Complications of upper GI endoscopy

Upper gastrointestinal endoscopy is a diagnostic procedure done to assess the conditions affecting the upper parts of the gastrointestinal tract. Complications due to this method are rather rare. All the complications may be divided into cardiopulmonary complications, complications due to sedation, infections, perforation within the gastrointestinal tract, and hemorrhage.

Cardiopulmonary complications occur mainly because of the anesthesia which is regularly administered during the endoscopy. Out of all complications, these are the most usual during endoscopy. They feature slight changes in vital signs and even can present with myocardial infarction and breathing depression. Shock due to hypotension may develop as well.

However, all of the previously mentioned complications are much more common for people who already suffer from cardiac and pulmonary diseases. They are also more frequent in elderly patients. Today conscious sedation is applied more, and constant monitoring prevents certain complications from developing. In the case of cardiopulmonary arrest, the methods of resuscitation are performed. All the medications that may be needed are at the doctor's hand.

The infections after the procedure may be caused by the procedure itself or the infective agents which may contaminate the equipment. There is the possibility of transitory bacteriemia during the endoscopy. In rather rare cases, bacterial endocarditis may occur as one pretty serious complication of the procedure. This is why in some cases antibiotics are administered as a method of prophylaxis.

In extreme cases, retropharyngeal or retro esophageal abscesses may develop. The equipment is regularly sterilized so the possibility of contamination is reduced to a minimum.

Perforation

One of the serious complications includes perforation. This does not happen often but can be severe. One of the factors that may predispose to this complication is the presence of anterior cervical osteophytes. Zenger’s diverticulum is a condition that makes the wall of the pharynx or esophagus thinner hence the place of the change is more susceptible to perforation.

Esophageal strictures and malignancies of the upper gastrointestinal tract may also be the cornerstone for perforation. In the case of esophageal perforation, the rate of lethal outcome is around 25%. The state features pain in the chest, fever, and an increased number of white blood cells.

If the air from the gastrointestinal tract comes into the peritoneum it can be identified by a plain radiograph of the abdomen. The prognosis of this complication basically depends on the place of perforation and the overall health of the patient.

Bleeding

Bleeding may also occur during the gastrointestinal endoscopy. Extreme bleeding is not so common. The individuals prone to bleeding are those suffering from thrombocytopenia and coagulopathy. All the biopsies are taken with precautions.

Upper GI (UGI) endoscopy is commonly performed and carries a low risk of adverse events. Large series report adverse event rates of 1 in 200 to 1 in 10,000 and mortality rates ranging from none to 1 in 2000. Data collected from the Clinical Outcomes Research Initiative database show a cardiopulmonary event rate of 1 in 170 and a mortality rate of 1 in 10,000 from among 140,000 UGI endoscopic procedures. The variability in rates of adverse events may be attributed to the method of data collection, patient populations, duration of follow-up, and definitions of adverse events.

The rate of cardiopulmonary adverse events in large, national studies is between 1 in 170 and 1 in 10,000. Reported adverse events range from minor incidents, such as changes in oxygen saturation or heart rate, to significant adverse events such as aspiration pneumonia, respiratory arrest, myocardial infarction, stroke, and shock.
Infectious adverse events of diagnostic UGI endoscopy can result from either the procedure itself or failure to follow guidelines for the reprocessing and use of endoscopic devices and accessories.
Prospective, multicenter registries report perforation rates of 1 in 2500 to 1 in 11,000. Factors predisposing to perforation include the presence of anterior cervical osteophytes, Zenker’s diverticulum, esophageal stricture, malignancies of the UGI tract, and duodenal diverticula. Perforation of the esophagus is associated with a mortality rate between 2% and 36%.
Clinically significant bleeding is a rare adverse event of diagnostic UGI endoscopy. Mallory-Weiss tears occur in less than 0.5% of diagnostic UGI endoscopic procedures and usually are not associated with significant bleeding. Bleeding may be more likely in individuals with thrombocytopenia and/or coagulopathy.
Data from randomized trials and large case series suggest that the overall rate of dilation adverse events is between 0.1% and 0.4%. The most common adverse events are perforation, hemorrhage, aspiration, and bacteremia. Most dilation-related bleeding is self-limited, but rare episodes of bleeding requiring endoscopic hemostasis and dissection into major blood vessels have been reported.
Many of the adverse events associated with endoluminal therapy can be treated endoscopically. Bleeding can be controlled with injection hemostasis, APC, hemostatic graspers, or endoscopic clips. The risk of delayed bleeding after EMR may be reduced by prophylactic closure of mucosal defects with endoscopic clips. High-dose proton pump inhibitor therapy improves ulcer healing rates and reduces the risk of delayed bleeding after ESD.

Knowledge of potential endoscopic adverse events, their expected frequency, and the risk factors for their occurrence may help to minimize the incidence of adverse events. Endoscopists are expected to carefully select patients for the appropriate intervention, be familiar with the planned procedure and available technology, and be prepared to manage any adverse events that may arise. Once an adverse event occurs, early recognition and prompt intervention may minimize the morbidity and mortality associated with that adverse event.

✓ Fact confirmed: Adverse events of upper GI endoscopy Tamir Ben-Menachem, G. Anton Decker, Dayna S. Early, Jerry Evans, Robert D. Fanelli, Deborah A. Fisher, Laurel Fisher, Norio Fukami, Joo Ha Hwang, Steven O. Ikenberry, Rajeev Jain, Terry L. Jue, Khalid M. Khan, Mary L. Krinsky, Phyllis M. Malpas, John T. Maple, Ravi N. Sharaf, Jason A. Dominitz, Brooks D. Cash; 2012 Oct