Variables Associated with Complications from Gastrointestinal Endoscopic Procedures

Purpose: Gastrointestinal (GI) endoscopy is a common and usually low risk procedure. Although rare, complications can be serious, which include complications as a result of instrumentation, cardiopulmonary and neurological. Guidelines from the American Society of Gastrointestinal Endoscopy (ASGE) suggest that patients who are elderly, who have concomitant medical problems, patients who are taking sedatives, opiates, and anxiolytics may be at increased risk. Aim: To identify variables associated with increased risk for complications from gastrointestinal endoscopic procedures and to establish the magnitude of risk. Methods: We conducted a case-control study from 17289 GI endoscopic procedures comparing 41 cases with complications to 115 controls. We looked at the confidence intervals and odds ratios. Cases and controls were matched by age (± 5 years) and gender. Comorbid conditions, medications, type and duration of the procedure and demographics were obtained from each of the patient's records. A univariate comparison was done initially using Chi-square test and we checked for interactions between variables with likelihood ratio test. Backward, stepwise, logistic regression analysis was done to control for confounding variables. Results: Logistic regression analysis yielded significant associations. Comorbid states related to complications included coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD) combined (OR 21, p= 0.003) and Renal disease (OR 12, p= 0.006). Procedure time (OR 1.1, p= 0.023) by minute showed increased risk, while pre-procedure sedative use (OR 0.007 p= 0.021) had a negative association. The following procedures were associated with low risk: EGD (OR 0.001, p= 0.011), colonoscopy (OR 0.002, p= 0.015) and others like flexible sigmoidoscopy and percutaneous gastostomy tube placement (OR0.001, p= 0.029). Conclusions: CAD and COPD combined in a patient, and renal disease with serum creatinine >2.0 conveyed significant risk for complications during GI endoscopic procedures. Duration of procedure had a direct relation to the occurrence of complications. EGD and colonoscopy along with other procedures are considered to have low risk for complications. Surprisingly, patients who take sedatives as outpatient are at low risk. This might be secondary to their tolerance to the sedation during the procedure. Obesity did not appear to have any significance.