Complications of upper GI endoscopy

This is one of a series of statements discussing the utilization of gastrointestinal endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained front the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations. Upper GI endoscopy is a very commonly performed procedure used as a diagnostic tool to evaluate patients with a wide range of problems and complaints. Complications related to diagnostic evaluations are rare. Based on a 1974 survey conducted by the American Society for Gastrointestinal Endoscopy, it was estimated that the overall complication rate based on over 200,000 esophagogastroduodenoscopy (EGD) examinations was 0.13% and carried an associated mortality of 0.004%.(1) More current data for complication rates, specifically looking at diagnostic endoscopic examinations, are relatively understudied and prospective multicenter analyses have not been conducted in a systematic fashion. With the introduction of large multicenter databases, such as the CORI (Clinical Outcomes Research Initiative) project, better estimates of complications should be available in the future. However, although more accurate data may be obtained for immediate postprocedure complications, late complications may still be underestimated because of under-reporting. Rates of complications are critically dependent on the method of data collection (prospective/retrospective), definition of complication, and duration of follow-up. Major complications related to diagnostic procedures can be broken down into cardiopulmonary complications, complications related to sedation, infectious complications, perforation, and bleeding.