Review
Complications of endoscopy

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Abstract

Background: Although most gastrointestinal endoscopic procedures are performed by gastroenterologists, surgeons often assist in the management of patients with complications. This review provides an introduction to the incidence, prevention, and treatment of complications that may occur after upper endoscopy, colonoscopy, percutaneous endoscopic gastrostomy, and endoscopic retrograde cholangiopancreatography.

Methods: Systematic review of the literature.

Results: Preprocedural complications include medication effects and adverse effects of bowel preparation. Major procedural complications consist primarily of perforation and hemorrhage. Percutaneous endoscopic gastrostomy tube placement may be complicated by fistula and obstruction. There is also a risk of infectious disease transmission, both to and from the patient.

Conclusions: Endoscopy, like all invasive procedures, carries significant potential risks for the patient. In practiced hands, and with awareness of the problems that may arise, many complications may be avoided and others successfully managed.

Section snippets

Methods

Systematic review of the literature was initiated with a search on Medline for all English-language articles with keywords “endoscopy,” “colonoscopy,” “EGD,” and “PEG.” All lists were combined with searches for “complications.” The bibliography of each article was then reviewed to produce further references.

Preprocedural complications

Some complications arise from the preparation for endoscopy, and not directly due to the endoscopy itself. These complications may be loosely grouped into three categories: conscious sedation, mechanical bowel preparation, and topical anesthesia. General anesthesia is reserved for extraordinary circumstances and selected pediatric patients, and will not be addressed here.

Procedural complications

The majority of complications of endoscopy are directly related to the procedure itself. These occur at the time of procedure due to the mechanical presence of the endoscope itself or due to therapeutic manipulations of the instrument.

Complications of colonoscopy

Overall, colonoscopy is viewed as a relatively safe procedure. Currently, more than 500,000 colonoscopies are performed each year in the United States. The incidence of complications of any nature has been estimated to range from 0.1% to 1.9% [[20], [21]].

Complications of upper endoscopy

Overall, esophagogastroduodenoscopy (EGD) is associated with a 0.1% incidence of complications [41]. The most serious of these complications are perforation and hemorrhage. Aspiration, Mallory-Weiss tears, and other “minor” complications such as retroesophageal abscess have also been described.

Complications of endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) has been utilized since the late 1960s to aid in the diagnosis and treatment of biliary disease. The procedure is itself an upper endoscopy (EGD), followed by cannulation of the major papilla of the duodenum. The endoscopist may then perform the diagnostic maneuver of dye injection through the papilla or the therapeutic maneuver of endoscopic sphincterotomy (ES). Inability to cannulate the papilla or to remove common bile duct stones are

Complications of percutaneous endoscopic gastrostomy

Since its introduction in 1979, percutaneous endoscopic gastrostomy (PEG) has become the procedure of choice for the insertion of long-term feeding tubes [59]. Multiple techniques have been described, but all include passage of an endoscope to the stomach and the percutaneous introduction of a large bore feeding tube. As the first portion is essentially an upper endoscopy, the procedure also carries the risks of upper endoscopy. However, other specific considerations for PEG are outlined in

Risks to the endoscopist

As with any invasive procedure, the endoscopist assumes a certain degree of risk in performing the procedure. As universal precautions are common, the risk of transmission of viral or bacterial agents from the patient to the endoscopist seems minimized. However, the patient may still (inadvertently or not) bite the fingers of the endoscopist during EGD if a bite block is not used.

Perhaps more importantly, the endoscopist is at risk of exposure to the patient’s body fluids. Aerosolization and

Conclusions

Endoscopy, like all invasive procedures, carries significant potential for injury to the patient. EGD, colonoscopy, ERCP, and PEG tube placement are specialized procedures that require sufficient experience to avoid the complications unique to each. However, in practiced hands, these difficulties may be minimized through proper patient selection, rigid attention to technique, and awareness of the possible complications that may arise. [35], [36], [67]

References (105)

  • P Mandelstam et al.

    Complications associated with esophagoduodenoscopy and with esophageal dilatation

    Gastrointest Endosc

    (1976)
  • B.E Berry et al.

    Perforation of the esophagus. A 30 year review

    J Thorac Cardiovasc Surg

    (1973)
  • F Al-Zamil et al.

    Meningococcaemiaa life threatening complication of upper gastrointestinal endoscopy

    J Infect

    (1994)
  • V.K Sharma et al.

    Metaanalysis of randomized controlled trials of endoscopic retrograde cholangiography and endoscopic sphincterotomy for the treatment of acute biliary pancreatitis

    Am J Gastroenterol

    (1999)
  • S Sherman et al.

    Complications of endoscopic sphincterotomy

    Gastroenterol

    (1991)
  • M.W.L Gauderer et al.

    Gastrostomy without laparotomya percutaneous endoscopic technique

    J Pediatr Surg

    (1980)
  • M.D Kaye

    Herpetic conjunctivitis as an unusual occupational hazard (endoscopists’ eye)

    Gastrointest Endosc

    (1974)
  • P.H Sugarbaker et al.

    Fiberoptic colonoscopy. A new look at old problems

    Am J Surg

    (1973)
  • N.M Agrawal et al.

    Chylothorax following esophagoscopy, unusual complication of endoscopy

    Gastrointest Endosc

    (1974)
  • M.A Bigard et al.

    Fatal colonic explosion during colonoscopic polypectomy

    Gastroenterol

    (1979)
  • E.K Fishman et al.

    Pneumoscrotum after colonoscopy

    Urology

    (1981)
  • R Enat et al.

    Retroesophageal abscess 25 days after eosphagoscopy. An unusual complication of endoscopy

    Gastrointest Endosc

    (1972)
  • A Rai et al.

    Tension pneumothorax complicating diagnostic upper endoscopya case report

    Am J Gastroenterol

    (1999)
  • D.E Fleischer et al.

    Prospective evaluation of complications in an endoscopy unituse of the A/S/G/E quality care guidelines

    Gastrointest Endosc

    (1992)
  • A Fich et al.

    Necrosis of the uvula after endoscopy [letter]

    Gastrointest Endosc

    (1984)
  • W.S Haubrich

    History of Endoscopy

  • P Frühmorgern et al.

    Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany. Results of an inquiry

    Endoscopy

    (1979)
  • R Hart et al.

    Complications of diagnostic gastrointestinal endoscopy

    Endoscopy

    (1990)
  • A Ismail et al.

    Oxygen desaturation during endoscopy [letter]

    J R Coll Phys London

    (1993)
  • S.B Benjamin

    Overview of monitoring in endoscopy

    Scand J Gastroenterol

    (1990)
  • J.A Alexander et al.

    Midazolam sedation for percutaneous liver biopsy

    Dig Dis Sci

    (1993)
  • M.A Quine et al.

    Prospective audit of upper gastrointestinal endoscopy in two regions of Englandsafety, staffing, and sedation methods

    Gut

    (1995)
  • P Salmon et al.

    Evaluating customer satisfaction with colonoscopy

    Endoscopy

    (1994)
  • G.D Bell et al.

    Recommendations for standards of sedation and patient monitoring during gastrointestinal endoscopy

    Gut

    (1991)
  • S.M Cohen et al.

    Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods

    Dis Colon Rectum

    (1994)
  • P Vukasin et al.

    Oral Fleet® Phospho®-Soda laxative-induced hyperphosphatemia and hypocalcemic tetany in an adult

    Report of a case. Dis Colon Rectum

    (1997)
  • L Oliveria et al.

    Mechanical bowel preparation for elective colorectal surgery

    Dis Colon Rectum

    (1997)
  • C.M Brown et al.

    Methemoglobinemialife threatening complication of endoscopy premedication

    Am J Gastroenterol

    (1994)
  • R Campo et al.

    Topical pharyngeal anesthesia improves tolerance of upper gastrointestinal endoscopya randomized double-blind study

    Endosc

    (1995)
  • W Hopper et al.

    Colonoscopy by a family physiciana 9-year experience of 1048 procedures

    J Fam Pract

    (1996)
  • T.M Gebedou et al.

    Clinical presentation and management of iatrogenic colon perforations

    Am J Surg

    (1996)
  • C.A Burt

    Pneumatic rupture of the intestinal canal with experimental data showing the mechanism of perforation and the pressure required

    Arch Surg

    (1931)
  • J.D Waye et al.

    Colonoscopya prospective report of complications

    J Clin Gastroenterol

    (1992)
  • L.H Erdman et al.

    Electrical ileal perforationsan unusual complication of colonoscopy

    Dis Colon Rectum

    (1979)
  • H.M Adiar et al.

    The management of colonoscopic and sigmoidoscopic perforation of the large bowel

    Br J Surg

    (1981)
  • C Hall et al.

    Colon perforation during colonoscopysurgical versus conservative management

    Br J Surg

    (1991)
  • Christie JP, Marrazzo III J. “Mini-perforation” of the colon—not all postpolypectomy perforations require laparotomy....
  • S.R Thomson et al.

    Iatrogenic and accidental colon injuries—what to do?

    Dis Colon Rectum

    (1994)
  • H Johnson

    Management of major complications encountered with flexible colonoscopy

    JNMA

    (1993)
  • Vernava III AM, Moore BA, Longo WE, Johnson FE. Lower gastrointestinal bleeding. Dis Colon Rectum...

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