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

Arthur I. Kooyker; Esther Toes-Zoutendijk; Annemieke W.J. Opstal-van Winden; Maaike Buskermolen; Hanneke J. van Vuuren; Ernst J. Kuipers; Folkert J. van Kemenade; Chris Ramakers; Evelien Dekker; Iris D. Nagtegaal; Harry J. de Koning; Manon C.W. Spaander; Iris Lansdorp-Vogelaar; Monique E. van Leerdam

doi:10.1016/j.cgh.2020.07.066

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

Arthur I. Kooyker^*, Esther Toes-Zoutendijk, Annemieke W.J. Opstal-van Winden, Maaike Buskermolen, Hanneke J. van Vuuren, Ernst J. Kuipers, Folkert J. van Kemenade, Chris Ramakers, Evelien Dekker, Iris D. Nagtegaal, Harry J. de Koning, Manon C.W. Spaander, Iris Lansdorp-Vogelaar, Monique E. van Leerdam

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

7 Citations (Scopus)

Abstract

Background & Aims: Many countries have introduced colorectal cancer (CRC) screening programs with fecal immunochemical tests (FITs), and follow-up colonoscopies for individuals with a positive FIT result. In order to make an informed decision to participate, individuals must be informed about the benefits and harms of FIT-based screening and subsequent colonoscopy. Colonoscopy-related fatal complications in FIT-based screening are understudied. We aimed to estimate the colonoscopy-related mortality in a national FIT-based CRC screening program. Methods: Colonoscopy-related mortality within 30 days after colonoscopy was assessed by analysis of data from national endoscopy complication databases in the Netherlands, determining the excess 30-day rate of death in FIT-positive individuals undergoing colonoscopy vs FIT-negative individuals (based on data from the national screening database), and determining the rate of likely colonoscopy-related deaths based on registered causes of death by the Statistics Netherlands. Results: Between October 2013 and December 2017, 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 FIT-positive 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.

Original language	English
Pages (from-to)	1418-1425
Number of pages	8
Journal	Clinical Gastroenterology and Hepatology
Volume	19
Issue number	7
DOIs	https://doi.org/10.1016/j.cgh.2020.07.066
Publication status	Published - 1 Jul 2021

Bibliographical note

Funding Information:
Funding This study was funded by the Dutch National Institute for Public Health and the Environment. The funding source had no involvement in study design, collection of data, analysis, and interpretation of the data.

Funding Information:
Conflicts of interest This author discloses the following: Evelien Dekker has endoscopic equipment on loan of FujiFilm; received a research grant from FujiFilm; has received an honorarium for consultancy from FujiFilm, Tillots, and Olympus; received a speaker's fee from Olympus and Roche; and is on the supervisory board of eNose. All other authors disclose no conflicts. Funding This study was funded by the Dutch National Institute for Public Health and the Environment. The funding source had no involvement in study design, collection of data, analysis, and interpretation of the data.

Publisher Copyright:
© 2021 The Authors

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Kooyker, A. I., Toes-Zoutendijk, E., Opstal-van Winden, A. W. J., Buskermolen, M., van Vuuren, H. J., Kuipers, E. J., van Kemenade, F. J., Ramakers, C., Dekker, E., Nagtegaal, I. D., de Koning, H. J., Spaander, M. C. W., Lansdorp-Vogelaar, I., & van Leerdam, M. E. (2021). Colonoscopy-Related Mortality in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program. Clinical Gastroenterology and Hepatology, 19(7), 1418-1425. https://doi.org/10.1016/j.cgh.2020.07.066

@article{ffd97a69ab6049f99052b9d98f576904,

title = "Colonoscopy-Related Mortality in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program",

abstract = "Background & Aims: Many countries have introduced colorectal cancer (CRC) screening programs with fecal immunochemical tests (FITs), and follow-up colonoscopies for individuals with a positive FIT result. In order to make an informed decision to participate, individuals must be informed about the benefits and harms of FIT-based screening and subsequent colonoscopy. Colonoscopy-related fatal complications in FIT-based screening are understudied. We aimed to estimate the colonoscopy-related mortality in a national FIT-based CRC screening program. Methods: Colonoscopy-related mortality within 30 days after colonoscopy was assessed by analysis of data from national endoscopy complication databases in the Netherlands, determining the excess 30-day rate of death in FIT-positive individuals undergoing colonoscopy vs FIT-negative individuals (based on data from the national screening database), and determining the rate of likely colonoscopy-related deaths based on registered causes of death by the Statistics Netherlands. Results: Between October 2013 and December 2017, 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 FIT-positive 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.",

author = "Kooyker, {Arthur I.} and Esther Toes-Zoutendijk and {Opstal-van Winden}, {Annemieke W.J.} and Maaike Buskermolen and {van Vuuren}, {Hanneke J.} and Kuipers, {Ernst J.} and {van Kemenade}, {Folkert J.} and Chris Ramakers and Evelien Dekker and Nagtegaal, {Iris D.} and {de Koning}, {Harry J.} and Spaander, {Manon C.W.} and Iris Lansdorp-Vogelaar and {van Leerdam}, {Monique E.}",

note = "Funding Information: Funding This study was funded by the Dutch National Institute for Public Health and the Environment. The funding source had no involvement in study design, collection of data, analysis, and interpretation of the data. Funding Information: Conflicts of interest This author discloses the following: Evelien Dekker has endoscopic equipment on loan of FujiFilm; received a research grant from FujiFilm; has received an honorarium for consultancy from FujiFilm, Tillots, and Olympus; received a speaker's fee from Olympus and Roche; and is on the supervisory board of eNose. All other authors disclose no conflicts. Funding This study was funded by the Dutch National Institute for Public Health and the Environment. The funding source had no involvement in study design, collection of data, analysis, and interpretation of the data. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2021",

month = jul,

day = "1",

doi = "10.1016/j.cgh.2020.07.066",

language = "English",

volume = "19",

pages = "1418--1425",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

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Kooyker, AI , Toes-Zoutendijk, E, Opstal-van Winden, AWJ, Buskermolen, M , van Vuuren, HJ , Kuipers, EJ , van Kemenade, FJ , Ramakers, C, Dekker, E, Nagtegaal, ID, de Koning, HJ , Spaander, MCW , Lansdorp-Vogelaar, I & van Leerdam, ME 2021, 'Colonoscopy-Related Mortality in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program', Clinical Gastroenterology and Hepatology, vol. 19, no. 7, pp. 1418-1425. https://doi.org/10.1016/j.cgh.2020.07.066

TY - JOUR

T1 - Colonoscopy-Related Mortality in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program

AU - Kooyker, Arthur I.

AU - Toes-Zoutendijk, Esther

AU - Opstal-van Winden, Annemieke W.J.

AU - Buskermolen, Maaike

AU - van Vuuren, Hanneke J.

AU - Kuipers, Ernst J.

AU - van Kemenade, Folkert J.

AU - Ramakers, Chris

AU - Dekker, Evelien

AU - Nagtegaal, Iris D.

AU - de Koning, Harry J.

AU - Spaander, Manon C.W.

AU - Lansdorp-Vogelaar, Iris

AU - van Leerdam, Monique E.

N1 - Funding Information: Funding This study was funded by the Dutch National Institute for Public Health and the Environment. The funding source had no involvement in study design, collection of data, analysis, and interpretation of the data. Funding Information: Conflicts of interest This author discloses the following: Evelien Dekker has endoscopic equipment on loan of FujiFilm; received a research grant from FujiFilm; has received an honorarium for consultancy from FujiFilm, Tillots, and Olympus; received a speaker's fee from Olympus and Roche; and is on the supervisory board of eNose. All other authors disclose no conflicts. Funding This study was funded by the Dutch National Institute for Public Health and the Environment. The funding source had no involvement in study design, collection of data, analysis, and interpretation of the data. Publisher Copyright: © 2021 The Authors

PY - 2021/7/1

Y1 - 2021/7/1

N2 - Background & Aims: Many countries have introduced colorectal cancer (CRC) screening programs with fecal immunochemical tests (FITs), and follow-up colonoscopies for individuals with a positive FIT result. In order to make an informed decision to participate, individuals must be informed about the benefits and harms of FIT-based screening and subsequent colonoscopy. Colonoscopy-related fatal complications in FIT-based screening are understudied. We aimed to estimate the colonoscopy-related mortality in a national FIT-based CRC screening program. Methods: Colonoscopy-related mortality within 30 days after colonoscopy was assessed by analysis of data from national endoscopy complication databases in the Netherlands, determining the excess 30-day rate of death in FIT-positive individuals undergoing colonoscopy vs FIT-negative individuals (based on data from the national screening database), and determining the rate of likely colonoscopy-related deaths based on registered causes of death by the Statistics Netherlands. Results: Between October 2013 and December 2017, 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 FIT-positive 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.

AB - Background & Aims: Many countries have introduced colorectal cancer (CRC) screening programs with fecal immunochemical tests (FITs), and follow-up colonoscopies for individuals with a positive FIT result. In order to make an informed decision to participate, individuals must be informed about the benefits and harms of FIT-based screening and subsequent colonoscopy. Colonoscopy-related fatal complications in FIT-based screening are understudied. We aimed to estimate the colonoscopy-related mortality in a national FIT-based CRC screening program. Methods: Colonoscopy-related mortality within 30 days after colonoscopy was assessed by analysis of data from national endoscopy complication databases in the Netherlands, determining the excess 30-day rate of death in FIT-positive individuals undergoing colonoscopy vs FIT-negative individuals (based on data from the national screening database), and determining the rate of likely colonoscopy-related deaths based on registered causes of death by the Statistics Netherlands. Results: Between October 2013 and December 2017, 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 FIT-positive 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.

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

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