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GI Endoscopy Complication Rates Higher Than Suspected: Study
Date:10/26/2010

By Amanda Gardner
HealthDay Reporter

MONDAY, Oct. 25 (HealthDay News) -- Complications following gastrointestinal endoscopies -- procedures performed to detect ulcers, cancer and other conditions -- may be higher than previously estimated.

The good news is that most of the problems reported were minor, such as abdominal pain, and the rate of serious complications is actually lower than previously suspected, according to a study published in the Oct. 25 issue of the Archives of Internal Medicine.

Although the overall risk of complications was two to three times higher than had been reported, the risk of severe complications, such as perforations and bleeding, heart attacks or even death, were lower than previous studies -- about half of that reported in earlier estimates, said study author Dr. Daniel Leffler, director of clinical research at the Celiac Center at Beth Israel Deaconess Medical Center in Boston.

Gastrointestinal endoscopic procedures -- in which doctors use a thin, flexible tube with a fiber-optic light and a tiny video camera at the tip to look inside the esophagus, stomach, intestines or colon -- are common in the United States, with some 15 million to 20 million performed each year, the authors stated.

These authors took advantage of the Beth Israel Deaconess Medical Center electronic medical record system to devise their own system to monitor emergency room visits and hospitalizations of patients who had had an endoscopy within the past two weeks.

Previous research indicates that most post-endoscopy-related hospital visits occur within a 14-day time frame.

The system recorded 6,383 endoscopies and 11,632 colonoscopies between March 1 and Nov. 30, 2007. A total of 419 emergency department visits and 266 hospitalizations took place within two weeks following the procedures. Of these, 134 (32 percent) of the emergency room visits were related to complications related to the endoscopies, as were 76 (29 percent) of the hospitalizations.

Traditional reporting by physicians recorded only 31 such complications, the study authors noted.

Almost half of the visits were due to abdominal pain, 12 percent to gastrointestinal tract bleeding and 11 percent involved chest pain, the researchers found.

Older patients were more likely to have complications.

Although most of the complications were minor, the cost of follow-up care was not. The average cost per emergency room visit following endoscopy was $1,403 and the average cost of hospitalization for post-procedure complications was $10,123, the researchers reported.

The findings may help guide how doctors counsel patients following one of these procedures.

"We've done a lot over the years to mitigate the risks of bleeding and perforation, and rightly so," Leffler said. "Now [that] we know of the underlying iceberg of minor complications, we can really look at those because they're a significant burden to patients and the health-care system. Most of these patients go home at the end of the day," he noted.

"We can alert patients that [certain symptoms] are common and here are some things you can try -- heating pads, things like that," he said. "If it's persistent and there are certain warning signs, they should let us know."

Leffler also pointed out that electronic medical records might emerge as a more rigorous way to determine complications from different hospital procedures.

Dr. Vivek Kaul, acting chief of the division of gastroenterology & hepatology at the University of Rochester Medical Center, said he was not particularly surprised by the findings.

"These types of events are not uncommon," he said. And "symptoms should be triaged [for example, first by a phone call to a doctor] before people are directed to the ER unless the symptoms are catastrophic. I don't think you can not direct patients to call or go to the ER. Who wants to take the chance of missing that one patient that could be saved by going to the ER."

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on endoscopy.

SOURCES: Daniel Leffler, M.D., director of clinical research, The Celiac Center, Beth Israel Deaconess Medical Center, Boston; Vivek Kaul, M.D., acting chief, division of gastroenterology & hepatology, University of Rochester Medical Center, Rochester, N.Y.; Oct. 25, 2010, Archives of Internal Medicine


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