GuidelineAdverse events of upper GI endoscopy
Section snippets
Cardiopulmonary adverse events
Most UGI procedures in the United States and Europe are performed with patients under sedation (moderate or deep).12 Cardiopulmonary adverse events related to sedation and analgesia account for as much as 60% of UGI endoscopy adverse events.1, 2, 3, 4, 7 The rate of cardiopulmonary adverse events in large, national studies is between 1 in 170 and 1 in 10,000.1, 2, 3, 4, 6, 7 Reported adverse events range from minor incidents, such as changes in oxygen saturation or heart rate, to significant
Adverse events of UGI dilation
Data from randomized trials and large case series suggest that the overall rate of dilation adverse events is between 0.1% and 0.4%.1, 41, 42, 43, 44 The most common adverse events are perforation, hemorrhage, aspiration, and bacteremia. Most dilation-related bleeding is self-limited, but rare episodes of bleeding requiring endoscopic hemostasis and dissection into major blood vessels have been reported.45, 46 Patients with significant obstruction of the UGI tract may be at risk of aspiration
Endoscopic management of adverse events of endoluminal therapy
Many of the adverse events associated with endoluminal therapy can be treated endoscopically. Bleeding can be controlled with injection hemostasis, APC, hemostatic graspers, or endoscopic clips.147, 148, 241 The risk of delayed bleeding after EMR may be reduced by prophylactic closure of mucosal defects with endoscopic clips.142, 242 High-dose proton pump inhibitor therapy improves ulcer healing rates and reduces the risk of delayed bleeding after ESD.148
Perforation caused by EMR or ESD may be
Adverse events of small-bowel enteroscopy
Deep enteroscopy using techniques such as double-balloon enteroscopy (DBE), single-balloon enteroscopy, or spiral enteroscopy have the potential for unique adverse events. Most data stem from DBE studies. A recent meta-analysis found major adverse events in 0.7% of 9047 DBE procedures, including perforation (n = 20), pancreatitis (n = 17), aspiration pneumonia (n = 8), bleeding (n = 6), and 1 death.245 Minor adverse events were reported in 9.1% of 2017 procedures. The adverse event rate is
Conclusions
Adverse events are inherent in the performance of UGI endoscopic procedures. Because endoscopy assumes a more therapeutic role in the management of GI disorders, the potential for adverse events will likely increase. Knowledge of potential endoscopic adverse events, their expected frequency, and the risk factors for their occurrence may help to minimize the incidence of adverse events. Endoscopists are expected to carefully select patients for the appropriate intervention, be familiar with the
Disclosure
All authors disclosed no financial relationships relevant to this publication.
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This document is a product of the ASGE Standards of Practice Committee. This document was reviewed and approved by the Governing Board of the ASGE.