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Abstract

We would like to thank Dr Yarze1Yarze J.C. Predictors of postcolonoscopy emergency department use.Gastrointest Endosc. 2018; 88: 204-205Abstract Full Text Full Text PDF Scopus (1) Google Scholar for his interest in our study “Predictors of post-colonoscopy emergency department use”2Grossberg L.B. Vodonos A. Papamichael K. et al.Predictors of post-colonoscopy emergency department use.Gastrointest Endosc. 2018; 87: 517-525Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar and his response. In our study, we aimed to determine the frequency, reasons, and relatedness of post-colonoscopy emergency department (ED) visits and to assess for predictors of these visits. We found increased patient complexity, higher endoscopist adenoma detection rates, and EMR to be predictors of unplanned hospital use after colonoscopy. Although post-procedure calls were not assessed in our study, we agree with Dr Yarze that ED use can certainly be influenced by the handling of post-procedure calls. One major aim of our work was to show that unplanned hospital use within 7 days of colonoscopy may not necessarily reflect poor-quality endoscopy but rather patient-specific variables and the inherent risk of the procedure. As Dr Yarze suggests, many endoscopists refer patients to the ED who call with abdominal complaints after the procedure to exclude a serious adverse event. As a result, the frequency of ED visits after colonoscopy likely overestimates the true rate of adverse events, and this supports our notion that post-colonoscopy ED visits are not a specific quality indicator for adverse outcomes or endoscopist skill. Our work also shows that most post-procedural abdominal pain is benign. We found that of the 50,309 colonoscopies included in our study, only 99 post-procedure ED visits were for abdominal pain, and fewer than half of these patients were admitted to the hospital. Therefore, our data should provide patients and providers some reassurance when opting for at-home monitoring rather than immediate ED referral for all patients with abdominal pain after colonoscopy. However, further research is needed to establish methods to target outreach to patients at highest risk for post-procedure adverse events to reduce unnecessary ED visits and cost. Predictors of postcolonoscopy emergency department useGastrointestinal EndoscopyVol. 88Issue 1PreviewI read the recent article by Dr Grossberg et al1 with interest. In their retrospective cohort study, the authors identified multiple patient-related and endoscopist-related factors associated with an unplanned emergency department (ED) visit within 7 days of the index colonoscopic examination. Although not studied, a potentially important factor in determining an individual patient’s propensity to seek ED evaluation might be the physician’s threshold for recommending the same. Full-Text PDF