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Screenees reported higher pain levels after TC than FS. The proportion of people complaining of severe side effects after discharge was similar. Bowel preparation was poorly tolerated by people undergoing TC. Subjects' reactions to the bowel preparation was predictive of post-procedural discomfort. A commitment of at least 48 hours was required of people undergoing TC, compared with 3-4 for FS.

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A strategy involving the sequential offer of FS and FIT is a feasible and efficient approach. FIT in people not attending for FS increases screening uptake and detection of advanced adenomas and CRCs.

Background and Aims Post-colonoscopy adverse events (AE) are a key quality indicator in population-based colorectal cancer screening programs, affecting safety and costs. Aim of this study was to assess colonoscopy-related AE and mortality in a screening setting. Methods We retrieved data from a cohort of patients undergoing colonoscopy within a screening program (Faecal Immunochemical Test every 2 years, 50 to 69 years old, or post-polypectomy surveillance) in Italy between 2002 and 2014, to assess the rate of post-colonoscopy related AE and mortality. Any admission within 30 days of a screening colonoscopy was reviewed to capture any possible AE. Mortality registries were also matched with endoscopy database to investigate 30-day post colonoscopy mortality rate. Association of each outcome with patient/procedure related variables was assessed with multivariable analysis. Results Overall, 117,881 screening colonoscopies (66,584, 56.5%, with polypectomy) were included. Overall, 497/117,881 (0.42%) post-colonoscopy AE occurred: 281 (0.24%) bleedings and 65 (0.05%) perforations (3.7‰/0.7‰, operative/diagnostic procedures, p<0.001). At multivariable analysis, bleeding was associated to polyp size (≥20mm: OR 16.29, 95%CI: 9.39-28.29), proximal location (OR 1.46, 95%CI: 1.14-1.87), and histology severity (high-risk adenoma, OR 5.6, 95%CI: 2.43-12.91), while perforation was associated to endoscopic resection (OR 2.91, 95%CI: 1.62-5.22), polyp size (OR 4.34, 95%CI: 1.46-12.92) and proximal location (OR 1.94, 95%CI: 1.12-3.37). Post-colonoscopy death occurred in 15/117,881 (1.27x10,000) cases. Conclusions In an organised screening program, post-colonoscopy AE are a rare but not negligible eventuality. The most frequent is post-polypectomy bleeding, especially after resection of large (≥20mm) and proximal lesions.