASGE reviewing Kooyker AI, et al. Clin Gastroenterol Hepatol 2020 Aug 7.

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.


These data indicate that colonoscopy in FIT-positive patients who have a high rate of therapeutic colonoscopy results in colonoscopy-related death in about 1 per 11,000 FIT-positive persons in the Netherlands. About half the deaths were cardiovascular events. Although unfortunate and worthy of continued efforts to reduce this rate, it is far outweighed by the benefit of finding CRC in 8% of asymptomatic persons.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures


Kooyker AI, Toes-Zoutendijk E, Opstal-van Winden AWJ, et al. Colonoscopy-related mortality in a fecal immunochemical test-based colorectal cancer screening program. Clin Gastroenterol Hepatol 2020 Aug 7. (Epub ahead of print) (