Complications Common After Endoscopy

By Kristina Fiore, Staff Writer, MedPage Today

Published: October 25, 2010

Reviewed by Zalman S. Agus, MD;

Emeritus Professor University of Pennsylvania School of Medicine.

Complications after endoscopy may be more common than previously thought, a review of electronic medical records (EMR) revealed.

The review, which examined more than 400 emergency department (ED) visits logged in one hospital's EMR system within two weeks of an endoscopic procedure, found that almost a third of those ED visits were related to the previous endoscopy, according to Daniel A. Leffler, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues

In contrast, the physician-reported complication rate for endoscopies was only 7%, Leffler and co-authors reported in the Oct. 25 Archives of Internal Medicine.
"Although the overall rate of severe complications, including perforation, myocardial infarction, and death remained low, the true range of adverse events is much greater than typically appreciated," they wrote.

Because there isn't a clear picture of the number of complications that arise after endoscopic procedures, the researchers developed a component of the EMR system at Beth Israel to capture admissions to the ED within 14 days of endoscopy.
The gastroenterology department at Beth Israel also maintains a voluntary, paper-based physician reporting system into which each gastroenterologist must submit a monthly form detailing any known complications.

Overall, they found a total of 6,383 esophagogastroduodenoscopies and 11,632 colonoscopies. The medical center's electronic reporting system caught 419 ED visits within two weeks of these procedures.

Physician reviewers determined 32% of these ED visits to be directly related to the endoscopic procedure. A total of 29% of the 266 subsequent hospitalizations were also procedure-related.
Yet only about 7% of these incidents were recorded by the standard physician reporting system, the researchers said (P<0.001).
"The standard physician reporting greatly underestimated the burden of medical care related to endoscopic procedures and unexpected hospital utilization," Leffler and colleagues wrote.
The most common reasons for the endoscopy-related ED visits were abdominal pain (47%), gastrointestinal bleeding (12%), and chest pain (11%).
Overall, procedure-related hospital visits occurred in 1.07% of all esophagogastroduodenoscopies, 0.79% of all endoscopies, 0.84% of colonoscopies, and 0.95% of all screening colonoscopies.

This 1% incidence of related hospital visits within two weeks of outpatient endoscopy, is two to three times higher than recent estimates, the researchers noted.
The mean time for a trip to the ED after a procedure was six days for esophagogastroduodenoscopies, and 5.2 days for colonoscopies.
The researchers calculated that the mean costs were $1,403 per ED visit and $10,123 per hospitalization, based on Medicare standardized rates.
Across the overall screening/surveillance colonoscopy program, these episodes added $48 per exam.

"The cost of unexpected hospital visits post-endoscopy may be significant and should be taken into account in screening or surveillance programs," they wrote, adding that it's a "cause for concern" because "otherwise healthy individuals are subjected to procedural risks."
The study was limited by the 14-day cutoff for post-endoscopic events. In addition, it does not capture visits to other EDs at outside institutions. Still, the researchers urged other centers to create similar automated adverse event reporting systems.
The researchers reported no conflicts of interest.

Primary source:

Archives of Internal MedicineSource reference:Leffler DA, et al "The incidence and cost of unexpected hospital use after scheduled outpatient endoscopy" Arch Intern Med 2010; 170(19): 1752-1757.