MONDAY, Oct. 25 (HealthDay News) -- Complications following
gastrointestinal endoscopies -- procedures performed to detect
ulcers, cancer and other conditions -- may be higher than
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
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."
U.S. National Institute of Diabetes and Digestive and
Kidney Diseases has more on endoscopy.