Retrospective Study to Evaluate Complication Rates during Diagnostic and Therapeutic GI Endoscopy: A Single-Center Experience

Background and Aim: Despite advances in training, endoscopic techniques, and technology, upper and lower gastrointestinal (GI) endoscopic procedures continue to have potential for significant morbidity. Large series report adverse event rates ranging from none to 1 in 5,000 for upper GI endoscopy and 2 to 3 per 1,000 procedures for colonoscopy. This study examines the complication rates of upper and lower GI endoscopic procedures performed by three consultants at a single tertiary care center in Western India.

Methods: All inpatient and outpatient diagnostic and therapeutic GI endoscopies performed during 6 years (2018–2023) were evaluated retrospectively. Data were extracted to identify rate of complications and their outcomes. Identified records were retrieved and hand searched to confirm an endoscopic-associated complications (mechanical, cardio-pulmonary, and sedation related). The type of procedure was recorded as either diagnostic or therapeutic depending on the presence or absence of a therapeutic endoscopic maneuver. For gastroscopy, therapeutic maneuvers included dilation, stent placement, variceal and nonvariceal hemostatic procedures, polypectomy and percutaneous endoscopic gastrostomy tube placement. For colonoscopy, therapeutic maneuvers included all therapeutic procedures identified for gastroscopy in addition to bowel decompression. Advanced, third space endoscopies, enteroscopies and ERCP were not included.

Results: A total of 13,458 endoscopies (9,363 upper GI and 4,095 lower GI) were performed (numbers affected due to long COVID outbreak). A total of 8 (0.059%) significant complications occurred without any mortality over 5 years. Endoscopic procedures continue to carry morbidity risks associated with complications. But when done meticulously, they can be minimized.

Conclusion: The possible reasons for such excellent safety profile are proper patient, proper procedure, and proper anesthesia/sedation selection.

Extensive preprocedure evaluation (clinical/biochemical/imaging).

Meticulous and continuous monitoring of the patient. Continuous water insufflation during colonoscopy and use of CO₂ for insufflation rather than air. Conscious sedation instead of deep sedation, due to which patient’s reactions can be picked up early in case of excessive luminal distension which prevents perforation.

Publication History

Article published online:
22 April 2024