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Analysis of 153 deaths after upper gastrointestinal endoscopy: room for improvement?
A M Thompson1, D J Wright, W Murray
1Department of Surgery and Molecular Oncology, University of Dundee, Dundee DD1 9SY, Scotland, UK. a.m.thompson@dundee.ac.uk
Background:
Upper gastrointestinal (GI) endoscopy is a widely used procedure that is generally considered to be safe.
Methods:
Of a total of 33,854 patients who underwent upper gastrointestinal endoscopy during 1999 under the care of surgeons in Scotland, 153 (0.004%) died. We reviewed the case notes of these 153 patients.
Results:
Death was directly related to endoscopy in 20 of 153 cases (13%), most commonly due to gastrointestinal perforation or acute pancreatitis. Ninety-one percent (139) of the patients undergoing endoscopy were American Society of Anesthesiologists grades (ASA) 3-5, and 88% received intravenous sedation; an anesthetist was present in 31 cases (20%). Oxygen was administered to 45% of patients during the endoscopy. In 56% of the procedures, there was monitoring of electrocardiograms (ECG), pulse oximetry, or blood pressure readings.
Conclusions:
Although deaths after endoscopy may be unavoidable, clinicians undertaking upper GI endoscopy or endoscopic retrograde cholangiopancreatography (ERCP) in ASA 3-5 patients should provide oxygen therapy and cardiovascular monitoring, and keep accurate records. The involvement of an anesthetist in airway management and the administration of intravenous sedation should be actively considered.
Insights
Deaths after upper gastrointestinal (GI) endoscopy are rare but can occur. For high-risk patients (ASA grades 3-5), enhanced monitoring and oxygen therapy during GI endoscopy are recommended.
Area of Science:
- Gastroenterology
- Anesthesiology
- Public Health
Background:
- Upper gastrointestinal (GI) endoscopy is a common and generally safe medical procedure.
- However, potential risks and mortality associated with endoscopy exist.
Purpose of the Study:
- To investigate the mortality rate and causes of death following upper GI endoscopy.
- To identify risk factors and recommend safety measures for high-risk patients undergoing endoscopy.
Main Methods:
- Retrospective review of 33,854 upper GI endoscopy cases performed by surgeons in Scotland in 1999.
- Analysis of case notes for 153 patients who died post-procedure.
Main Results:
- A mortality rate of 0.004% (153 deaths) was observed.
- Directly related deaths occurred in 13% of cases, primarily due to gastrointestinal perforation or pancreatitis.
- Most deceased patients were high-risk (ASA grades 3-5), with varying levels of sedation and monitoring.
Conclusions:
- While some deaths may be unavoidable, enhanced care is crucial for high-risk patients.
- Recommendations include oxygen therapy, cardiovascular monitoring, and consideration of anesthetist involvement for ASA 3-5 patients undergoing GI endoscopy or ERCP.
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