Endoscopies Are More Dangerous Than Previously Thought

A new study has found that the number of emergency department (ED) visits and hospitalizations following outpatient endoscopy procedures is much higher than previously indicated.

Researchers at Beth Israel Deaconess medical Center (Boston, MA, USA) collected patient information from the hospital's electronic medical record (EMR) system, which uses an automated patient tracking mechanism. The EMR system documented 6,383 outpatient esophagogastroduodenoscopy (EGD) procedures and 11,632 outpatient colonoscopies--7,392 of these for screening and surveillance. A 14-day cut-off period was set for subsequent ED visits and hospitalizations after the procedures. The numbers of visits and hospitalizations were compared with another set of figures gathered by standard physician reporting, using both paper and online forms.

The results showed more than 4 times as many combined ED visits and hospitalizations were reported through the automated patient tracking system than by using traditional recording methods; 134 ED visits related to endoscopic procedures (32%) were documented by the patient tracking system, while only 31 complications requiring an ED visit or hospitalization were reported through standard physician methods. When analyzing the data, the researchers found that hospital visit rates were 0.79% for endoscopies, 0.84% for colonoscopies, and for 0.95% for screening colonoscopies. The mean time between the procedure and ED visit was 6 days in EGD patients and 5.2 days for colonoscopy patients for each ED visit. The study was published in the October 25, 2010, issue of the Archives of Internal Medicine.

"Using a novel automated system, we observed a 1% incidence of related hospital visits within 14 days of outpatient endoscopy, 2- to 3-fold higher than recent estimates. Most events were not captured by standard reporting, and strategies for automating adverse event reporting should be developed,” concluded lead author Daniel Leffler, M.D., and colleagues from the division of gastroenterology.

Endoscopy complications can include over-sedation resulting in "deep sedation,” paradoxical excitement and or sexual fantasies, drug induced respiratory depression with hypoxia and CO2.

Retention, aspiration pneumonia, cardiac arrhythmias, hypertension, hypotension, vasovagal fainting, angina and myocardial infarct (MI), stroke, nausea and vomiting, generalized flushing, and side effects specific to anticholinergics.

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Beth Israel Deaconess Medical Center