Safety Of Gastrointestinal Endoscopy Research Articles

Safety of Gastrointestinal Endoscopy in Korea: A Nationwide Survey and Population-Based Study.

BackgroundAttention should be paid to endoscopy-related complications and safety-related accidents that may occur in the endoscopy unit. This study investigated the current status of complications associated with diagnostic and therapeutic endoscopy in Korea.MethodsA questionnaire survey on endoscopy-related complications was conducted in a total of 50 tertiary or general hospitals in Korea. The results were compared to the population-level claims data from the Health Insurance Review & Assessment Service (HIRA), which analyzed endoscopy procedures conducted in 2017 in Korea.ResultsThe incidences of bleeding associated with diagnostic and therapeutic esophagogastroduodenoscopy (EGD) and with diagnostic and therapeutic colonoscopy were 0.224% and 3.155% and 0.198% and 0.356%, respectively, in the 2017 HIRA claims data, compared to 0.012% and 1.857%, and 0.024% and 0.717%, in the 50 hospitals surveyed. The incidences of perforation associated with diagnostic and therapeutic EGD and with diagnostic and therapeutic colonoscopy were 0.023% and 0.613%, and 0.007% and 0.013%, respectively, in the 2017 HIRA claims data compared to 0.001% and 0.325%, and 0.017% and 0.206%, in the 50 hospitals surveyed. In the HIRA claims data, the incidence of bleeding/perforation after diagnostic colonoscopy in clinics, community hospitals, general hospitals, and tertiary hospitals was 0.129%/0.000%, 0.088%/0.004%, 0.262%/0.009%, and 0.479%/0.030% respectively, and the corresponding incidence of bleeding/perforation after therapeutic colonoscopy was 0.258%/0.004%, 0.401%/0.007%, 0.408%/0.024%, and 0.731%/0.055%.ConclusionThe incidences of complications associated with diagnostic and therapeutic EGD or colonoscopy tended to increase with the hospital volume in Korea.Trial RegistrationClinical Research Information Service Identifier: KCT0001728

S0526 Mortality and Infectious Adverse Events in Neutropenic Patients Undergoing Gastrointestinal Endoscopic Procedures: A Systematic Review and Meta-Analysis

INTRODUCTION: The safety of gastrointestinal endoscopy in neutropenic patients is unclear. American Society for Gastrointestinal Endoscopy guidelines state that patients with absolute neutrophil count (ANC) < 500 cells/µL and advanced hematologic malignancies are at increased risk for bacteremia and sepsis after endoscopy. Infectious Diseases Society of America guidelines state that endoscopy should be avoided in neutropenic patients. We performed a systematic review and meta-analysis to assess the safety of endoscopy in patients with neutropenia. METHODS: Bibliographic databases (Medline, EMBASE, Cochrane Library, Web of Science, Scopus, PubMed) were searched through November 2019 for studies in neutropenic patients (ANC < 1000 cells/µL) undergoing endoscopy with outcome data on infections, mortality, or fever. Abstracts from Digestive Disease Week, American College of Gastroenterology Annual Scientific Meeting, and United European Gastroenterology Week from January 2017 to January 2020 were also searched. Two independent reviewers identified studies meeting inclusion criteria, performed data extraction using a standardized form, and assessed risk of bias using the Newcastle-Ottawa scale. Co-primary outcomes were 30-day infection-related mortality and new infection within 30 days of endoscopy. Secondary outcomes included new bacteremia and new fever within 30 days. Random effects meta-analysis was used to calculate pooled proportions and effect estimates. RESULTS: Database search identified 2733 unique citations. Four studies from database search and 1 from conference abstract review met eligibility criteria (N = 928). All studies had high risk of bias. Overall proportion of infection-related mortality was 0.0% (95% CI: 0.0–0.4% I2: 0.0%) and infectious adverse events was 1.9% (95% CI: 0.0–6.4% I2: 77.0%) (Table 1). The proportion of neutropenic patients developing bacteremia was 1.7% (CI: 0.0-6.8% I2: 82.3%) and new fever was 0.0% (95% CI: 0.0–0.0% I2: 0.0%) (Table 2). Subgroup analysis was not performed due to zero events in a majority of studies and limited number of studies. However, data on antibiotic use prior to endoscopy was available in 3 studies; here the proportion of patients on antibiotics that developed new infections ranged from 0.0 to 1.2%. CONCLUSION: This systematic review and meta-analysis showed a low rate of mortality and infection following endoscopy in neutropenic patients. Additional large studies designed to assess the safety of endoscopy in neutropenic patients are needed.Figure 1.: PRISMA flow diagram summarizing study selection.Table 1.: Primary outcomes: 30 day infection-related mortality and infectious adverse events in neutropenic patients undergoing endoscopyTable 2.: Secondary outcomes: Bacteremia and new fever in neutropenic patients undergoing endoscopy

COVID-19 as a barrier to attending for gastrointestinal endoscopy: weighing up the risks

COVID-19 as a barrier to attending for gastrointestinal endoscopy: weighing up the risks

Safety analysis of gastrointestinal endoscopy in elderly patients undergoing intravenous anesthesia

Objective To investigate the safety of gastrointestinal endoscopy in elderly patients undergoing intravenous anesthesia. Methods 130 patients undergoing gastrointestinal endoscopy were selected.The patients were divided into the elderly group(A group): 65 to 75 years old, 65 cases, and young group (B group): 30 to 65 years old, 65 cases.The vital signs(including heart rate, blood pressure, blood oxygen saturation), anesthesia time, consciousness recovery time, dosage, patients' experience and adverse reaction were analyzed in the same group of fentanyl combined with propofol intravenous anesthesia. Results (1)Intravenous anesthesia, the blood pressure, heart rate of the two groups decreased in varying degrees, compared between before examination and during examination in the two groups, there were no statistically significant differences in A group(t=0.11, 0.67, 0.73, all P>0.05), and there were no statistically significant differences in B group(t=0.27, 0.83, 1.82, all P>0.05). In the surgery, 1 case of heart rate dropped to 50 times/min below in A group and B group; In A group, 1 case of SBP decreased by 30% of baseline blood pressure before examination, and B group did not show 30% reduction in SBP before reaching baseline blood pressure.Intravenous anesthesia had greater impact on SpO2 in elderly patients, and with age increased, the incidence increased, after symptomatic treatment, SpO2 immediately rebounded, and successfully completed the inspection.(2)In A group, the anesthesia time was (16.75±5.76)min, the conscious recovery time was (3.51±0.69)min, the propofol dosage was (72.43±19.58)mg.In B group, the anesthesia time was (15.96±6.58)min, conscious recovery time was (2.98±0.71)min, the propofol dosage was (71.67±20.49)mg, there were no statistically significant differences between the two groups(t=1.85, 1.57, 1.96, all P>0.05), but the amount of A group was more than that of B group, indicated that with age increased, the dosage decreased.(3)The patients of the two groups underwent intravenous anesthesia under the gastrointestinal endoscopy could achieve satisfactory anesthesia sedative effect, and safe to complete the examination.And no bleeding, perforation and even death and other serious adverse consequences were observed. Conclusion In the strict control of indications and close observation, elderly patients undergoing anesthesia under the gastrointestinal endoscopy is safe, comfortable and feasible. Key words: Gastroscopy; Duodenoscopy; Anesthesia, intravenous; Aged

Safety of gastrointestinal endoscopy with conscious sedation in obstructive sleep apnea.

AIMTo perform a systematic review and meta-analysis to assess the safety of conscious sedation in patients with obstructive sleep apnea (OSA).METHODSA comprehensive electronic search of MEDLINE and EMBASE was performed from inception until March 1, 2015. In an effort to include unpublished data, abstracts from prior gastroenterological society meetings as well as other reference sources were interrogated. After study selection, two authors utilizing a standardized data extraction form collected the data independently. Any disagreements between authors were resolved by consensus among four authors. The methodological quality was assessed using the Newcastle Ottawa tool for observational studies. The primary variables of interest included incidence of hypoxia, hypotension, tachycardia, and bradycardia. Continuous data were summarized as odds ratio (OR) and 95%CI and pooled using generic inverse variance under the random-effects model. Heterogeneity between pooled studies was assessed using the I2 statistic.RESULTSInitial search of MEDLINE and EMBASE identified 357 citations. A search of meeting abstracts did not yield any relevant citations. After systematic review and exclusion consensus meetings, seven studies met the a priori determined inclusion criteria. The overall methodological quality of included studies ranged from moderate to low. No significant differences between OSA patients and controls were identified among any of the study variables: Incidence of hypoxia (7 studies, 3005 patients; OR = 1.11; 95%CI: 0.73-1.11; P = 0.47; I2 = 0%), incidence of hypotension (4 studies, 2125 patients; OR = 1.10; 95%CI: 0.75-1.60; P = 0.63; I2 = 0%), incidence of tachycardia (3 studies, 2030 patients; OR = 0.94; 95%CI: 0.53-1.65; P = 0.28; I2 = 21%), and incidence of bradycardia (3 studies, 2030 patients; OR = 0.88; 95%CI: 0.63-1.22; P = 0.59; I2 = 0%).CONCLUSIONOSA is not a significant risk factor for cardiopulmonary complications in patients undergoing endoscopic procedures with conscious sedation.

Safety of Gastrointestinal Endoscopy with Monitored Anesthesia Care in Patients with Obstructive Sleep Apnea

Introduction: Patients with obstructive sleep apnea (OSA) undergoing endoscopy with sedation are considered by practitioners to be at a higher risk for cardiopulmonary complications. The aim of the present study was to evaluate the safety of monitored anesthesia care (MAC) in patients with OSA undergoing gastrointestinal endoscopy. Methods: We performed a prospective single arm cohort study at the James A. Haley VA Hospital which was IRB-approved. All consecutive adult patients with OSA confirmed using polysomnography undergoing endoscopy with MAC were eligible for inclusion. Cardiopulmonary variables such as heart rate, level of blood oxygen saturation and blood pressure were recorded continuously throughout the endoscopic procedures. Additionally, anesthesia maneuvers such as the use of suction, head tilt, nasal trumpet, and laryngeal mask airway (LMA) were recorded. Other variables such as the use of CPAP, bronchodilators, robinol, and lidocaine either as vein analgesia or for arrhythmia were also recorded. Event rates were assessed using descriptive statistics. All analyses were performed using SPSS v22 statistical analysis software. Results: A total of 76 with confirmed moderate or severe OSA met the inclusion criteria. Heart rate remained stable in 96.1% (n=73/76), blood pressure remained stable in 100% (n=76/76), and O2 saturation remained stable in 96% (n=72/76) of patients. Changes in heart rate and O2 saturation were transitory and recovered spontaneously without any additional intervention. In our cohort suction was only needed in 21.1% (n=16/76), head tilt was performed in 28.9% (n=22/76), nasal trumpet was used in 7.9% (n=6/76), LMA was used in 1.3% (n=1/76), 97.4% (n=74/76) of the patients maintained a normal pCO2 and none required the use of CPAP. IV lidocaine was used in 68.4% (n=52/76) of patients for vein analgesia and none required IV lidocaine for arrhythmia control. Bronchodilators were used in 2.6% (n=2/76) and robinol was used in 14.5% (n=11/76) of patients to inhibit intestinal motility. None of the cases required advanced anesthesia care such as general endotracheal intubation nor was there a procedure aborted. Conclusion: Despite the presumed increased risk of cardiopulmonary complications, patients with OSA who undergo endoscopy with monitored anesthesia care have clinically insignificant variations in cardiopulmonary parameters as suggested by this prospective study. Additionally, the anesthesia-related interventions were clinically insignificant.

Safety of Gastrointestinal Endoscopy With Conscious Sedation in Patients With and Without Obstructive Sleep Apnea.

Patients with obstructive sleep apnea (OSA) undergoing endoscopy with sedation are considered by practitioners to be at a higher risk for cardiopulmonary complications. The aim of the present study was to evaluate the safety of conscious sedation in patients with OSA undergoing gastrointestinal endoscopy. This is an IRB-approved prospective cohort study performed at the James A. Haley VA. A total of 248 patients with confirmed moderate or severe OSA by polysomnography and 252 patients without OSA were enrolled. Cardiopulmonary variables such as heart rate, blood pressure, and level of blood oxygen saturation were recorded at 3-minute intervals throughout the endoscopic procedure. In total, 302 colonoscopies, 119 esophagogastroduodenoscopies, 6 flexible sigmoidoscopies, and 60 esophagogastroduodenoscopy/colonoscopies were performed. None of the patients in the study required endotracheal intubation, pharmacologic reversal, or experienced an adverse outcome as a result of changes in blood pressure, heart rate, or blood oxygen saturation. There were no significant differences in the rate of tachycardia (P=0.749), bradycardia (P=0.438), hypotension (systolic/diastolic, P=0.460; mean arterial pressure, P=0.571), or hypoxia (P=0.787) between groups. The average length of time spent in each procedure and the average dose of sedation administered also did not differ significantly between the groups. Despite the presumed increased risk of cardiopulmonary complications, patients with OSA who undergo endoscopy with conscious sedation have clinically insignificant variations in cardiopulmonary parameters that do not differ from those without OSA. Costly preventative measures in patients with OSA are not warranted.

The Safety of Gastrointestinal Endoscopy With Conscious Sedation in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

The Safety of Gastrointestinal Endoscopy With Conscious Sedation in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

Adverse events of upper GI endoscopy

Adverse events of upper GI endoscopy

Safety of gastrointestinal endoscopy during pregnancy

There are only few data of gastrointestinal endoscopy in pregnant patients. Only 0.4% of all procedures are carried out during pregnancy. Case reports and some small retrospective studies are available. Because of physiological changes in pregnancy there might be special risks of endoscopy. There might be complaints which can be physiologic during pregnancy, but can be signs of gastrointestinal disorders, too. Therefore, indications for endoscopy are not always clear and easy. Safety of the procedures is also not well studied. Besides the risks of endoscopy, medication given to the mother, electrocoagulation and radiation exposure from fluoroscopy during endoscopic retrograde cholangiopancreatography might be harmful to the fetus. Endoscopy should only be done when indication is unquestionable and strong. Only FDA "A" and "B" category medication is allowed. Gastroscopy is necessary for bleeding and for patients with pyrosis going together with alarm signs. Nausea, vomiting, abdominal pain and fecal occult blood test positivity are not indications for endoscopy, only for gastroenterogical consultation. Sigmoidoscopy is recommended for indication of lower gastrointestinal bleeding and sigmoid or rectal mass. Only therapeutic endoscopic retrograde cholangiopancreatography should be performed. Obstructive jaundice and biliary pancreatitis need immediate endoscopic intervention. The fetus must be shielded from radiation exposure.

Sa1615 Usefulness of Carbon Dioxide Insufflation in Percutaneous Endoscopic Gastrostomy Procedure

Since carbon dioxide (CO2) is rapidly absorbed by the gastrointestinal tract, CO2 insufflation is known to improve the comfort and safety of gastrointestinal endoscopy. However, its use in percutaneous endoscopic gastrostomy (PEG) procedure has not been reported. We investigated the usefulness of CO2 insufflation during the PEG procedure.

The indications, utilization and safety of gastrointestinal endoscopy in an extremely elderly patient cohort.

In developed nations, increasing proportions of the population now reach advanced age. Physicians may be reluctant to refer such patients for non-critical diagnostic and therapeutic interventions, on the basis of perceived diminution of tolerance, safety and substantive benefits in these patients. We aimed to review the utility and safety of gastrointestinal endoscopy in an extremely elderly cohort. The study involved 214 consecutive participants aged 85 years or more, between 1995 and 1997. They were identified using a prospective database linked to the endoscopy reporting system. Procedure type, indication, use of sedation, complications, and outcomes were evaluated. The median age was 87 (85-94, sigma = 2). The female:male ratio was 3:2; 185 had undergone one procedure and 29 two or more; and 65% of procedures were performed on an outpatient basis. Of the inpatient procedures, 10% of all procedures were performed emergently, predominantly for upper gastrointestinal hemorrhage. Midazolam was administered to 129 patients (60%), at a median dose of 2 mg (range 1-11); of these, 75 (35%) also received a median dose of 25 microg fentanyl (range 12.5-125). Colonoscopy (n = 95) was the most frequently performed procedure, followed by esophagogastroduodenoscopy (EGD) (n = 64) and endoscopic retrograde cholangiopancreatography (ERCP) (n = 21). There was no procedure-related mortality. The incidence of post-ERCP pancreatitis was 5%, colonic perforation 1%, and cardiopulmonary complications in sedated patients, 0.6%. The majority underwent procedures which related to active management of ongoing medical problems, and procedures were performed for palliative indications in only 15 (7%) patients. Gastrointestinal endoscopy is extremely safe and well tolerated in extremely elderly patients. Age alone should not influence decisions relating to its utilization.

THE SAFETY AND EFFICACY OF GASTROINTESTINAL ENDOSCOPY DURING PREGNANCY

More than 12,000 pregnant patients in the United States per year have conditions normally evaluated by esophagogastroduodenoscopy (EGD). More than 6000 pregnant patient in the United States per year have conditions normally evaluated by sigmoidoscopy or colonoscopy. Endoscopy during pregnancy raises the unique issue of fetal safety, and endoscopic medications comprise a significant component of fetal risks from endoscopy. This article analyzes the safety of endoscopic medications during pregnancy, reviews the literature on the safety of gastrointestinal endoscopy during pregnancy, proposes guidelines for endoscopic indications during pregnancy, and describes modifications of gastrointestinal endoscopy during pregnancy to increase fetal and maternal safety.

Safety of endoscopy in the immediate postoperative period following gastric anastomosis.

The safety of gastrointestinal endoscopy in the immediate postoperative period following partial gastrectomy was assessed in ten dogs. Endoscopy was performed preoperatively and at 1, 2, 3, and 7 days postoperatively. The mean pressures required to perform an adequate endoscopy varied from 17 to 20 mm Hg. Following partial gastrectomy, the abdominal wall was closed with a zipper to facilitate inspection of the gastric anastomosis. No leakage of air or intra-abdominal abscesses were seen following endoscopy. The results of this study suggest that endoscopy can be safely performed in the immediate postgastrectomy period.