Unrelated Disease Progression Is Major Cause of Short-Term Death After GI Endoscopy

Progression of underlying malignancies unrelated to a gastrointestinal (GI) endoscopy is the leading cause of death in the 30 days after the procedure, according to study results published in BMJ Open Gastroenterology.

For the analysis, researchers conducted a retrospective monocentric study in a tertiary care hospital. Researchers reviewed all esophagogastroduodenoscopies (EGD), colonoscopies, percutaneous endoscopic gastrostomies (PEG), endoscopic retrograde cholangiopancreatographies (ERCP), and endoscopic ultrasounds (EUS) conducted from January 1, 2017, to December 31, 2019, based on electronic health records.

A total of 18,233 procedures were conducted, and 251 patients died within 30 days after 345 (1.89%) endoscopies. The study participants had a median age of 70 (IQR, 61-79) years, and 68.92% were men. A majority had 1 procedure (74.10%), and 18 patients had at least 3 procedures (7.17%). The median Charlson Comorbidity Index score was 5 (IQR, 3-7), and 218 participants (86.85%) had an ASA score of at least 3.

EGD was the most frequently performed procedure (70.72%), followed by colonoscopies (15.36%), EUS (6.67%), ERCP (5.51%), and PEG (1.74%).

Among inpatients, 39.42% were hospitalized to have the endoscopy — 32.75% were in an urgent setting and 6.67% were on an elective basis. Patients were hospitalized in intensive care units in most cases (21.74%).

Suspected GI bleeding (46.67%) was the leading indication and purpose of 136/244 EGD (55.74%) and 25/53 colonoscopies (47.16%). The most common diagnoses of EGD for suspicion of GI bleeding were peptic ulcer (13.93%), variceal bleeding (8.61%), and portal hypertensive gastropathy (2.46%).

A total of 50 examinations (14.49%), which included 28 EGD (11.47%), 13 colonoscopies (24.53%), 2 EUS (28.57%), and 7 EUS with fine-needle aspiration (FNA) (41.17%), were conducted for tumorous investigation or staging. Among the 251 participants who died, GI malignancy progression was the primary cause of death (17.93%), followed by GI bleeding (10.4%), and liver failure (7.9%).

Regarding the total number of procedures, the 30-day mortality rate was the greatest in patients who had a PEG (3.05%), followed by EGD (2.66%), ERCP (2.63%), EUS with FNA (1.98%), EUS (0.96%), and colonoscopy (0.91%).

Study limitations include the retrospective data collection and lack of a control group. Also, the sample size was small for certain procedures, and the data are from a tertiary transplant hospital.

“Following various improvements in anesthesia and monitoring in the last decade, we should focus our attention on oncological patients and define who can benefit from endoscopies in this era of new chemotherapies and immunotherapies,” the study authors noted. “All conditions that put patients at high anesthetic risk should be reviewed by the gastroenterologist and, if in doubt, an anesthesiologist should be sought to evaluate the need of an anesthesiologist for the procedure. Gastroenterologists must discuss with physicians of other specialties, patients and families about the risk and benefit profiles, which are very heterogeneous due to different settings and indications.”