Colonoscopy-Related Adverse Events in the 21st Century: An Updated Systematic Review and Meta-Analysis

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Public Health

Background:

• Colonoscopy is a frequent, generally low-risk endoscopic procedure.
• Adverse events (AEs) associated with colonoscopy can pose clinical challenges.
• Understanding the global incidence of these AEs is crucial for patient safety.

Purpose of the Study:

• To estimate the global incidence of colonoscopy-related adverse events (AEs).
• To analyze the frequency of both gastrointestinal and non-gastrointestinal AEs.
• To identify potential factors influencing AE rates through subgroup analysis.

Main Methods:

• Systematic search of multiple databases for population-based studies up to December 2024.
• Meta-analysis of gastrointestinal and non-gastrointestinal AEs.
• Subgroup analyses based on WHO region, publication year, sample size, data collection, and study design.

Main Results:

• Analysis of 82 studies involving 38.5 million colonoscopies.
• Incidence per 10,000 colonoscopies: gastrointestinal AEs (perforation 5.15, bleeding 18.39, splenic injury 0.61); non-gastrointestinal AEs (cardiovascular 52.11, respiratory 4.26, deaths 0.18).
• Subgroup analyses showed varied findings; most studies had low to moderate risk of bias.

Conclusions:

• This meta-analysis offers critical data on global colonoscopy-related AE incidence.
• Highlights the importance of ongoing efforts to improve colonoscopy safety.
• Provides a foundation for targeted risk mitigation strategies.