Upper gastrointestinal endoscopy is a widely used procedure. It is generally thought to be safe.
In this study, investigators from Scotland evaluated 33,854 patients who underwent upper gastrointestinal endoscopy in 1999.
Of these patients, 153 (0.004%) died.
The investigators reviewed the case notes of these 153 patients.
|Death was directly related to endoscopy in 13% of cases.|
The team found that death was directly related to endoscopy in 13% of the cases. This tended to be due to gastrointestinal perforation or acute pancreatitis.
The team determined that 91% of deaths occurred in patients who were American Society of Anesthesiologists grades (ASA) 3 to 5.
They found that 88% of cases received intravenous sedation. An anesthetist was present in 20% of cases.
In addition, oxygen was administered to 45% of patients during the endoscopy.
The team also found that there was monitoring of electrocardiograms (ECG), pulse oximetry, or blood pressure readings in 56% of cases.
Dr Thompson's team concluded, "Although deaths after endoscopy may be unavoidable, clinicians undertaking upper GI endoscopy or ERCP in ASA 3 to 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".