Risk of Death From Colonoscopy in the Italian FIT Screening Program

Risk of Death From Colonoscopy in the Italian FIT Screening Program

Douglas K. Rex, MD, MASGE, reviewing Benazzato L, et al. Endoscopy 2020 Jul 28.

Organized fecal immunochemical test (FIT)-based screening programs offer the opportunity to prospectively assess adverse events of colonoscopy. A recent large study from the Netherlands found a colonoscopy-related death rate of about 1 per 11,000 procedures in FIT-positive patients. 

In this study from one region of Italy, there were 119,293 colonoscopies performed, of which 85% followed a positive FIT result. 

Adverse events were about as expected and were strongly associated with polyp resection. Bleeding was most common and was associated with polyp size of ≥20 mm and location in the proximal colon. Perforation occurred in 0.05% of patients (65 total perforations). 

There were 15 deaths within 30 days of colonoscopy, of which 3 were related to perforation, and most of the others were cardiovascular-related.

Douglas K. Rex, MD, FASGE


This rate of 1 death per 7000 colonoscopies is similar to what was observed in the Netherlands (1 per 11,000) and may overestimate deaths caused by colonoscopy by not accounting for the background incidence of cardiovascular-related death.

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.


Benazzato L, Zorzi M, Antonelli G, Guzzinati S, Hassan C, Fantin A. Colonoscopy related adverse events and mortality in an Italian organized colorectal cancer screening program. Endoscopy 2020 Jul 28. (Epub ahead of print) (https://doi.org/10.1055/a-1228-9225)

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