3345 Incidence of complications within 30 days of outpatient endoscopy: what you don't know can hurt you.

Abstract

Background: Although the incidence of early complications of endoscopy has been well described, there is a paucity of data on late outcomes.A recent study reported a 30-day complication rate of 16.6% after outpatient endoscopy (Gastrointest Endosc 1999;50:322). However, this study focused on colonoscopy and the majority of the procedures were performed by GI attendings. Our aim was to determine the incidence of complications within 30 days of outpatient EGD, colonoscopy, and flexible sigmoidoscopy (FS) in a training program setting. Methods: 1000 consecutive patients undergoing outpatient endoscopy performed by GI fellows under direct attending supervision were mailed a survey 30 days after the procedure. Patients were asked about symptoms that were possibly related to the endoscopy, if they had to see a physician, or if they were admitted to the hospital within 30 days of the procedure. A minimum of 3 attempts was made to contact all patients by telephone who did not return the survey. Complications were categorized as major (resulting in a physician visit or hospital admission) or minor. We also determined the proportion of major and minor complications that were known to the GI service and discussed at our QA or M&M conference. Results: Of the 1000 patients, 867 (86.7%) were contacted. The 30-day incidence of complications was 14.3%, of which 0.6% were major and 13.7% were minor. Major complications (n = 5) included 1 colon perforation, 1 post-polypectomy bleed, 1 admission for abdominal pain, 1 transient hypoxia requiring narcan, and 1 physician visit for rectal pain. No patient died within 30 days of endoscopy. Minor complications included abdominal pain (5.9%), sore throat (4.7%), nausea or vomiting (3.1%), mild shortness of breath (3.1%), headache (2.8%), rectal bleeding (2.3%), change in bowel habits (2.2%), pain at the IV site (1.6%), and dizziness (1.5%). The 30-day incidence of complications was 17.1% for EGD, 15.0% for colonoscopy, 24.4% for same-day EGD + colonoscopy (P < 0.05 compared to colonoscopy alone), and 7.8% for FS. The GI service was aware of 100% of the major and 16.0% of the minor complications. Contacting patients 30 days after endoscopy increased the detection of complications from 2.4% to 14.3% (P < 0.001). Conclusions: Contacting patients 30 days after outpatient endoscopy revealed significantly more complications than were previously known. Similar to our surgical colleagues, 30-day follow-up should be the standard of care for reporting endoscopic complications. Background: Although the incidence of early complications of endoscopy has been well described, there is a paucity of data on late outcomes.A recent study reported a 30-day complication rate of 16.6% after outpatient endoscopy (Gastrointest Endosc 1999;50:322). However, this study focused on colonoscopy and the majority of the procedures were performed by GI attendings. Our aim was to determine the incidence of complications within 30 days of outpatient EGD, colonoscopy, and flexible sigmoidoscopy (FS) in a training program setting. Methods: 1000 consecutive patients undergoing outpatient endoscopy performed by GI fellows under direct attending supervision were mailed a survey 30 days after the procedure. Patients were asked about symptoms that were possibly related to the endoscopy, if they had to see a physician, or if they were admitted to the hospital within 30 days of the procedure. A minimum of 3 attempts was made to contact all patients by telephone who did not return the survey. Complications were categorized as major (resulting in a physician visit or hospital admission) or minor. We also determined the proportion of major and minor complications that were known to the GI service and discussed at our QA or M&M conference. Results: Of the 1000 patients, 867 (86.7%) were contacted. The 30-day incidence of complications was 14.3%, of which 0.6% were major and 13.7% were minor. Major complications (n = 5) included 1 colon perforation, 1 post-polypectomy bleed, 1 admission for abdominal pain, 1 transient hypoxia requiring narcan, and 1 physician visit for rectal pain. No patient died within 30 days of endoscopy. Minor complications included abdominal pain (5.9%), sore throat (4.7%), nausea or vomiting (3.1%), mild shortness of breath (3.1%), headache (2.8%), rectal bleeding (2.3%), change in bowel habits (2.2%), pain at the IV site (1.6%), and dizziness (1.5%). The 30-day incidence of complications was 17.1% for EGD, 15.0% for colonoscopy, 24.4% for same-day EGD + colonoscopy (P < 0.05 compared to colonoscopy alone), and 7.8% for FS. The GI service was aware of 100% of the major and 16.0% of the minor complications. Contacting patients 30 days after endoscopy increased the detection of complications from 2.4% to 14.3% (P < 0.001). Conclusions: Contacting patients 30 days after outpatient endoscopy revealed significantly more complications than were previously known. Similar to our surgical colleagues, 30-day follow-up should be the standard of care for reporting endoscopic complications.