From the Guidelines
Upper GI endoscopy complications are rare but can be serious, with a risk of 1-in-1000 to 1-in-10 000 for complications such as perforation, cardiovascular events, or death 1.
Common Complications
- Perforation: a rare but life-threatening complication, occurring in less than 0.1% of cases, often requiring surgical intervention 1.
- Aspiration pneumonia: a rare but real risk, especially in patients receiving sedation with medications like midazolam 2-5mg IV or fentanyl 50-100mcg IV, and should be monitored closely during and after the procedure 1.
- Respiratory failure: a rare but real risk, especially in patients receiving sedation with medications like midazolam 2-5mg IV or fentanyl 50-100mcg IV, and should be monitored closely during and after the procedure 1.
- Hypotension: a rare but real risk, especially in patients receiving sedation with medications like midazolam 2-5mg IV or fentanyl 50-100mcg IV, and should be monitored closely during and after the procedure 1.
- Dysrhythmia: a rare but real risk, especially in patients receiving sedation with medications like midazolam 2-5mg IV or fentanyl 50-100mcg IV, and should be monitored closely during and after the procedure 1.
Prevention of Complications
To minimize risks, patients should be carefully selected and prepared for the procedure, and informed consent outlining the risks, benefits, alternatives, and potential complications associated with the procedure should be obtained and documented 2. Patients with certain heart conditions may require antibiotic prophylaxis, such as amoxicillin 2g orally 1 hour before the procedure, and should be monitored closely during and after the procedure 3. Supplemental oxygen administration has been shown to reduce the magnitude of oxygen desaturation during endoscopic procedures performed under sedation and should be considered mandatory, especially in patients with impaired pulmonary function or significant pre-sedation oxygen desaturation and patients in whom a prolonged or complex procedure is anticipated 3. Continuous electrocardiographic (ECG) monitoring is reasonable in high-risk patients, although improved outcomes with such monitoring have not been shown conclusively in controlled trials 3. Care must be taken to avoid suppression of the hypoxic ventilatory drive, which can lead to profound hypercapnoea 3.
From the Research
Complications of Upper Gastrointestinal (GI) Endoscopy
The complications of Upper GI endoscopy are rare, but can be serious. Some of the common complications include:
- Perforation: This is one of the most common complications of Upper GI endoscopy, although it is still relatively rare, with a frequency of less than 1/1,000 per year 4.
- Bleeding: This is another major complication of Upper GI endoscopy, and can be caused by factors such as polypectomy or other procedures performed during the endoscopy 5.
- Cardiopulmonary events: These are the most common complications of Upper GI endoscopy, and can include events such as heart attack or stroke 6.
- Infection: There is a risk of infectious disease transmission during endoscopy, both to and from the patient 7.
- Pancreatitis: This is a unique complication associated with upper enteroscopy, and can occur in up to 1% of cases 5.
Risk Factors for Complications
Certain factors can increase the risk of complications during Upper GI endoscopy, including:
- Advanced age: Older patients are at higher risk for complications, particularly cardiopulmonary events 4, 6.
- Chronic obstructive pulmonary disease (COPD): Patients with COPD are at higher risk for cardiopulmonary complications 6.
- Coronary heart disease: Patients with coronary heart disease are at higher risk for cardiopulmonary complications 6.
- Valvular heart disease: Patients with valvular heart disease are at higher risk for infectious complications, and may require antibiotic prophylaxis 6.
- Sedation: The use of sedation during endoscopy can increase the risk of complications, particularly cardiopulmonary events 6, 7.