Abstract

Background and aims: Complications of endoscopy are usually under-reported. They are usually held hidden but carry a significant morbidity and sometimes mortality to the patients. Luminal perforation, bleeding and post ERCP pancreatitis are the dreaded complications of endoscopic procedures. Data on these complications is lacking from centers in developing countries. In this study, we looked at the incidence, etiology, outcome and implications of these major complications in a high-volume tertiary care teaching hospital in northern India and their context with developed countries.
Methods: A retrospective analysis of a prospectively maintained database of all endoscopic procedures done in our center from March 2000 to March 2008.
Results: Of 41,979 procedures during the period, perforations occurred in 40 cases (0.095%): 0.010% during diagnostic upper GI endoscopies, 0.014% during endoscopic injection sclerotherapy (EST), 0.12% during diagnostic colonoscopies, 0.66% during stricture dilatations, 2.16% during achalasia dilatations, and 0.48% during other miscell neous procedures. Among 2479 ERCPs, (90% therapeutic) perforation occurred in 0.52% and clinically significant bleeding in 1.01% of the cases. All perforations in diagnostic endoscopy (n=5) occurred in elderly individuals with significant co- morbidities. Perforations, which occurred during management of esophageal varices, were with sclerotherapy and not with EVL. In achalasia dilatation, 4 of 5 perforations occurred in patients who underwent repeat procedures with larger sized balloons after a failed initial dilatation. Management of perforations was by surgery in 60% of the cases. Injection therapy sufficed to control post EPT bleed in 64%, but mortality occurred in 2 cases. Post ERCP pancreatitis occurred in 3.7% (n=91), with 0.32% (n=8) having severe pancreatitis.
Conclusion: The incidence of major post endoscopy complications in a tertiary care teaching hospital in a developing country like India is well comparable to that of all major centers in the developed world. Unexpected complications lead to significant economic and social consequences as most patients are not covered by medical insurances and find itdifficult to bear the additional cost of managing complications.

Keywords

Endoscopy