Objectives: To give a profound analysis on fatalities associated with endoscopic procedures. Methods: Protocols of all autopsies performed within 20 years in a large Department of Forensic Medicine were retrospectively analyzed to identify all fatalities directly related to an endoscopic procedure. Data were further specified focussing on the type of endoscopy and the final cause of death. Results: Out of 22,615 autopsies performed between January 2000 to September 2019, 86 deaths were identified as a complication of an endoscopic procedure. The average age of these 86 cases was 70,9 years (66,4 [26-89] years in male (n=35) and 74,1 [22-94] years in female (n=51) patients). Endoscopic procedures included 29 ERCPs, 27 colonoscopies, 18 PEG placements, 6 gastroscopies, 2 upper endosopic ultrasonographies, and 4 transesophageal echocardiographies. ERCP, colonoscopy and PEG procedures together accounted for 74/86 (86%) endoscopy related deaths. Focussing on the single procedures, post-ERCP-pancreatitis (14/29, 48%), colonoscopy associated perforation (24/27, 89%), and peritonitis after PEG-placement (16/18, 88%) were the most common causes of death. Conclusions: Even in the thought-to-be-safe and screening endoscopic procedures fatalities do occur. This study gives an overview of endoscopy-related fatalities, stressing the role of ERCP, colonoscopy, and PEG. Keywords: Fatal outcomes; Endoscopy; Autopsy; Forensic Medicine; fatality