Colonoscopy-related adverse events in the 21st century: an updated systematic review and meta-analysis

Colonoscopy is one of the most commonly performed endoscopic procedures and is generally considered low-risk. However, when adverse events (AEs) occur, they can present significant challenges in clinical practice. The aim of this study was to estimate the global incidence of colonoscopy-related AEs. We searched multiple databases for population-based studies reporting the incidence of colonoscopy-related AEs up to December 22, 2024. Meta-analyses were conducted for both gastrointestinal and non-gastrointestinal AEs. Subgroup analyses were performed based on factors including WHO region, publication year, sample size, data collection method, and study design. Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% CI 4.19-6.34, I2=99%), bleeding (18.39; 95% CI 13.53-24.99, I2=100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2=93%); non-gastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2=100%), respiratory events (4.26; 95% CI 0.73-24.99, I2=100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2=74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias. This comprehensive meta-analysis provides valuable insights into the global incidence of colonoscopy-related AEs and underscores the imperative need for continuous efforts to enhance the safety of this procedure.