Background and study aims: Adverse events associated with overtube-assisted enteroscopy are similar to those
with routine endoscopy. Our endoscopy quality program identified a number of respiratory
adverse events resulting in emergency resuscitation efforts. The aim is to report
all adverse events identified by quality monitoring and outcomes of adverse events
associated with overtube-assisted enteroscopy.
Methods: A retrospective study used data prospectively obtained from consecutive patients
undergoing overtube-assisted enteroscopy between December 2008 and July 2012. Patient
characteristics, medical history, procedure indication, and procedure outcomes, including
diagnosis, endoscopic therapy, and complications, were obtained.
Results: In 432 overtube-assisted enteroscopies, 15 adverse events (most frequently hypoxemia,
9 /15, 60 %) occurred in 14 patients (3.2 % of total cohort; 12 were outpatients)
mostly during antegrade enteroscopy. Four patients required endotracheal intubation
and 4 /12 outpatients required intensive care. The procedure was aborted in 13 /14
patients, and only 1 of 10 patients scheduled for repeat antegrade enteroscopy returned.
There was no mortality. Based on the frequency of adverse events, and in consultation
with anesthesia providers, from August 2012 all antegrade overtube-assisted enteroscopies
at our institution were done with general anesthesia. From then till September 2013,
145 antegrade and 52 retrograde overtube-assisted enteroscopies have been done, with
no adverse events.
Conclusions: Monitoring of endoscopy practice identified adverse events associated with overtube-assisted
enteroscopy. The peer-review prompted a change in practice: all patients undergoing
antegrade overtube-assisted enteroscopy at our institution now have endotracheal intubation
which has dramatically decreased the rate of respiratory adverse events. The impact
of endoscopic quality measurements on practices, procedures, and outcomes will be
of further interest.
