Complications From Screening Endoscopic Procedures Underestimated
Screening procedures are often considered to be benign. While this is true compared to the diseases being screened for such as colon cancer, a new study reports the rate of serious side effects from endoscopic procedures (endoscopy and colonoscopy) is actually 2- to 3-fold higher than recent estimates.
Daniel A. Leffler, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues have published the results of their study in the Oct. 25 Archives of Internal Medicine. Rather than relying on the standard physician reporting method of adverse events, the researchers used electronic medical records to track patient emergency visits and hospital admissions that occurred within two weeks of their endoscopic procedure.
A total of 15 to 20 million endoscopic procedures are performed annually in the United States. The American Society for Gastrointestinal Endoscopy (ASGE) survey from 1976 remains one of the most commonly cited and states the complication rate of 0.13% for upper endoscopy and 0.35% for colonoscopy.
Leffler and colleagues evaluated 6383 upper endoscopies (EGDs) and 11 632 colonoscopies within the BIDMC system. The EMR captured 419 ED visits and 266 hospitalizations which occurred within 14 days after the procedure.
Nearly a third of the ED visits (134 of 419, 32%) and hospitalizations (76 of 266, 29%) were found to be related the procedure. Only31 of these incidents were recorded by the standard physician reporting system.
The most common reasons for the ED visits related to the endoscopic procedures were abdominal pain (47%), gastrointestinal bleeding (12%), and chest pain (11%). The mean time for a trip to the ED after a procedure was six days for EGDs, and 5.2 days for colonoscopies.
The researchers found procedure-related hospital visits occurred in 1.07% of all EGDs, 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 more five times the 1976 stated risk of o.13% for upper endoscopy. It is nearly three times higher than 1976 stated risk of 0.35% for colonoscopy.
Using Medicare standardized rate, the researchers estimated the mean costs at $1403 per ED visit and $10 123 per hospitalization. Across the overall screening/surveillance colonoscopy program, these episodes added $48 per examination.
As this study could only capture the ED and hospital visits within the BIDMC, there may have been some missed if other hospitals were used by the patient. Regardless, the procedures and possible risks must be discussed and considered with patients.
The Incidence and Cost of Unexpected Hospital Use After Scheduled Outpatient Endoscopy; Daniel A. Leffler; Rakhi Kheraj; Sagar Garud; Naama Neeman; Larry A. Nathanson; Ciaran P. Kelly; Mandeep Sawhney; Bruce Landon; Richard Doyle; Stanley Rosenberg; Mark Aronson; Arch Intern Med. 2010;170(19):1752-1757.