Are $4,600 and $13,250 the same colonoscopy? A full breakdown of what drives private quotations apart, the public system's three routes, and the risk band

TL;DR This article does not give you a range "from X to Y", because the two ends are not the same basis: one end is Union Hospital's "minimum charge", which expressly excludes consultation, the doctor's fee, the anaesthetist's fee and pathology; the other end is an all-inclusive package. Subtracting one from the other only measures the distance between two numbers that cannot be compared. What actually drives the difference is two things: what the quotation includes, and which risk band you are placed in — and the second of those is assessed by a doctor, not chosen by you. On the public side there are three routes, not two: the subsidised schedule, the non-subsidised schedule, and the invitation-only Colon Assessment Public-Private Partnership Programme. Whether a test suits you, which sedation is used and when you should be scoped again are for a doctor to decide on the clinical picture.

#Why is removing a polyp more than "just a look"?

A colonoscopy is one of the few procedures where the examination and the treatment happen in the same sitting — a polyp found can be removed there and then, and removing an adenoma is itself prevention. The bilingual price documents can be read for scope, but they also have places that cannot be read off: CUHK Medical Centre puts "Oesophagogastroduodenoscopy (Diagnostic) (IVS)" against a Chinese label that names only the stomach — the English OGD covers the oesophagus, stomach and duodenum, three segments, so on this line the two languages do not in fact line up; another line pairs "Colonoscopy (Diagnostic) (IVS)" with the Chinese for colonoscopy under sedation. The Controller of the Centre for Health Protection, Dr Edwin Tsui, said in a press release of 31 December 2025 that "removing colorectal adenoma during a colonoscopy can prevent it from developing into cancer". In one line: removing an adenoma is not finding a cancer, it is stopping one from forming.

Three days of bowel preparation come first. The University of Hong Kong's endoscopy centre — a service provider under the screening programme — instructs patients to eat low-fibre food for three days beforehand while avoiding fruit, vegetables and whole grains; to take only clear fluids the day before; and to take a strong laxative the night before (commonly a polyethylene glycol (PEG) preparation) until what is passed is water without residue, which it gives as the sign that the bowel is completely clear. Anyone taking anticoagulants (such as warfarin or dabigatran), antiplatelet drugs (such as aspirin or clopidogrel) or iron supplements may need to stop some medication beforehand, and should tell the doctor in advance.

The cost of an inadequate preparation is not only paying again. Inadequate preparation makes the examination miss things and raises the risk of complications: Zhao and colleagues pooled 43 studies and more than 15,000 tandem colonoscopies in 2019 (the same person examined twice within a short interval, the second used to count what the first missed) and reported an adenoma miss rate of 26% (95% CI 23%–30%), 9% for advanced adenomas (4%–16%) and 27% for serrated polyps (16%–40%), with the authors noting that miss rates "could be decreased by adequate bowel preparation". In a prospective study of 6,196 patients at the Hong Kong Sanatorium endoscopy centre, inadequate bowel preparation was among the strongest predictors of an immediate complication (adjusted odds ratio 3.5). Which is to say: prepare inadequately and you may both pay again and fail to find what was there to find.

Three pairs of ideas to separate first:

• Screening is not diagnosis. The Secretary for Health's Legislative Council reply of 22 May 2024 (LCQ19) states that "screening refers to the examination of people without symptoms". Being examined because you have symptoms is diagnosis.
• An adenoma is not a cancer. An adenoma is one type of polyp that may become cancerous. The same release records that, as at the end of November 2025, the programme had cumulatively enrolled more than 579 000 participants, with about 45 000 diagnosed with colorectal adenoma and about 3 800 with colorectal cancer. The release uses "Among them" to name that cumulative body of more than 579 000 participants as the denominator, yet the percentage it prints alongside does not match that denominator (45 000 ÷ 579 000 = 7.77%, while the release says 7.9%; taken against the FIT-positive group it would be about 51.8%), so this article cites the counts only (the denominator question is dealt with in the colorectal cancer screening article).
• Screening is not diagnosis is not surveillance. Screening looks for disease in people without symptoms; diagnosis establishes the cause where there are symptoms, or after a positive screen; surveillance is periodic re-examination once polyps or a relevant history are known. One common misreading is worth naming: a family history does not move you automatically into "surveillance" — the expert working group places it under screening arrangements for people at increased risk, and on more than one condition. That summary table is an all-English document (not one Chinese character in it), and it puts the arrangement in a single sentence (see [Note 1]). The same cell also gives an alternative (see [Note 9]). As for those with a first-degree relative diagnosed with a hereditary bowel syndrome, a 2017 Legislative Council reply (LCQ22) groups them under "high risk".

Who most needs to know this: anyone who thinks a colonoscopy is simply a test for cancer — the line on the quotation about whether a polyp is removed decides both the medical result and the bill; and "nothing found" does not mean nothing is there.

#Where did this structure of charges and subsidies come from?

Today's price structure is policy laid down in layers: first an expert group and a set of principles, then the subsidy schemes, and only then the 2026 public fee reform.

The Cancer Coordinating Committee was established in 2001 and its Cancer Expert Working Group on Cancer Prevention and Screening in 2002, which issued recommendations on seven common cancers in 2004 and "adopted World Health Organization (WHO)'s Wilson and Jungner principles as guiding principles in its deliberations" (the group's overview document of June 2018). The first of those 1968 principles reads: "The condition sought should be an important health problem." — whether something is worth asking a whole population to do begins with how much of a burden the disease is locally.

The Colorectal Cancer Screening Programme was piloted in 2016, made regular in 2018 and rolled out fully in 2020, using a two-yearly faecal immunochemical test (FIT) as the primary screen, with a positive result referred on to a government-subsidised colonoscopy; the public system separately runs the Colon Assessment Public-Private Partnership Programme (Colon PPP) from December 2016. The current public fee schedule took effect on 1 January 2026 and introduced an annual spending cap of ten thousand dollars with no means test (see below — it has to be applied for, it is not an automatic ceiling).

#What are private quotations actually arguing about? Two things: how much is included, and which risk band you are in

The argument is not about technique. Ranking quotations from cheapest to dearest is ranking them from "includes nothing" to "includes everything" — and after that ranking there is still one box that is not in your hands: the risk band. Union Hospital's price list sets out its exclusions expressly (see [Note 3]). That is to say: consultation, recovery bed and observation, doctor's fee, anaesthetist's fee, pathology, ancillary pathology and any emergency service or treatment all sit outside the listed price. And the line immediately above it matters just as much (see [Note 7]): — meaning that even the facility-and-equipment part of the $4,600 is itself only a floor, rising with the duration and complexity of the examination; the same document also states "The above prices are only applicable to non-inpatient clients."

CUHK Medical Centre goes the other way: "Doctors' Fees - Include surgeon/ procedure fee, anaesthesiologist fee (if applicable), and attending doctor fee", and it also covers "Complications arising from the relevant operation/ procedure". It is not a fixed price either: the same document states that "Package Fee will be estimated, and may be subsequently adjusted to a higher level, according to the relevant Medical Condition Level", and that "The above prices are applicable to Hong Kong residents and for Day/ 4-bed Room only."

The risk band is the easiest box to miss. Every row of Gleneagles' endoscopy package price list carries two price columns, headed "Normal Risk" and "Intermediate Risk". For the same day colonoscopy package under sedation excluding polypectomy and biopsy (code END14A), normal risk is $13,300 and intermediate risk $17,290 — a difference of $3,990 — and the terms state that after consulting the patient the doctor assesses risk on the patient's condition and decides whether the patient is suitable for the package, and that the hospital reserves the final decision on package risk assessment and on the patient's suitability. That box is not yours to choose.

The form of sedation is a separate box again. CUHK Medical Centre spells out "IVS: Intravenous Sedation" (and on another page of the same document renders IVS differently in Chinese, so the wording is inconsistent within one price list); at the same hospital the same diagnostic colonoscopy is $13,250 as a day case under IVS and $16,350 under MAC, a difference of $3,100; the Canossa DAE out-patient package (diagnostic, no specimen) is $11,860 against $13,980. The hospital documents list only the name, the sedative drugs and the monitoring (Hong Kong Sanatorium states that both are "two sedative agents" and includes "Cardiac monitoring including SpO2 and ETCO2"), without defining the depth of sedation — so asking the price without naming which one is not asking a price at all. But the definitions are not hard to find. The Hong Kong Academy of Medicine's Guidelines on Procedural Sedation (version 2.2, effective 17 January 2025) — linked directly from the colonscreen.gov.hk page of colonoscopist teaching materials this article cites — states at section 2.1 that sedation is not a set of discrete, well-defined stages but a continuum running from full consciousness through to general anaesthesia (see [Note 10]), then defines Minimal sedation, Conscious (Moderate) Sedation, Deep Sedation and General Anaesthesia in turn at sections 2.2 to 2.5, with a comparison table at 2.6 across responsiveness, airway, spontaneous ventilation and cardiovascular function; section 7.2 requires routine monitoring of the depth of sedation, and section 7.4 requires capnography for deep sedation. Which is to say: the standard exists, it is simply not on any price list. And the form of sedation is not only a matter of price: see the local Hong Kong data below, where MAC carries an immediate-complication odds ratio of 1.8.

A price list sorted by number, smallest first, actively misleads, so the table below is sorted by how much is included, and gives the second price as well for rows that are risk-banded.

Effective dates: Union 2025-07-01; both the Canossa DAE and Non-DAE schedules state 2026-04-01; Hong Kong Sanatorium 2026-08-01; CUHK Medical Centre 2025-11-01; Gleneagles 2025-04-14.

"All-inclusive" has its own exceptions in each case: CUHK Medical Centre and Gleneagles both expressly exclude pre-admission and post-discharge consultations; Hong Kong Sanatorium charges a specialist consultation fee of HKD$620 separately, covering one consultation before and one after; Gleneagles excludes pre-procedure biopsy, CT and MRI. The Hong Kong Sanatorium schedule lists six exclusions: besides the consultation fee, there are pre- and post-procedure drugs, additional histopathology and microbiology, special procedures such as complex polypectomy at an extra 25% of the package price, haemostatic devices (clips at HKD$500 - $1,200 each), and additional drugs, accessories and equipment for sedation and monitored anaesthesia; a further note states that the endoscopist cannot be specified under this scheme.

Who most needs to know this: the person ringing round for prices — asking "how much is a colonoscopy" returns six numbers that cannot be compared; asking "does this price include the doctor's fee, the anaesthetist's fee, pathology and complications", and then "which risk band is this price, and who decides that", returns answers that can be.

#Working the numbers: on a "$4,600" quotation, which boxes are empty?

The cheapest listed price is not a bill; it is a document that states what it is missing. And what those missing boxes are worth, Union does publish — just not on that price list. Everything below is in Hong Kong dollars, day/out-patient, colonoscopy with sedation.

Step one: start from the minimum charge and add back the item in the same document that has a price. Union's colonoscopy (IVS) minimum charge is $4,600; the same document lists post-operative recovery bed and observation service at $630 - $740 and expressly excludes it.

$4,600 + $630 = $5,230; $4,600 + $740 = $5,340

But these two are not a floor and a ceiling. The same document states expressly that the listed price is based on "minimum operation time" and that actual charges depend on the duration and complexity of the examination, so $5,340 is not an upper bound in any sense — it is only "the minimum charge plus the dearer recovery bed". There is no ceiling on this route to speak of.

Step two: what is still missing — and these boxes Union does publish. The exclusion list leaves out consultation, the doctor's fee, the anaesthetist's fee and pathology entirely. Those do not appear on the day endoscopy price list, but they do appear in another document under Union's same "Health Info → Estimated Charges" node: its reference material on common surgical charges under the government pilot programme (last updated 15 July 2026). Under "Endoscopy", the non-inpatient row for colonoscopy with or without polypectomy covers 116 cases:

The same table's non-inpatient row for gastroscopy with or without polypectomy covers 113 cases, with a median doctor's fee of $6,500, anaesthetist's fee of $2,000 and total charge of $15,560. Note three states that the doctor's fee includes the doctor's fee for the relevant procedure and the doctor's ward round fee.

This table has to be read with four limits held together. (i) It is a distribution of actual bills, not a package quotation — the document states that the data are taken from the hospital's standard ward charge records for January to June 2026. (ii) The row is "with or without polypectomy", so cases with and without removal are pooled and it cannot be treated as the price of a purely diagnostic colonoscopy. (iii) Note two states that these are statistics for patients undergoing a single procedure and staying in a standard room, and that cases involving two or more simultaneous procedures are excluded. (iv) That total-charge median of $17,550 is already higher than CUHK Medical Centre's $13,250 — which is to say, comparing a $4,600 minimum charge against someone else's all-inclusive package runs the comparison backwards.

Step three: change the angle and look at a hospital that publishes both kinds of price. On the same Canossa page, the same out-patient diagnostic colonoscopy (sedation, no specimen) carries two prices — Non-DAE $6,875, with the doctor's fee, anaesthetist's fee and doctor's procedure fee all separate; and the DAE package at $11,860.

$11,860 − $6,875 = $4,985

But that $4,985 is not the "doctor's fee plus anaesthetist's fee" box. Canossa itself lists seven things the DAE package covers: basic drugs and consumables, the endoscopy report, general medical equipment, use of the recovery room, the Helicobacter pylori test for gastroscopy, histopathology, and the endoscopist's and anaesthetist's fees. The difference spans seven items, not two. And the two tiers are not two wrappings of one thing, they are two entrances: the DAE package states "1. DAE Package (Referred by Canossa Outpatient Department)" and "The above package is applicable for designated doctors only."; while for Non-DAE the page states that the patient must first be assessed by its resident doctor and may be referred on to a specialist before the package can be used, and that extra cost may be incurred and the patient may not be able to use the package at all (see [Note 8]). Both tiers have an assessment gate that can raise the price, or leave you unable to use the package at all (see [Note 13]). So this difference measures the distance between two Canossa entrances, not the price of any one box. Both prices are at the "no specimen" level, so there is in practice no pathology inside the difference (the DAE scope does state that histopathology is included, but this level has no specimen). Only your hospital and your doctor can answer for your bill.

Who most needs to know this: anyone choosing the cheapest hospital to save money — the "minimum charge" is the single least informative number on the whole price list. Ask for an itemised quotation, and ask as well whether the hospital publishes the actual bill distribution for comparable cases: Union does, in another document.

#What does the public system and the screening programme actually charge? And how long is the wait?

The public system has three routes, not two. The subsidised schedule, the non-subsidised schedule and the public-private partnership programme differ by orders of magnitude.

(i) Subsidised charges (Eligible Persons). Hospital Authority Fees and Charges, effective 1 January 2026: specialist out-patient $250 per attendance (drugs $20 per item) against $850 for non-eligible persons ($90 per item); day procedure and treatment $250 per attendance against $7,400; in-patient (acute general bed) $300 per day against $7,400; pathology per item free at basic level, $50 medium, $200 high, against $400, $800 and $16,100. This schedule genuinely carries no "colonoscopy" item — endoscopy is charged as day procedure and treatment, or as an in-patient stay. (Searching the page's raw HTML in full, 32,008 characters word by word — this being the extraction method, and all nine counts below obtained the same way — colonoscop / endoscop / gastroscop / sigmoidoscop each occur 0 times; while on the same page the control terms pathology service occur 4 times, $250 5 times, Gazette 7 times, non-subsidised 7 times and day procedure 6 times, which shows the search itself works. One of the seven Gazette hits sits inside an href attribute pointing at the gazette PDF, so counted on visible text alone it is 6.)

(ii) The non-subsidised schedule does carry the item, in both languages. Section 5.6 of the gazetted non-subsidised schedule, "Endoscopy and biopsy (not requiring general anaesthesia)", puts endoscopy into four charge classes: Class 1 2,320; Class 2 2,320 – 11,650; Class 3 11,650 – 59,150; Class 4 44,350 – 133,100, with a note that pathology is charged separately. Which item falls in which class is set out in Annex III: oesophagogastroduodenoscopy with or without biopsy is Class 2, $2,320 – $11,650; colonoscopy, and colonoscopy with removal of polyp or lesion, are Class 3, $11,650 – $59,150; and colonoscopy with endoscopic submucosal dissection (with or without monitored anaesthesia) is Class 4, $44,350 – $133,100. Two things to note: these are charges for non-eligible persons (that is, without local status), not what a member of the public pays for a colonoscopy in a public hospital; and it is a class range, not the price of an item.

(iii) The public-private partnership route — this one has a real, purchasable public price: a basic co-payment of $1,000, and $0 for some patients. The Hospital Authority's Colon Assessment Public-Private Partnership Programme states in its programme introduction that the HA provides each patient with a one-off fixed subsidy of HK$6,800 (without polypectomy) or HK$7,500 (with polypectomy); that the patient pays only a basic co-payment of HK$1,000; that individual private doctors may charge an additional fee of no more than HK$1,000; and that all additional fees are published in the HA's list of private specialists for patients to choose from. The sentence immediately following carries an exception that rewrites that price: patients eligible for a waiver under the programme's criteria may choose a private specialist who charges no co-payment, and the HA will pay the HK$1,000 co-payment for them. That is to say, some patients pay $0 in practice. Who qualifies? The programme's "General Information" page carries a separate document on eligible waived patients (Hospital Authority, 1 April 2023) listing four categories: Comprehensive Social Security Assistance recipients; holders of a certificate for full waiver of medical charges; recipients of Old Age Living Allowance aged 75 or above; and holders of a Level 0 voucher under the Residential Care Service Voucher Scheme for the Elderly. But it has a hard threshold, and it is not one you can apply through. The same page states that the programme invites patients who are on a public hospital waiting list for colonoscopy, are classified as stable cases, are able to carry out the bowel preparation at home and are suitable for colonoscopy in a day medical facility; and that the programme office sets priority by the patient's registration date on the colonoscopy waiting list and clinical condition, issuing invitation letters in batches, with no need for patients to apply themselves. Those invited must still attend a designated HA clinic for assessment, submit an application form and register with the electronic health system. Those two words, "stable cases", are also the only clue in this whole article to a public triage level: an unstable case does not travel this route.

The ten-thousand-dollar ceiling is not automatic. The Hospital Authority's Annual Spending Cap (For Eligible Persons) describes it as "a HK$10,000 cap on an eligible patient's annual spending for specified public medical fees and charges without requiring financial assessment" — the key word being annual — and states that "Upon successful application, such patient will not be required to pay for any further Eligible Medical Fees and Charges for that calendar year." Four conditions are commonly left out: (a) it must be applied for, it is not automatic; (b) it runs by calendar year (1 January to 31 December), with a fresh application each year; (c) the relevant fees for that year must already have been paid in full at the time of application, with nothing outstanding at the HA; and (d) self-financed drugs and medical devices do not count towards it. The application window runs from 1 January of that calendar year to 31 March of the next, and late applications are not accepted. In other words it is an annual ceiling you reach by having paid first, not an automatic brake on the bill; and $250 is an attendance fee, not a price at which an endoscopy can be bought.

The screening pathway is charged separately: the government subsidy for a colonoscopy is $8,500 with polypectomy and $7,800 without, of which $300 is the subsidy for the pre-procedure consultation; the doctor's additional fee is capped at $1,000, and the Department of Health announced on 31 December 2025 that "over 70 per cent of these service locations not charging any additional payment for colonoscopy and polyp removal". Three easy traps: (i) the official page for the subsidy amounts is dated 6 August 2018 and has not changed in eight years (only the $1,000 cap was confirmed again in the December 2025 release). (ii) The $300 pre-procedure consultation subsidy is issued once in a lifetime: the Chinese page states that the government subsidises the pre-colonoscopy consultation fee only once per participant, and that participants pay for any subsequent pre-colonoscopy consultations themselves. So if you shop around and see more than one colonoscopist, the second pre-procedure consultation is entirely at your own expense. (iii) The $1,000 cap governs only the "basic service of colonoscopy" segment — for the additional fee charged by a primary care doctor at the FIT stage, the official page sets no cap, saying only that "PCD is encouraged to adopt a zero co-payment amount"; though "no cap" is not the same as no rules, since the same page states that a primary care doctor may not charge for four things: programme enrolment procedures, laboratory analysis of the FIT, an extra visit to obtain the screening recommendation or replacement FIT sample tubes, and an extra visit to notify a negative FIT result. Eligibility is covered in the colorectal cancer screening article.

On waiting times, two Hospital Authority written replies to the Legislative Council carry the same sentence: "The Hospital Authority (HA) does not keep statistics on the waiting time for colonoscopy examination in public hospitals in the past five years." (LCQ22, 29 March 2017); LCQ8 of 4 July 2018 repeats it ("in the past three years") and gives volumes instead: 49 314, 55 147 and 55 315 examinations in 2015-16 to 2017-18. The widely repeated "at least a year in the public system" traces to the wording of a member's question at the Legislative Council on 17 April 2019 (LCQ20): "as it has been reported that the current waiting time for colonoscopy examinations in public hospitals is at least one year". In one line: that is a member quoting a press report, not a government statistic. The reply section of that same LCQ20 (paragraph 4) does have substance, though (see [Note 2]): the HA states that it has taken measures to meet public demand for endoscopy, including launching the Colon Assessment Public-Private Partnership Programme so that eligible patients can have a colonoscopy in the private sector, and it gives the number of participating private specialists and the number of colonoscopies completed.

Who most needs to know this: anyone looking for a waiting-time figure on which to decide between waiting in the public system and paying privately — no official waiting statistic is kept, but you have more than two options. If you are already waiting for a colonoscopy in the public system and are classified a stable case, the third route (Colon PPP, $1,000 co-payment; $0 for the four categories of eligible waived patients) is one the HA invites you to, and it is worth asking at your specialist follow-up whether you are on that list.

#How large is the risk? Read it with the denominator

Endoscopy is an invasive procedure; complications are uncommon but real — and the harms ledger for screening must always be counted together with the examination that follows a positive result. Reumkens and colleagues' 2016 systematic review and pooled analysis (21 population-based studies covering colonoscopies performed between 2001 and 2015) reported, for all colonoscopies, perforation at 0.5 per 1,000 (95% CI 0.4–0.7), bleeding at 2.6 per 1,000 (1.7–3.7) and death at 2.9 per 100,000 (1.1–5.5); where polyps were removed, perforation rose to 0.8 per 1,000 (0.6–1.0) and bleeding to 9.8 per 1,000 (7.7–12.1). Two limits that must travel with those figures: the same abstract goes on to say "Complication rate was lower for screening/surveillance than for diagnostic examinations." — and every colonoscopy price in the table above is a price for a diagnostic examination, which is precisely the higher-complication side, so this pooled figure understates the setting this article is about (the polypectomy prices printed here — Gleneagles' row for removing more than 3 lesions at $19,000 / $24,700, for instance — correspond to the polyp-removal group above, perforation 0.8 and bleeding 9.8 per 1,000, pointing the same way); the same passage ends "Overall, considerable heterogeneity was observed in most of the analyses.", the authors marking the studies as differing considerably among themselves. The same analysis also records a direction of travel: post-colonoscopy bleeding fell from 6.4 to 1.0 per 1,000 between 2001 and 2015.

There are Hong Kong figures, and they come from one of the hospitals in the price table above. Chan and colleagues' prospective cohort study, published in the Hong Kong Medical Journal in 2015, covered every colonoscopy patient at the Hong Kong Sanatorium endoscopy centre between 1 June 2011 and 31 May 2012: 6,196 people (mean age 53.7 years, standard deviation 12.7; 3,143 women), with an immediate complication rate of 15.3 per 1,000 (95% CI 12.3–18.4), of which 50.5% were related to the colonoscopy itself, including one perforation; delayed complications at 1.6 per 1,000 (0.3–3.0), being five post-polypectomy bleeds and one post-polypectomy inflammation; and 17.8 per 1,000 overall (13.5–22.1). The study also lists predictors of immediate complications (adjusted odds ratios): female sex 1.6, use of monitored anaesthesia care (MAC) 1.8, inadequate bowel preparation 3.5, and an incomplete colonoscopy 4.5. Limits to carry: a single private hospital, a single year, and only 3,657 of the 6,196 completed the 30-day telephone follow-up. But that 1.8 for MAC is worth noting — the same hospitals' IVS and MAC prices at the same level differ by $2,120 to $3,100 (Canossa DAE $11,860 against $13,980, so $2,120; CUHK Medical Centre $13,250 against $16,350, so $3,100), and the price list answers what the difference costs, not what the difference is.

"Nothing found" does not mean nothing is there — and this is the box fewest people ask about. The Zhao 2019 pooled analysis cited above puts the adenoma miss rate at 26%; in the upper gastrointestinal tract, Menon and Trudgill pooled ten studies and 3,787 upper gastrointestinal cancer patients in 2014, finding that 6.4% (95% CI 4.3–9.5) had had a gastroscopy within the year before diagnosis at which the cancer was not diagnosed, and 11.3% (95% CI 7.5–16.6) within three years; the authors also flag extremely high heterogeneity between studies (I² 94.4%). The World Health Organization Regional Office for Europe's 2020 screening guide puts it more bluntly: "False-negative (normal) results always occur in screening programmes, because no programme is 100% sensitive." — and the consequence is that "People who receive a negative test result may ignore important symptoms, resulting in delayed diagnosis". Which is to say, a clean report is not a three-year amnesty; if symptoms appear afterwards, you still see a doctor. The LCQ22 reply makes the same point from the other side: the expert working group advises that people at high risk should not use faecal occult blood testing, because "bleeding not occurring at the time of the FOBT" would delay them, and it stresses that "Anyone who has suspected symptoms should seek early consultation".

That same WHO guide uses colonoscopic perforation as one of its examples of the harm brought by following up a positive screen (see [Note 6]).. The passage immediately following speaks directly to another theme of this article (see [Note 5]) — many false positives eat endoscopy capacity, and people with symptoms then wait longer.

The denominator on the benefit side. In the NordICC trial, among 11 843 people who actually underwent a screening colonoscopy, "15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy." (that follow-up analysis covered the Polish, Norwegian and Swedish groups only, not the Dutch group). The benefit figures from the same study are: ten-year colorectal cancer risk of 0.98% in the invited group against 1.20% in the usual-care group, a relative risk reduction of 18% (hazard ratio 0.82; 95% CI 0.70–0.93), with a number needed to invite of 455 (95% CI 270–1429); and colorectal cancer mortality of 0.28% against 0.31% (hazard ratio 0.90; 95% CI 0.64–1.16, which includes 1). The WHO guide warns that benefits and harms are only meaningful compared on the same basis, and these two sets of figures are not on the same denominator, nor over the same period: the harms (15 major post-polypectomy bleeds, 0 perforations or deaths) were measured only in the 11,843 who actually had a screening colonoscopy, over a window of 30 days after the procedure; the benefits (ten-year colorectal cancer risk and mortality) use the whole invited group of 28,220 on an intention-to-screen basis, over a ten-year window. Neither the denominator nor the window matches, so the two sets cannot be subtracted from or compared with each other directly — and that gap is itself the thing to watch for when reading screening data of this kind.

#Gastroscopy: why does Hong Kong not recommend stomach cancer screening when Japan and Korea do?

Because population screening is a decision calculated on local burden and the balance of benefit and harm, not on "we can, so we should". The Government's Cancer Online Resource Hub page on stomach cancer (carrying the expert working group's recommendation, last revised 28 April 2026) states that screening for stomach cancer is not recommended in asymptomatic persons at average risk (see [Note 11]).

That recommendation has a second sentence, and it is the one that bites (see [Note 12]): screening asymptomatic persons in the general population for Helicobacter pylori is not recommended either. Why single it out? Because "you can test for Helicobacter without a gastroscopy" is the most common substitute on sale: the Hong Kong Sanatorium price list carries "Microbiology Examination for HP Culture, 1 bottle $1,140" and its package includes "Biopsy for Helicobacter Pylori"; the Canossa DAE package scope states it includes the "Helicobacter pylori test for gastroscopy"; and the HA non-subsidised schedule places the Helicobacter urea breath test under 5.1 minor investigations ($695 – $2,440). In that single sentence, the expert working group recommends against both. Symptoms, or a precancerous lesion or family history, are another matter — see below.

The grade of "not recommended" is worth reading closely. The Centre for Health Protection's 2026 summary table of recommendations uses at least three formulations: lung (2023), stomach (2024), liver (2025), thyroid (2018), ovarian (2018) and pancreatic (2022) cancers are written as "is not recommended"; nasopharyngeal cancer is "There is insufficient evidence to recommend" (as is breast cancer, 2020, for clinical breast examination and ultrasound); and prostate cancer is "insufficient scientific evidence to recommend for or against". So stomach cancer sits in the outright category, not the evidence-not-yet-sufficient one; the same table also states that people at increased risk (with a precancerous lesion or a family history, for example) are treated separately.

Japan's National Cancer Center "Ganjoho" page on stomach cancer screening (updated 20 September 2024) reads 「50歳から、2年に1度定期的に受診してください。」 — attend regularly, at the stated interval, from the stated age — and 「胃部X線検査または胃内視鏡検査のどちらかを選択して受診してください。」, that one may choose either the upper gastrointestinal X-ray examination or the upper endoscopy. In Korea, Jun and colleagues in 2017 (a nested case-control study within a cohort of 16.58 million) found that, compared with those never screened, those screened by upper endoscopy had an odds ratio of 0.53 (95% CI 0.51–0.56) for death from stomach cancer, while upper gastrointestinal series gave 0.98 (95% CI 0.95–1.01, which includes 1); the conclusion being that those who had endoscopy were less likely to die of stomach cancer while no association was observed for the series — an association from an observational study, not proof of causation.

How different is the burden? Shin and colleagues in 2023 (Cancers) record age-standardised stomach cancer incidence in 2020 for the three places (per 100,000, male/female): Japan 48.1/17.3, Korea 39.7/17.6, Hong Kong 9.3/6.2. But those three sets do not come from one source. The paper sets them out in three separate sections: the Japan and Korea sections attribute the data to the World Health Organization's International Agency for Research on Cancer (IARC), while the Hong Kong section states "Based on the report of the Hong Kong Cancer Registry, Hospital Authority". Which is to say: Japan and Korea are international estimates and Hong Kong is a local registry figure, and that has to be known when the three are set side by side. The same paper also records that Japan has run screening nationally since 1983 ("the Health Law for the Aged has extended GC screening across the country since 1983") and that Korea screens every two years from age 40. The Hong Kong Cancer Registry's 2023 stomach cancer report carries a different set again: 736 new cases in men and 548 in women, ranking 5th in men and 8th in women, with male incidence falling an average 2.0% a year and male mortality 5.2% a year over the past decade, both statistically significant. (The two sets come from different sources and different years and should not be joined up.)

Why does a low burden make screening a worse deal? The WHO's 2020 screening guide gives the mechanism (see [Note 4]). In one line: the less common the disease, the higher the proportion of false positives from the same test — and a false positive has to be excluded by doing another examination, which, on this topic, is itself a gastroscopy.

Who most needs to know this: an asymptomatic person considering paying for a gastroscopy to "check for stomach cancer while we're at it" — the Government's position is the most direct grade, "is not recommended", rather than the insufficient-evidence grade; and the same sentence recommends against Helicobacter screening too, so "skip the gastroscopy and just test for the bacteria" is not an officially endorsed substitute. Symptoms make it diagnosis; those with a precancerous lesion or a family history are told by the same table to discuss the need for, and the method of, screening with a doctor — still screening, but for a doctor to decide case by case.

#What happens afterwards?

Two things rewrite the charge — whether anything was removed, and whether anything was sent to the laboratory — and hospitals add different amounts, which is another thing to ask about. CUHK Medical Centre's day diagnostic colonoscopy is $13,250, $15,300 with one biopsy bottle and $18,680 for a complex case; Canossa's DAE goes from $11,860 (no specimen) to $18,140 (more than 3 specimens); Gleneagles from $13,300 to $19,000 (more than 3 lesions, normal risk; the intermediate-risk figure on the same row is $24,700); Hong Kong Sanatorium charges pathology separately, at $1,725 - $4,305 for 1 to 12 bottles of histopathology, with special procedures such as complex polypectomy adding 25% of the package price. Which is to say the final spread on one colonoscopy can run to five figures, and the moment it is decided is on the examination table, not on the quotation. When to be examined again is surveillance, for the doctor to decide on the pathology result; for screening alone, the expert working group's wording for people at average risk aged 50 to 75 is that they "should consider" one of the following: faecal occult blood testing every one or two years, flexible sigmoidoscopy every five years, or colonoscopy every ten years.

#What to do next

1. When you ask the price, do not ask "how much is a colonoscopy". Ask whether the price includes consultation, the doctor's fee, the anaesthetist's fee, pathology, and the handling of complications arising from the procedure — that is the question that returns comparable numbers.
2. Ask which risk band you have been placed in. The same package code carries two prices, normal risk and intermediate risk, and the band is decided by a doctor after assessment, not by you.
3. Ask about the sedation, and ask for its name. A price list can tell you how much the difference costs; it cannot tell you what the difference is. Depth of sedation has a professional standard — it is simply not on any price list.
4. If you are already waiting in the public system as a stable case, ask about the Colon PPP at your next appointment. That route costs $1,000 out of pocket, and $0 for the four categories of eligible waived patient, but it is by invitation and you cannot apply for it yourself.
5. Do the bowel preparation properly. Inadequate preparation raises the miss rate and the complication risk at the same time — it is the one box entirely within your control.
6. After the examination, symptoms still need a doctor. A clean report is not an amnesty; the miss rates are published, so do not put off new symptoms because you were examined last time.

#Frequently asked questions

Why does the same colonoscopy cost $4,600 at one hospital and $13,250 at another?

Because the two quotations include different things, and the $4,600 is a floor as well: it is a minimum charge excluding consultation, the doctor's fee, the anaesthetist's fee and pathology, and it states expressly that the actual charge depends on the duration and complexity of the examination; the $13,250 is a package estimated by the patient's Medical Condition Level, including the doctor's fee, the anaesthetist's fee and the handling of complications arising from that procedure. For what Union's missing boxes are worth, see Union's other document: non-inpatient colonoscopy (116 cases), median doctor's fee $8,000, anaesthetist's fee $2,500, total charge $17,550 — higher than $13,250.

Is a public colonoscopy $250?

No. $250 is the per-attendance fee for a specialist out-patient clinic or for day procedure and treatment (from 1 January 2026), with pathology charged separately by band. The subsidised schedule carries no "colonoscopy" item; the non-subsidised one does, placing colonoscopy in Class 3 at $11,650 – $59,150 (those charges applying to non-eligible persons). Eligible persons also have an annual spending cap of ten thousand dollars with no means test, but it must be applied for, runs by calendar year and must be applied for afresh each year, and self-financed drugs and medical devices do not count towards it.

How long is the public wait, and is there a third route?

In two Legislative Council replies, of 29 March 2017 and 4 July 2018, the Hospital Authority stated that it did not keep that statistic at the time, and no updated official figure has appeared since; the popular "at least a year" comes from a member's wording quoting a press report in a 2019 Legislative Council question. The third route is the HA's Colon Assessment Public-Private Partnership Programme: the patient pays a basic co-payment of $1,000 (an individual doctor may charge up to a further $1,000; while Comprehensive Social Security Assistance recipients, holders of a certificate for full waiver of medical charges, recipients of Old Age Living Allowance aged 75 or above, and holders of a Level 0 Residential Care Service Voucher are eligible waived patients, who may choose a doctor charging no co-payment, with the HA paying that $1,000, so $0 in practice) — but it is by invitation, aimed at patients already waiting for a colonoscopy in a public hospital who are classified "stable cases" and are suitable for a day facility, and patients do not (and cannot) apply themselves.

If the examination says "nothing found", am I safe?

It is not an amnesty. Pooled data put the adenoma miss rate at about 26%, and about 11.3% of upper gastrointestinal cancers had had a gastroscopy within the preceding three years at which they were not found; the WHO notes that "no programme is 100% sensitive", and that people who receive a negative result may ignore symptoms and be diagnosed late. Inadequate bowel preparation raises both the miss rate and the complication risk. If you have symptoms, see a doctor rather than putting it off because you were examined last time.

If I have no symptoms, should I have a gastroscopy to check for stomach cancer?

The expert working group's recommendation for asymptomatic people at average risk is "is not recommended"; the same sentence also recommends against Helicobacter screening in the general population (urea breath test, serology or stool antigen). Those with a precancerous lesion or a family history should discuss it with a doctor.

#Notes: the official wording

[Note 1] "For individuals with one first-degree relative diagnosed with colorectal cancer at or below 60 years of age, or more than one first-degree relatives with colorectal cancer irrespective of age at diagnosis, and without hereditary bowel syndromes, screening by colonoscopy every 5 years beginning at the age of 40 or 10 years prior to the age at diagnosis of the youngest affected relative, but not earlier than 12 years of age is recommended."

[Note 2] "HA has taken measures to meet the public demand for endoscopy examination, including launching the Colon Assessment Public-Private Partnership Programme (Colon PPP) since December 2016 to offer choices to eligible patients to receive colonoscopy in the private sector. As at December 2018, a total of 150 private specialists participated in the Colon PPP, with 1 107 colonoscopies completed."

[Note 3] "The prices listed above are the Minimum Charges for the examination specified. It does not include consultation fee before and after the procedure, post-operative recovery bed and observation service charge, doctor fee, anaesthetist fee, pathology charge, ancillary pathology tests required for classifying special tumor types, and any emergency services or treatment / procedures."

[Note 4] "When a condition is less common in a country (low prevalence), the positive predictive value is lower. This means that there will be more false positives than in a country with a higher prevalence of the condition, even though the sensitivity and specificity are the same."

[Note 5] "A screening programme with many false positives can strain the health system because they need to be investigated and use already stretched diagnostic services such as endoscopy. This, in turn, can make people with symptoms wait longer to be treated by general services."

[Note 6] "Complications of investigations that are carried out following a screen-positive result can be devastating, such as a miscarriage after amniocentesis for a screen-positive test for Down's syndrome or perforation of the bowel after a colonoscopy"

[Note 7] "The prices listed above are based on the basic equipment, drugs, consumables used and minimum operation time of respective examination. The actual charges will depend on the duration and complexity of the examination."

[Note 8] "Patient must be assessed by our resident doctor, and maybe further referred to specialist doctor in order to use the Non-DAE Endoscopy package. Extra cost maybe incurred and patient may not be able to use the package."

[Note 9] "As an alternative, the individuals at increased risk may consider Faecal Immunochemical Test (FIT) every 1 or 2 years after understanding the pros and cons of FIT as compared with colonoscopy."

[Note 10] "Sedation is not a set of discrete, well-defined stages but a continuum where there is the transition from complete consciousness through the various depths of sedation to general anaesthesia."

[Note 11] "Screening for stomach cancer (by upper gastrointestinal series, upper endoscopy or biomarkers, such as H. pylori serology) is not recommended in asymptomatic persons at average risk."

[Note 12] "Screening for H. pylori infection (by urea breath test, serology or stool antigen test) among asymptomatic persons in the general population is also not recommended."

[Note 13] "The package fee will be estimated and may be subsequently adjusted to a higher level, according to the relevant category, as determined by the doctor."

#Matters on which this article makes no statement

• Cross-hospital comparison of private bill-distribution statistics: this article cites only Union's own published percentile table (that hospital's own cases) and does not set it against other hospitals' package list prices as a like-for-like comparison — the former is a distribution of actual bills, the latter a quotation, and they are not the same kind of thing. Every other hospital price in the text comes from that hospital's own published price document.
• Item-level prices for HA non-subsidised (private) endoscopy: the gazetted non-subsidised medical services schedule and its Annex III list only class ranges (colonoscopy Class 3, gastroscopy Class 2) and no single item price; this article cites the class ranges and derives no individual amount payable from them. Those charges apply to non-eligible persons.
• Details of the scope of service under the Colon Assessment Public-Private Partnership Programme: the programme's "General Information" page lists documents including the framework and terms and conditions, service provider information, and an anti-corruption guide for service providers; this article did not open the framework and terms and conditions, and therefore states nothing about the details of the scope of service. Attribution required: the name of that framework document comes from the "General Information" page; the programme introduction page cited elsewhere in this article does not contain that string anywhere (0 occurrences), so the document should not be attributed to the programme introduction page. The subsidy amounts, co-payment and invitation conditions cited here come from the programme introduction page; the fee waiver material comes from the text of that same introduction page and from the eligible-waived-patients document on the same "General Information" page (1 page, 1 April 2023), both of which were opened.
• Adverse-event data from the Colorectal Cancer Screening Programme itself: on 9 August 2026, a recursive crawl of the English-language links of colonscreen.gov.hk from /en/index.html retrieved 51 pages returning HTTP 200, made up as follows: 10 under public/, 39 under service/ (37 reached by the crawl, plus 2 added by hand, the subsidy_level_and_copayment.html pages — cited elsewhere in this article but reachable from neither the index nor the sitemap), plus index.html and contact_us.html at the /en/ root, 2 pages that fall under none of those path prefixes. 10 + 39 + 2 = 51. This is the result of a recursive link crawl and is not the same as every navigational node on the site — the two pages added by hand are themselves proof that link crawling is not complete. A further note: 16 of the 51 are blank video-frame pages of 167 to 188 bytes (crc_system_video1 to 8 for each of the colonoscopist and primary_care_doctor groups, all under service/), leaving 35 with substantive content. 4 navigational links returned 404 during the crawl: public/programme/enrolment_into_the_programme.html, public/programme/resource_video1and2.html, service/primary_care_doctor/reference.materials.html, and about-colorectal-cancer/what-is-colorectal-cancer.html. Searching the full text of those 51 pages (extraction method: script, style and comment blocks removed first, then all HTML tags removed, character entities restored and runs of whitespace collapsed, giving 41,073 characters of visible text; counts are case-insensitive, non-overlapping substring matches): adverse / complication / perforation / statistic / audit / incident / safety / miss rate occur 0 times each. Those eight terms are 0 under two other extraction methods as well — text with script and style blocks together with HTML comments retained before tags are stripped (170,329 characters), and the raw HTML with no tags stripped at all; quality assurance is not 0 but 2, both occurrences in service/colonoscopist/education_materials.html (31,084 bytes) in a link block headed "Related documents on Quality Assurance" pointing at Core standards for Day Procedure Centres and Guidelines on Procedural Sedation, two service-provider quality documents, not adverse-event data from the programme itself. Control terms under the same extraction method, measured on 9 August 2026: colorectal 118, screening 106, colonoscopy 43, subsid 31; FIT is counted at 14 under a separate uppercase whole-word rule, since it would otherwise match words such as fitness. This is a live site and control-term counts will move as pages are updated, so those five numbers are that day's measurement and not a fixed property of the site; that all eight target terms are 0 does not move with them. Every control term hitting while all eight target terms are 0 shows the search works. To be noted: control-term counts are highly sensitive to the extraction method — on the same 51 pages, retaining script and style blocks together with HTML comments before stripping tags (170,329 characters) turns those same four counts into 169 / 165 / 48 / 38; the comments step is necessary — retaining only script and style while still removing comments yields a different set again. So counts of this kind must be quoted with the extraction method stated step by step; leave one step out and they cannot be checked. More direct evidence still is the programme's own outcome report: Colorectal Cancer Screening Programme – Progress Report of the Screening Outcome for Participants Enrolled between 28 September 2016 and 31 December 2024 (PDF, 5 pages, 366,962 bytes) — the programme's formal publication of screening results — returns 0 occurrences of adverse / complication / perforation / bleeding / incident / safety / audit / quality assurance / miss rate / statistic, while control terms in the same document return colonoscopy 11, participant 27 and adenoma 7. So: the programme publishes outcome data, but no adverse-event data of its own has been found. The Hong Kong complication figures in this article come from Chan and colleagues' 2015 single-private-hospital study, not from the screening programme.
• The clinical definitions of sedation and monitored anaesthesia care: the price documents list only names, drugs and monitoring, without defining depth of sedation; who administers it is stated in some documents (CUHK Medical Centre "anaesthesiologist fee (if applicable)", Canossa DAE "Endoscopist fee and Anaesthetist fee", Gleneagles "anaesthesiologist's fees if applicable"). As for published guidance from the local specialty society: a crawl of the Hong Kong Society of Digestive Endoscopy website on 9 August 2026 (http://www.hksde.org/, HTTP 200; the https:// version failed to connect) found its navigation to carry only six content nodes — About Us / Membership / HK Live Endoscopy / News and Events / Video / Contact Us — with no guidelines or quality-standards section (guideline and standard each occurring 0 times across the site), so this article cites no local specialty society guideline. That is the result of crawling that society's website and does not mean no relevant local professional standard exists — the body of this article does cite the Hong Kong Academy of Medicine's Guidelines on Procedural Sedation (version 2.2) for the definitions of depth of sedation; the Academy is a college rather than a specialty society, and that guideline is not inside any of the price documents either.
• A total for the Union route: Union has published the bill distribution for comparable cases (above), but that row is labelled "with or without polypectomy", pooling cases with and without removal, and covers only single-procedure, standard-room cases, so it cannot be treated as the price of a purely diagnostic colonoscopy; nor does this article build any total up from the $4,600 minimum charge.
• What sits inside the difference between Canossa's two tiers: the $4,985 spans the seven items of the DAE package scope and is not a "doctor's fee plus anaesthetist's fee" box; the two tiers are also two entrances (DAE requiring referral from the hospital's out-patient department and designated doctors only), as noted in the text. The two prices compared are both at the "no specimen" level, so the difference contains no actual histopathology charge.
• Public colonoscopy waiting times after 2018, and comparisons of merit between institutions: on the first, the two replies state that the statistic was not kept at the time and no updated figure has appeared since, so no number is offered; on the second, no comparison is made — only each hospital's own published charges and scope of inclusion are listed.

#Sources

• Day-case minimum charges for colonoscopy and gastroscopy ($4,600 / $4,200), the full text of the stated exclusions, the listed price being based on minimum operation time with actual charges depending on duration and complexity, applicability to non-inpatient clients only, and the recovery bed at $630-$740: Union Hospital Day Surgery and Endoscopy Centre price list (effective 1 July 2025), https://www.union.org/gicentre/files/Day_Case_Endoscopy_Plan_EN.pdf (retrieved 9 August 2026, HTTP 200, 93,577 bytes)
• Median and 90th-percentile doctor's fee, anaesthetist's fee, hospital charge and total charge for non-inpatient colonoscopy and gastroscopy, case counts, and notes two and three: Union Hospital, reference material on common surgical charges under the government pilot programme, Chinese version (last updated 15 July 2026), https://www.union.org/appassets/For-Health-Professionals/Budget-Documents/GPP_RCCSP_TC.pdf; English version https://www.union.org/appassets/For-Health-Professionals/Budget-Documents/GPP_RCCSP_EN.pdf (both retrieved 9 August 2026, HTTP 200, 260,568 and 167,435 bytes respectively; amounts read by character coordinate rather than by layout text order)
• Union specialist out-patient registration fee $310, specialist consultation from $800 (that section marked last updated 15 November 2023), and a pathology department listing only haematology and biochemistry with no histopathology price: Union Hospital, hospital fees and charges by room class under the government pilot programme, Chinese version 6.8, https://www.union.org/appassets/For-Health-Professionals/Budget-Documents/PriceTransparancy_CN_Version_6.8.pdf (retrieved 9 August 2026, HTTP 200, 591,491 bytes, 12 pages); the Chinese title of that document also appears in the Union Chinese page title at https://www.union.org/tc/healthcare-professionals-corner/budget-document/government-pilot-programme-fees-and-charges-by-all-room-class
• Fixed package charges, the IVS/MAC names in both languages, the package including doctors' fees and complications, the package fee being estimated by Medical Condition Level and adjustable upwards, applicability to Hong Kong residents and day/4-bed room only, day and in-patient prices for gastroscopy and colonoscopy, and biopsy banding: CUHK Medical Centre, CUMC Medical Package (Endoscopy) (effective 1 November 2025), https://www.cuhkmc.hk/fees-and-charges/medical-packages/cumc-medical-package/endoscopy-package-fees; price PDF "(CMP) Endo Package_20251101_2.pdf" (retrieved 9 August 2026, HTTP 200, 534,813 bytes, 10 pages)
• The DAE and Non-DAE tiers, the seven items covered by DAE, DAE requiring referral from the hospital's out-patient department and designated doctors only, the Non-DAE assessment and referral terms, the package fee being adjustable upwards, the exclusions of each, and specimen-count banding: Canossa Hospital Endoscopy Centre (both the DAE and Non-DAE schedules marked effective 1 April 2026), https://www.canossahospital.org.hk/en/service/endoscopy_centre/ (retrieved 9 August 2026, HTTP 200, 134,974 bytes)
• The two risk bands (normal / intermediate) on the all-inclusive package prices, the END14A / END14B / END14C rows, the day gastroscopy package under sedation END08A $11,100 / $14,430, the risk-assessment terms and the hospital's final decision, complications being covered, and the day package excluding the doctor's ward round fee: Gleneagles Hospital All-Inclusive Package Price List — Endoscopic Procedures (effective 14 April 2025), https://gleneagles.hk/media/GHK-All-Inclusive-Package-Price-List-END02_250414.pdf (retrieved 9 August 2026, HTTP 200, 512,242 bytes, 6 pages; the 36 package rows in that table were read row by row from the two price columns by coordinate, x=464.4 and x=525.6, the lowest cell in the whole table being END08A normal risk $11,100 and the highest END28C intermediate risk $50,310; this article cites only those rows within day-case, diagnostic scope)
• The package charge of $12,490, the twelve inclusions and six exclusions (including the specialist consultation fee of $620, complex polypectomy at an extra 25% of the package price, haemostatic clips at $500-$1,200, histopathology at $1,725-$4,305 for 1-12 bottles, and Helicobacter culture at $1,140), both forms of sedation being two sedative agents, cardiopulmonary monitoring, and the endoscopist not being specifiable: Hong Kong Sanatorium Open Access Endoscopy Package Charges (effective 1 August 2026), charges page https://www.hksh-hospital.com/en/fees-and-charges/service-packages/endoscopy-centre; price-list image https://www.hksh.com/global/pricelist/en/Endoscopy;%20Page1;%20L-HV.jpg (retrieved 9 August 2026, HTTP 200, 1,201,817 bytes JPEG, read directly as an image; returns 403 without a browser User-Agent)
• Public subsidised charges (specialist out-patient $250, day procedure $250, in-patient $300, pathology banding, non-eligible-person charges) and the word-by-word counts showing no endoscopy item on that schedule: Hospital Authority Fees and Charges (effective 1 January 2026), https://www.ha.org.hk/visitor/ha_view_content.asp?Content_ID=10045&Lang=ENG (note that the ha_view_content.asp endpoint itself 302-redirects: without following the redirect it returns only a 267-byte shell, on which any word-by-word count returns 0 for everything; the redirect must be followed to fees_and_charges.asp and the document identified by its content. All figures cited here were obtained after following the redirect) (retrieved 9 August 2026, HTTP 200, 32,382 bytes)
• The nature of the ten-thousand-dollar annual spending cap (annual, by calendar year, requiring application, requiring prior payment, excluding self-financed drugs and devices, and the application deadline): Hospital Authority, Annual Spending Cap (For Eligible Persons), https://www.ha.org.hk/visitor/ha_view_content.asp?Content_ID=281820&Lang=ENG (retrieved 9 August 2026, HTTP 200, 9,108 bytes; the same ha_view_content.asp endpoint as the entry above, and it 302-redirects in the same way — 268 bytes without following, resolving to haho/ho/frm/asc_en.htm, the 9,108 bytes being the size after following)
• The four charge classes and ranges for endoscopy and biopsy at section 5.6 of the non-subsidised schedule, the note that pathology is charged separately, and the guidance in Annex III: Hospital Authority gazetted non-subsidised schedule, Chinese version https://www.ha.org.hk/haho/ho/cc/Gazette_tc.pdf (retrieved 9 August 2026, HTTP 200, 750,006 bytes, 31 pages); English version https://www.ha.org.hk/haho/ho/cc/Gazette_en.pdf (retrieved the same day, HTTP 200, 299,672 bytes, 30 pages). Note that Gazette_chi.pdf, Gazette_chib5.pdf and Gazette_cn.pdf in the same directory all return a 260-byte 404 error page with HTTP 200, and are not PDFs
• The names in both languages, and the classes, of colonoscopy, colonoscopy with removal of polyp or lesion, oesophagogastroduodenoscopy with or without biopsy, the Helicobacter urea breath test and related items: Hospital Authority, non-subsidised medical services, Annex III "Diagnostic/Therapeutic Procedures", https://www3.ha.org.hk/fnc/DiagnosticTherapeuticProcedures.aspx?lang=ENG (English) and https://www3.ha.org.hk/fnc/DiagnosticTherapeuticProcedures.aspx?lang=CHIB5 (Chinese) (both retrieved 9 August 2026, HTTP 200, 220,063 and 219,418 bytes respectively. Note the host is www3; the same path on www.ha.org.hk/fnc/ returns 404)
• The Colon Assessment Public-Private Partnership Programme subsidy of $6,800 / $7,500, the $1,000 basic co-payment, the cap on additional fees, the HA paying the co-payment for eligible waived patients, the invitation conditions, stable cases, and patients not applying themselves: Hospital Authority, Colon Assessment Public-Private Partnership Programme, programme introduction, https://www4.ha.org.hk/ppp/ppp-programmes/colonppp/programme-intro (retrieved 9 August 2026, HTTP 200, 61,864 bytes)
• The four categories of eligible waived patients, and the existence and names of documents such as the framework and terms and conditions: Hospital Authority Colon Assessment Public-Private Partnership Programme, "General Information" page, https://www4.ha.org.hk/ppp/ppp-programmes/colonppp/useful-info (retrieved 9 August 2026, HTTP 200, 72,185 bytes); eligible-waived-patients PDF (1 April 2023), https://www4.ha.org.hk/ppp/docs/default-source/colon-ppp/waiver-eligible-patients_colonppp-chi-2023-(2023-04-1).pdf (retrieved 9 August 2026, HTTP 200, 387,101 bytes, 1 page). Note that the framework and terms and conditions title appears on this page only, and 0 times on the programme introduction page
• The colonoscopy subsidy of $8,500 / $7,800, the $300 pre-procedure consultation subsidy being issued once only, and the $1,000 cap on additional fees applying only to the basic service of colonoscopy: Colorectal Cancer Screening Programme, Subsidy level and co-payment (colonoscopist), https://www.colonscreen.gov.hk/en/service/colonoscopist/subsidy_level_and_copayment.html; the Chinese amounts, and the statement that participants pay for subsequent pre-colonoscopy consultations themselves, appear at https://www.colonscreen.gov.hk/tc/service/colonoscopist/subsidy_level_and_copayment.html (page dated 6 August 2018; both retrieved 9 August 2026, HTTP 200)
• No cap on the primary care doctor's additional fee at the FIT stage, the subsidies of $280 and $76, and the four things that may not be charged for: Colorectal Cancer Screening Programme, Subsidy level and co-payment (primary care doctor), https://www.colonscreen.gov.hk/en/service/primary_care_doctor/subsidy_level_and_copayment.html (retrieved 9 August 2026, HTTP 200, 24,969 bytes)
• No adverse-event data of its own found published by the screening programme (result of a recursive link crawl): 51 pages returning HTTP 200 across the English colonscreen.gov.hk site (10 under public/; 39 under service/, including 2 subsidy_level_and_copayment.html pages not reached by the crawl and added by hand; and index.html and contact_us.html at the /en/ root, 2 pages), of which 16 are blank video-frame pages of 167-188 bytes, leaving 35 with substantive content; 4 navigational links returned 404 (public/programme/enrolment_into_the_programme.html, public/programme/resource_video1and2.html, service/primary_care_doctor/reference.materials.html, about-colorectal-cancer/what-is-colorectal-cancer.html) (retrieved 9 August 2026)
• All ten adverse-event terms returning 0 occurrences in the programme's own outcome report: Colorectal Cancer Screening Programme – Progress Report of the Screening Outcome for Participants Enrolled between 28 September 2016 and 31 December 2024, https://www.colonscreen.gov.hk/sites/default/files/pdf/CRCSP_progress_report.pdf (retrieved 9 August 2026, HTTP 200, 366,962 bytes, 5 pages); linked from https://www.colonscreen.gov.hk/en/service/colonoscopist/progress_report.html
• The definition of depth of sedation, the four-level classification, the comparison table at section 2.6, the requirement at 7.2 to monitor depth of sedation and at 7.4 to use capnography for deep sedation: Hong Kong Academy of Medicine, Guidelines on Procedural Sedation, version 2.2 (effective 17 January 2025), https://hkam.org.hk/sites/default/files/PDFs/(17%20Jan%202025)%202.2%20version%20Guidelines_on_Procedural_Sedation.pdf (retrieved 9 August 2026, HTTP 200, 488,121 bytes, 16 pages; linked from the "Related documents on Quality Assurance" section of https://www.colonscreen.gov.hk/en/service/colonoscopist/education_materials.html)
• Removing an adenoma preventing it from becoming cancer, over 70 per cent of service locations charging no additional payment, and the cumulative total of more than 579 000 participants as at the end of November 2025 with the numbers found to have adenoma and colorectal cancer (the release uses "Among them" to name that cumulative participant body as the denominator, though the percentage printed does not match it): Department of Health press release, 31 December 2025, https://www.info.gov.hk/gia/general/202512/31/P2025123100231.htm (retrieved 9 August 2026, HTTP 200)
• The programme being piloted in 2016, made regular in 2018 and rolled out fully in 2020, and the two-stage pathway: Cancer Expert Working Group on Cancer Prevention and Screening, Recommendations on Prevention and Screening for Colorectal Cancer, For Health Professionals (June 2024), https://www.chp.gov.hk/files/pdf/cewg_crc_professional_hp.pdf (retrieved 1 August 2026)
• The Cancer Coordinating Committee established in 2001, the expert working group in 2002, the 2004 recommendations on seven cancers, and the adoption of the Wilson and Jungner principles: Recommendations of CEWG on Cancer Prevention and Screening – An Overview for Health Professionals (June 2018), https://www.chp.gov.hk/files/pdf/overview_of_cewg_recommendations_professional_hp.pdf (retrieved 1 August 2026)
• The text of the first of the ten principles: Wilson JMG, Jungner G. Principles and practice of screening for disease. WHO Public Health Papers 34. Geneva: WHO; 1968, https://iris.who.int/items/7a67638b-14e3-4dba-b013-dc206ff279d8 (retrieved 1 August 2026)
• The HA not keeping colonoscopy waiting-time statistics (2017, 2018), colonoscopy volumes, people at high risk not being advised to use faecal occult blood testing, and "Anyone who has suspected symptoms should seek early consultation": Legislative Council LCQ22 (29 March 2017) https://www.info.gov.hk/gia/general/201703/29/P2017032900449.htm; LCQ8 (4 July 2018) https://www.info.gov.hk/gia/general/201807/04/P2018070400454.htm (LCQ22 retrieved 9 August 2026, HTTP 200; LCQ8 retrieved 1 August 2026)
• "At least one year" being a member's wording, the partnership programme launching in December 2016, and the 150 doctors and 1 107 examinations in paragraph 4 of the reply: Legislative Council LCQ20 (17 April 2019), https://www.info.gov.hk/gia/general/201904/17/P2019041700580.htm (retrieved 9 August 2026, HTTP 200, 25,079 bytes)
• The definition of screening: Legislative Council LCQ19 (22 May 2024), https://www.info.gov.hk/gia/general/202405/22/P2024052200498.htm (retrieved 1 August 2026)
• Pooled colonoscopy complication rates, diagnostic exceeding screening/surveillance, the heterogeneity statement and the time trend: Reumkens A, et al. Post-Colonoscopy Complications: A Systematic Review, Time Trends, and Meta-Analysis of Population-Based Studies. Am J Gastroenterol 2016;111(8):1092-101 (PMID 27296945; DOI 10.1038/ajg.2016.234; abstract re-retrieved via PubMed efetch on 9 August 2026)
• Local Hong Kong colonoscopy complication rates and predictors (female 1.6, MAC 1.8, inadequate bowel preparation 3.5, incomplete colonoscopy 4.5): Chan AO, Lee LN, Chan AC, et al. Predictive factors for colonoscopy complications. Hong Kong Med J 2015;21(1):23-9 (PMID 25634931; DOI 10.12809/hkmj144266). Setting: the Hong Kong Sanatorium endoscopy centre, 1 June 2011 to 31 May 2012, 6,196 people, of whom 3,657 completed the 30-day follow-up (abstract retrieved via PubMed efetch on 9 August 2026)
• Colonoscopy adenoma miss rate and its relationship with bowel preparation: Zhao S, et al. Magnitude, Risk Factors, and Factors Associated With Adenoma Miss Rate of Tandem Colonoscopy: A Systematic Review and Meta-analysis. Gastroenterology 2019;156(6):1661-1674.e11 (PMID 30738046; DOI 10.1053/j.gastro.2019.01.260)
• Upper gastrointestinal cancer endoscopic miss rate: Menon S, Trudgill N. How commonly is upper gastrointestinal cancer missed at endoscopy? A meta-analysis. Endosc Int Open 2014;2(2):E46-50 (PMID 26135259; DOI 10.1055/s-0034-1365524)
• Actual complication counts in screening colonoscopy, the ten-year risk and the number needed to invite: Bretthauer M, et al. N Engl J Med 2022;387:1547-1556 (NordICC; PMID 36214590; DOI 10.1056/NEJMoa2208375)
• Colonoscopic perforation as an example of harm from following up a positive screen, false positives crowding out endoscopy capacity, false negatives and delayed diagnosis, no programme being 100% sensitive, and positive predictive value falling at low prevalence: WHO Regional Office for Europe. Screening programmes: a short guide. Copenhagen; 2020, https://iris.who.int/items/ba910aa7-3c5a-4cf4-97d8-b128ac712881 (full text obtained via the IRIS REST bitstream path: https://iris.who.int/server/api/core/bitstreams/28017594-9982-4381-88d2-fb20a155bd11/content, retrieved 9 August 2026, HTTP 200, 123,825 bytes, a plain text file rather than a PDF)
• The bowel preparation process (three days of low-fibre diet, clear fluids, PEG preparation, adjustment of anticoagulants): The University of Hong Kong endoscopy centre, "Preparation for colonoscopy examination", https://www.endoscopy.hku.hk/en/Colonoscopy-screening/Preparation-for-colonoscopy-examination (retrieved 1 August 2026)
• The wording of the stomach cancer screening recommendation, Helicobacter screening being equally not recommended, and the arrangement for those at increased risk: Government Cancer Online Resource Hub, "Stomach Cancer" (last revised 28 April 2026, that date emitted as a div attribute data-last-revision-date and not visible in a plain-text view), https://www.cancer.gov.hk/en/hong_kong_cancer/common_cancers_in_hong_kong/stomach_cancer.html (retrieved 9 August 2026, HTTP 200, 33,080 bytes)
• The grading of the three formulations, the recommendation year for each cancer site, the "should consider" wording and three options for average-risk colorectal cancer, and the four conditions and FIT alternative for those at increased risk: Centre for Health Protection, Summary of CEWG Recommendations on Cancer Screening (2026), https://www.chp.gov.hk/files/pdf/12_summary_tables_on_extracted_cewg_recommendations_all_11_cancer_sites_eng.pdf (retrieved 9 August 2026, HTTP 200, 288,118 bytes, 8 pages; the document is entirely in English with no Chinese characters, so this article quotes its original English)
• Japanese stomach cancer screening age and interval: National Cancer Center Japan, Ganjoho, stomach cancer screening (updated 20 September 2024), https://ganjoho.jp/public/pre_scr/screening/stomach.html (retrieved 1 August 2026)
• Korean National Cancer Screening Program endoscopic screening and stomach cancer mortality risk: Jun JK, et al. Gastroenterology 2017;152(6):1319-1328.e7 (PMID 28147224; DOI 10.1053/j.gastro.2017.01.029)
• Age-standardised stomach cancer incidence for Japan, Korea and Hong Kong (given in sections 3.2, 3.3 and 3.4 of that paper respectively; Japan and Korea attributed to IARC/WHO, Hong Kong to the Hong Kong Cancer Registry), and national screening in Japan from 1983 and in Korea from age 40 every two years: Shin WS, Xie F, Chen B, et al. Updated Epidemiology of Gastric Cancer in Asia: Decreased Incidence but Still a Big Challenge. Cancers (Basel) 2023;15(9):2639 (PMID 37174105; DOI 10.3390/cancers15092639). Full text obtained via the Europe PMC REST fullTextXML endpoint (https://www.ebi.ac.uk/europepmc/webservices/rest/PMC10177574/fullTextXML, retrieved 9 August 2026, HTTP 200, 251,749 bytes; the PMC web version returned a reCAPTCHA interstitial that day, and the MDPI page and PDF returned 403)
• Hong Kong stomach cancer new case numbers, rankings and ten-year trends for 2023: Hong Kong Cancer Registry, stomach cancer statistics 2023 (August 2025), https://www3.ha.org.hk/cancereg/pdf/factsheet/2023/stomach_2023.pdf (retrieved 1 August 2026)

This article was written by the editorial team from the official and academic sources above; information date: 9 August 2026. It is health information, not medical advice.