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

INTRODUCTION: 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. METHODS: 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 nongastrointestinal AEs. Subgroup analyses were performed based on factors including World Health Organization region, publication year, sample size, data collection method, and study design. RESULTS: 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% confidence interval [CI] 4.19–6.34, I 2 = 99%), bleeding (18.39; 95% CI 13.53–24.99, I 2 = 100%), and splenic injury (0.61; 95% CI 0.43–0.85, I 2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67–144.59, I 2 = 100%), respiratory events (4.26; 95% CI 0.73–24.99, I 2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10–0.34, I 2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias. DISCUSSION: 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.