Colonoscopy-related adverse events minimal after abnormal stool-based tests

The overall risk of severe adverse events, perforation, bleeding, and death appears insignificant in colonoscopies performed following abnormal stool-based testing, reports a recent study.

A systematic review and comprehensive meta-analysis were conducted to assess colonoscopy-related adverse events in individuals with a positive faecal immunochemical test (FIT) and guaiac-based faecal occult blood test (gFOBT).

The investigators run a detailed search in January 2021, with the assistance of a medical librarian, for studies reporting on colonoscopy-related adverse events as part of organized colorectal cancer (CRC) screening programs. They performed a meta-analysis using the random-effects model; the results were expressed for pooled proportions along with relevant 95 percent confidence intervals (CIs).

Thirty-one studies met the eligibility criteria, which included a total of 771,730 colonoscopies carried out in patients undergoing CRC screening with either gFOBT or FIT.

The overall pooled incidence of severe adverse events in the entire patient cohort was 0.42 percent (95 percent CI, 0.20‒0.64; I², 38.76 percent). In patients with abnormal gFOBT and in those with a positive FIT, the incidence was 0.2 percent (95 percent CI, 0.1‒0.3; I², 24.6 percent) and 0.4 percent (95 percent CI, 0.2‒0.7; I², 48.89 percent), respectively.

Furthermore, the overall pooled incidence of perforation was 0.13 percent (95 percent CI, 0.09‒0.21; I², 22.84 percent), while that of bleeding and death was 0.3 percent (95 percent CI, 0.2‒0.4; I², 35.58 percent) and 0.01 percent (95 percent CI, 0.00‒0.01; I², 33.21 percent), respectively.