WHAT ARE THE RISKS WITH ENDOSCOPY?
What is an Endoscope?
Endoscope is essentially a flexible hose with a camera connected to a television so that a doctor can look at what is wrong inside your body without having to cut you open or perform surgery.
The modern endoscope is a technological marvel that can be used to perform anything from diagnostics, procedures and even ultrasound in the hands of a competent doctor. You can watch this video to learn more.
There is more than 1 type of Endoscope right?
Yes. It is usually named based on where we like to put it.
- Nasal – for your nose and upper airways
- Gastroscope/OGDS – for your stomach
- Colonoscope – for your colon
- Enteroscope – for your small bowels
- Duodenoscope/ERCP – for your liver and pancreas
- EUS – to perform ultrasound on your liver and pancreas
- Bronchoscope – for your lungs
- Pleuroscope – for the lining outside your lungs
- EBUS – to perform ultrasound on your lungs
- Cystoscope – for your bladder
However most of these functions are performed by the same device. For example the Ultra Thin Endoscope might be used for nasal endoscopy, gastroscopy, bronchoscopy, pleuroscopy and cystoscopy depending on the availability.
The doctor usually selects the appropriate scope depending on the procedure intended. It is common for the doctor to use different endoscopes from different manufacturers to perform a procedure. The most important measure for you, the patient, is the succesful outcome of the procedure.
What is Endoscopy?
The act of inserting the endoscope into the patient.
What are the risks of Endoscopy?
You are going to hear these lines:
- Sedation related
- Bleeding
- Infection
- Perforation requiring surgery.
In reality, Endoscopy is generally very safe and in my experience rarely has any complications when undertaken safely. Yes, it is difficult to predict outcomes in emergencies as anything can, might and will happen.
| Risk | Precautions & Risk Reductions |
| Sedation Related | |
| The largest study undertaken to date indicated that major complications occurred in 0.01% and minor complications in 0.3% of patients with sedation.1 This is the most common complication encountered by an Endoscopist. In most cases, a patient’s oxygen levels or blood pressure drops during the procedure due to the medications administered during sedation. Rarely patients have died. | We reduce the risk by continuous monitoring of Heart Rate, Blood Pressure and Oxygen Levels during the procedure. We also give oxygen via a nasal cannula to your nose during the procedure. Should you unfortunately drop your oxygen levels or blood pressure, then we will give medications to reverse the effects of the sedation. In the worst case scenario, we might stop the procedure. |
| Bleeding | |
| The risk of bleeding is generally <1% 2–4 This risk increases up to 6% after a removal of polyp.5 | We generally reduce the risk by injecting adrenaline to the base of the polyp removing it using cautery. We also prevent delayed bleeding by applying clip or cautery to the base of the polyp to prevent delayed bleeding. |
| Infection | |
| The risk of Endoscope Associated Infection (EAI) is around 0.2%.6 Generally speaking the risks are higher with Duodenoscope which are used in ERCP due to the bridge mechanisms. Hepatitis B, C and HIV transmission are generally extremely low to non-existent due to modern reprocessing protocols.7 | All Endoscopes are cleaned and disinfected following the manufacturers protocols which often follows Internationally recognised standards. |
| Perforation | |
| Perforation or a tear to the wall of your stomach, duodenum, small bowels and colon are generally small at <1%.8 This can happen up to 2 weeks later after removal of polyps, we call it delayed perforation. | Generally I prevent complications by employing a technique called Endoscopic Mucosal Resection (EMR) where we inject adrenaline to the base of polyp before removal. I also reduce risk of delayed perforation by using clips after removal of polyps to prevent delayed perforation. |
| Surgery | |
| Surgery might be required if you develop perforation. | I make endoscopy safer by using Carbon Dioxide gas during endoscopy which prevents discomfort and increases safety in a perforation. Most small perforation can be closed using clips and managed conservatively using antibiotics. |
Emergency Endoscopy
Emergency endoscopy might occasionally require a patient to be intubated by the anaesthetist in order to protect their ability to breathe, this is usually done in bleeding patients who are vomiting blood to prevent the blood from entering the lungs. The patient might have their endoscopy done bedside at the Intensive Care Unit (ICU) or the Operation Theatre (OT) in a more controlled environment as compared to the regular Endoscopy Unit.
REFERENCE
1. David J. Bjorkman MD. Complications of Sedation for Endoscopy. NEJM J Watch. 2018;2018. doi:10.1056/nejm-jw.NA45926
2. Fisher DA, Maple JT, Ben-Menachem T, et al. Complications of colonoscopy. Gastrointest Endosc. 2011;74(4):745-752. doi:10.1016/j.gie.2011.07.025
3. Palmer KR. Complications of gastrointestinal endoscopy. Gut. 2007;56(4):456-457. doi:10.1136/gut.2006.105577
4. Waddingham W, Kamran U, Kumar B, Trudgill NJ, Tsiamoulos ZP, Banks M. Complications of diagnostic upper Gastrointestinal endoscopy: common and rare – recognition, assessment and management. BMJ Open Gastroenterol. 2022;9(1):e000688. doi:10.1136/bmjgast-2021-000688
5. Kwon MJ, Kim YS, Bae SI, et al. Risk Factors for Delayed Post-Polypectomy Bleeding. Intest Res. 2015;13(2):160-165. doi:10.5217/ir.2015.13.2.160
6. Deb A, Perisetti A, Goyal H, et al. Gastrointestinal Endoscopy-Associated Infections: Update on an Emerging Issue. Dig Dis Sci. 2022;67(5):1718-1732. doi:10.1007/s10620-022-07441-8
7. Kovaleva J, Peters FTM, van der Mei HC, Degener JE. Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy. Clin Microbiol Rev. 2013;26(2):231-254. doi:10.1128/CMR.00085-12
8. (PDF) Colonoscopy-related complications in a nationwide immunochemical fecal occult blood test-based colorectal cancer screening program. Accessed January 9, 2025. https://www.researchgate.net/publication/328904320_Colonoscopy-related_complications_in_a_nationwide_immunochemical_fecal_occult_blood_test-based_colorectal_cancer_screening_program
