The risk for complications with EGD and colonoscopy are underestimated but can be minimized by adhering to surgical principles, using meticulous techniques and by optimizing the patient selection process for these procedures.
That is the view of Dr Anca Pop, board-certified gastroenterologist speaking in a recent AllMed webinar aimed at risk management professionals.
Both EGD (upper endoscopy) and colonoscopy carry the risk of cardiopulmonary complications that range from minor fluctuations in oxygen saturation or heart rate, to significant complications such as respiratory arrest, cardiac arrhythmias, myocardial infarction, stroke, and shock.
Although rare, these complications can be life-threatening, which is an area of concern for hospital quality and risk management professionals. During the webinar, Dr Pop discussed how hospitals can monitor physician performance and minimize risk associated with these common gastroenterology procedures.
“About one complication occurs for every 1,000 EGD procedures, and the overall serious adverse event rate is about 2.9 per 1,000 colonoscopy procedures,” said Dr Pop.
She added that the risk of some complications may be higher with colonoscopy if it is performed for an indication other than screening. Absolute contraindications for colonoscopy include a competent patient who is unwilling to give consent, an uncooperative patient who has given consent but in whom adequate sedation cannot be achieved, toxic megacolon, fulminant colitis, and known free colonic perforation.
Dr. Pop noted that the use of anesthesia services for colonoscopy and EGD has doubled in recent years and that this trend is projected to continue.
Quality indicators for EGD and colonoscopy include proper indication, informed consent, and risk stratification. In addition to affecting reimbursement, incomplete documentation can also affect patient outcomes and may increase risk of liability and malpractice claims. Complications arising from procedures and unplanned operations and admissions are important factors to review in order to assess patient outcomes. However, it is important to consider the nature and extent of the surgery being performed.
In reviewing these cases, hospitals not only need to consider the evolving medical evidence, but also must take into account any conflicts of interest involving friendships and/or competition among the members of the medical staff. External peer review facilitates the objective review of sensitive cases and allows for hospitals and physicians to honor their commitment to safe, timely, appropriate, and compliant care for every patient.
Colonoscopy, EGD, surgical, colonoscopy, risk
