Endoscopy complications more common than once thought: study

by Brendon Nafziger, DOTmed News Associate Editor | October 25, 2010
Complications related to endoscopies and colonoscopies could be three times more common than previously thought, according to a new study, contributing possibly hundreds of millions of dollars to the nation's health care costs.

The study, published Monday in the Archives of Internal Medicine, also showed the potential promise of electronic medical records in helping physicians better understand patient outcomes.

For the study, the researchers used an EMR system to automatically track hospital visits following outpatient endoscopy procedures with doctors affiliated with Beth Israel Deaconness Medical Center in Boston.

The researchers said this new method found around five times more complications, such as pain and GI bleeding, than voluntary physician reporting, relied on for earlier estimates and known from some studies to miss as many as 15 to 45 percent of adverse events, according to the paper.

"The standard physician reporting greatly underestimated the burden of medical care related to endoscopic procedures and unexpected hospital utilization, which adds considerably to the cost of our screening or surveillance colonoscopy program," wrote the authors, led by Dr. Daniel A. Leffler, a gastroenterologist with Beth Israel.

In the study, the EMR system automatically recorded visits to the emergency room within two weeks of an endoscopy. Doctors evaluated cases and determined if they were "related" to the procedure based on certain criteria. For instance, "abdominal pain" could be classified as related if it followed a screening colonoscopy, typically done on healthy adults, but not if it was the reason the patient sought an endoscopy in the first place.

Using the medical records to record more than 6,000 esophagogastroduodenoscopies and almost 12,000 colonoscopies (almost two-thirds for screening or surveillance), the doctors recorded 419 emergency room visits and 266 hospitalizations following a procedure.

Of these, 134 of the ER visits and 76 hospitalizations were classified as procedure-related. In contrast, physician reporting only turned up 31 complications.

Although the overall endoscopy complication rate was very low, at less than 1 percent, the rate was still several times higher than many earlier estimates, the researchers said. A widely relied-on 1976 survey conducted by the American Society for Gastrointestinal Endoscopy found complication rates between one out of 1,000 for upper endoscopy and one out of 285 for colonoscopies, the authors said.