Objectives Colonoscopy is considered a safe examination, serious complications being uncommon. Our study aimed to assess the adverse events of colonoscopy in a colorectal cancer screening programme with faecal immunochemical test (FIT) and to compare them with those of a previous programme with guaiac-based faecal occult blood test (gFOBT). Design Retrospective observational study Setting Population-based community-based colorectal cancer screening programme organised in Alsace, part of the national French programme, with FIT from 2015 to 2018 and gFOBT from 2003 to 2014. Participants All residents aged 50 to 74 years having a colonoscopy performed for a positive FOBT. Main outcome measures Adverse events were recorded through prospective voluntary reporting by community gastroenterologists and retrospective postal surveys addressed to persons screened. Results Of 9576 colonoscopies performed for a positive FIT, 6194 (64.7%) were therapeutic. Overall, 180 adverse events were recorded (1.88%, 95% CI 1.61-2.15), 114 of them (1.19%, 95% CI 0.97-1.41) requiring hospitalisation, 55 (0.57, 95% CI 0.42-0.73) hospitalisation >24hrs, and 8 (0.08%, 95% CI 0.03-0.14) surgery. The main complications requiring hospitalisation were perforation (n=18, 0.19%, 95% CI 0.10-0.27) and bleeding (n=31, 0.32%, 95% CI 0.21-0.44). We observed one death (1 / 27,000 colonoscopies). Overall, 52 persons harbouring at least one adenoma ≥ 10 mm were detected for one adverse event requiring hospitalisation >24hrs. The rate of adverse events remained stable between gFOBT and FIT programmes. Conclusions The harms of colonoscopy in a colorectal cancer screening programme with FIT are more frequent than usually estimated, here six adverse events requiring hospitalisation >24hrs (three bleedings, two perforations), one necessitating surgery and 50 minor complications per 1000 colonoscopies. The price to be paid to save lives through colorectal cancer screening programmes is higher than what is stated in most pilots. Today, comparison between series dealing with colonoscopy-related adverse events is almost impossible.

中文翻译：

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结肠镜检查在大肠癌筛查程序中进行的粪便免疫化学测试不良事件：基于人群的基于社区的观察性研究。

目的结肠镜检查被认为是安全的检查，严重并发症很少见。我们的研究旨在通过粪便免疫化学测试（FIT）评估大肠癌筛查程序中结肠镜检查的不良事件，并将其与以前的基于愈创木脂粪便潜血测试（gFOBT）的程序进行比较。设计回顾性观察性研究设定在法国阿尔萨斯组织的阿尔萨斯组织的以人群为基础的基于社区的结肠直肠癌筛查计划，2015年至2018年进行FIT，2003年至2014年进行gFOBT。表现为正的FOBT。主要结果指标不良事件通过社区肠胃病专家的前瞻性自愿报告和针对被筛查人员的回顾性邮政调查进行记录。结果FIT阳性的9576例结肠镜检查中，有6194例（64.7％）具有治疗效果。总共记录了180例不良事件（1.88％，95％CI 1.61-2.15），其中114例（1.19％，95％CI 0.97-1.41）需要住院治疗，55例（0.57，95％CI 0.42-0.73）住院时间超过24小时，以及8（0.08％，95％CI 0.03-0.14）手术。需要住院治疗的主要并发症是穿孔（n = 18，0.19％，95％CI 0.10-0.27）和出血（n = 31，0.32％，95％CI 0.21-0.44）。我们观察到一例死亡（1 / 27,000例结肠镜检查）。总体而言，发现52例至少有1例≥10 mm腺瘤的人发生了一项需要住院> 24小时的不良事件。gFOBT和FIT计划之间的不良事件发生率保持稳定。结论在FIT的大肠癌筛查程序中，结肠镜检查的危害比通常估计的更为常见，这里有6例不良事件需要住院> 24小时（3例出血，2例穿孔），其中一项需要手术，每1000例结肠镜检查需要50例轻微并发症。通过大肠癌筛查计划挽救生命所要付出的代价高于大多数飞行员所说的。今天，处理结肠镜检查相关不良事件的系列之间的比较几乎是不可能的。24小时（3个出血，2个穿孔），每1000例结肠镜检查需要进行1例手术和50例轻微并发症。通过大肠癌筛查计划挽救生命所要付出的代价高于大多数飞行员所说的。今天，处理结肠镜检查相关不良事件的系列之间的比较几乎是不可能的。24小时（3个出血，2个穿孔），每1000例结肠镜检查需要进行1例手术和50例轻微并发症。通过大肠癌筛查计划挽救生命所要付出的代价高于大多数飞行员所说的。今天，处理结肠镜检查相关不良事件的系列之间的比较几乎是不可能的。