Tag: endoscopy

Diagnostic gastrointestinal endoscopy was associated with an excess of unexpected events requiring primary care consultation or emergency hospitalization, according to research in Alimentary Pharmacology & Therapeutics.

“There is reported to be inappropriate overuse of gastroscopy worldwide which is worryingly increasing over time. While the majority of endoscopy is perceived as safe, more than 10% of procedures are performed in those over 80 years of age, who have increasing levels of frailty and complex comorbidity, which may predispose them to adverse events,” Colin J Crooks, PhD, clinical associate professor at the University of Nottingham, and colleagues wrote. “The data reported to date, therefore, do not allow us with any confidence to describe to our patients the overall risk of a routine day-case gastroscopy.”

In a cohort study, Crooks and colleagues sought to determine the excess risk for acute medical events among 225,304 patients who underwent 277,535 diagnostic day-case gastroscopies in the United Kingdom. They further frequency-matched 1,383,535 30-day periods without gastroscopy within 991,249 patients by year, gender and decade of birth. Recorded outcomes included non-cancer deaths, emergency non-cancer admissions and cardiovascular or respiratory (CVR) primary care consultations.

According to study results, 5.1% of day-case diagnostic gastroscopies were followed by emergency hospital admissions within 30 days, of which 1.4% were unrelated to a GI or cancer diagnosis and 0.4% had a CVR diagnoses. Compared with controls, there was a 0.1% excess of CVR-related admissions, which reduced to 0.05% (95% CI, 0.04-0.06) among patients younger than 40 years and increased to 1.1% (95% CI, 0.6-1.6) among patients older than 90 years with high comorbidities.

Further, 3.8% of gastroscopies were followed by a primary care consultation for a CVR event within 30 days, with excess risk increasing from 0.13% in 40-year-old patients with no comorbidities to 0.31% in patients aged 90 years. The 30-day risk for emergency hospital admission increased 30-fold with age from 0.03% to 0.9% for those with no comorbidities to 0.1% to 2.7% in those with high comorbidities.

“We have shown that one in 245 day-case diagnostic gastroscopies were followed by an unexpected medically attended cardio, vascular or respiratory event resulting in either primary care consultation or emergency admission to hospital,” Crooks and colleagues concluded. “However, this risk varies in magnitude and consequence depending on age and morbidity of the patient undergoing the gastroscopy. It is important for clinicians to weigh up these risks against the expected benefits of a diagnostic gastroscopy when planning to do this test and in consenting their patients.”