Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Clin Gastroenterol Hepatol. 2021 Jul;19(7):1418-1425. doi: 10.1016/j.cgh.2020.07.066. Epub 2020 Aug 7.
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.
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.
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.
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.
许多国家已经引入了基于粪便免疫化学检测（FIT）的结直肠癌（CRC）筛查计划，并对 FIT 检测阳性的个体进行后续结肠镜检查。为了做出知情决策，个体必须了解基于 FIT 的筛查和后续结肠镜检查的益处和危害。基于 FIT 的筛查中与结肠镜检查相关的致命并发症研究较少。我们旨在评估全国性基于 FIT 的 CRC 筛查计划中的结肠镜检查相关死亡率。
通过分析荷兰全国内镜并发症数据库中的数据评估结肠镜检查后 30 天内与结肠镜检查相关的死亡率，确定 FIT 阳性个体接受结肠镜检查的 30 天内死亡率与 FIT 阴性个体相比是否过高（基于全国筛查数据库的数据），并根据荷兰统计局登记的死因确定可能与结肠镜检查相关的死亡率。
2013 年 10 月至 2017 年 12 月，172797 名参与者在荷兰全国 CRC 筛查计划中接受了 FIT 检测阳性结果后进行了结肠镜检查；13848 名参与者被诊断患有 CRC。报告的致命并发症发生率为每 10000 名 FIT 阳性参与者 0.23 例（或每 43199 名参与者 1 例；95%CI，0.090-0.60）接受结肠镜检查，而根据超额死亡率，这一数字为每 10000 名 FIT 阳性参与者 0.91 例（或每 10961 名参与者 1 例；95%CI，0.44-1.38）。在接受结肠镜检查的每 10000 名 FIT 阳性参与者中，有 0.86 例（或每 11236 名参与者 1 例；95%CI，0.48-1.63）报告了可能与结肠镜检查相关的死亡原因，其中 50%被认为是心血管事件。
荷兰基于 FIT 的 CRC 筛查计划中与结肠镜检查相关的死亡率估计范围为每 10000 名接受结肠镜检查的 FIT 阳性参与者 0.23 至 0.91 例。这些发现表明，登记处报告的致命并发症存在漏报情况，且致命心血管不良事件的发生率值得进一步调查。尽管如此，基于 FIT 的 CRC 筛查的危害远远大于益处。
