[7] Williams EJ, Taylor S, Fairclough P, et al; BSG Audit of ERCP. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. Gut. 2007; 56(6):821–829
[8] Valori R, Morris E, Rutter MD. Rates of Post Colonoscopy Colorectal Cancer (PCCRC) Are Significantly Affected by Methodology, but Are Nevertheless Declining in the NHS. UEG Week; 2014; Vienna
[9] Pabby A, Schoen RE, Weissfeld JL, et al. Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. Gastrointest Endosc. 2005; 61(3):385–391
[10] Robertson DJ, Lieberman DA, Winawer SJ, et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut. 2014; 63(6):949–956
[11] Barclay RL, Vicari JJ, Doughty AS. et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006; 355(24):2533–2541
[12] Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol. 2007; 102(4):856–861
[13] Pohl H, Srivastava A, Bensen SP, et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology. 2013; 144(1):74–80.e1
[14] Raftopoulos SC, Segarajasingam DS, Burke V. et al A cohort study of missed and new cancers after esophagogastroduodenoscopy. Am J Gastroenterol. 2010; 105(6):1292–1297
[15] Cohen J, Safdi MA, Deal SE, et al; ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for esophagogastroduodenoscopy. Am J Gastroenterol. 2006; 101(4):886–891
[16] Faigel DO, Pike IM, Baron TH, et al; ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for gastrointestinal endoscopic procedures: an introduction. Am J Gastroenterol. 2006; 101(4):866–872
[17] Park WG, Cohen J. Quality measurement and improvement in upper endoscopy. Tech Gastrointest Endosc. 2012; 14(1):13–20
[18] Gavin DR, Valori RM, Anderson JT. et al. The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut. 2013; 62(2):242–249
[19] Enochsson L, Swahn F, Arnelo U. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastrointest Endosc. 2010; 72(6):1175–1184, 1184.e1–1184.e3
[20] Baron TH, Petersen BT, Mergener K, et al; ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for endoscopic retrograde cholangiopancreatography. Am J Gastroenterol. 2006; 101(4):892–897
[21] Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009; 70(1):80–88
[22] Yalamarthi S, Witherspoon P, McCole D, Auld CD. Missed diagnoses in patients with upper gastrointestinal cancers. Endoscopy. 2004; 36(10):874–879
[23] Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014; 370(14):1298–1306
[24] Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010; 362(19):1795–1803
[25] Haynes AB, Weiser TG, Berry WR, et al; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009; 360(5):491–499
[26] de Vries EN, Prins HA, Crolla RM, et al; SURPASS Collaborative Group. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med. 2010; 363(20):1928–1937
[27] Rutter MD, Senore C, Bisschops R, et al. The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures. Endoscopy. 2016; 48(1):81–89
[28] Calderwood AH, Jacobson BC. Colonoscopy quality: metrics and implementation. Gastroenterol Clin North Am. 2013; 42(3):599–618
[29] Thomas-Gibson S, Barton JR, Green J, et al. Mentoring and Quality Assurance of Screening Endoscopists within the NHS Bowel Cancer Screening Programme. NHS BCSP Publication; 2013
[30] Barclay RL, Vicari JJ, Greenlaw RL. Effect of a time-dependent colonoscopic withdrawal protocol on adenoma detection during screening colonoscopy. Clin Gastroenterol Hepatol. 2008; 6(10):1091–1098
[31] Lin OS, Kozarek RA, Arai A, et al. The effect of periodic monitoring and feedback on screening colonoscopy withdrawal times, polyp detection rates, and patient satisfaction scores. Gastrointest Endosc. 2010; 71(7):1253–1259
[32] Sawhney MS, Cury MS, Neeman N, et al. Effect of institution-wide policy of colonoscopy withdrawal time> or =7 minutes on polyp detection. Gastroenterology. 2008; 135(6):1892–1898
[33] Matharoo M, Thomas-Gibson S, Haycock A, Sevdalis N. Implementation of an endoscopy safety checklist. Frontline Gastroenterol. 2014; 5(4):260–265
[34] Adler DG, Lieb JG, II, Cohen J, et al. Quality indicators for ERCP. Gastrointest Endosc. 2015; 81(1):54–66
[35] Blanks RG, Nickerson C, Patnick J. et al. Evaluation of colonoscopy performance based on post-procedure bleeding complications: application of procedure complexity-adjusted model. Endoscopy. 2015; 47(10):910–916
10 Endoscopic Complications
Daniel Blero and Jacques Devière
10.1 Introduction
An endoscopic complication can be defined as an adverse event that requires a deviation from the initial plan for diagnosis and/or treatment, and this adverse event can be qualified as severe when it prolongs hospitalization and/or results in an unscheduled hospital admission.1 The frequency of endoscopic complications is likely to increase in proportion to the indications and complexity of therapeutic procedures. The best way to prevent complication is to carefully analyze procedural indications and avoid unnecessary invasive examinations. Gastrointestinal (GI) endoscopy is a discipline evolving quickly within a multidisciplinary environment with paradigm changes such as the development of alternative, noninvasive diagnostic techniques, for example, magnetic resonance cholangiopancreatography (MRCP), which has entirely replaced diagnostic endoscopic retrograde cholangiopancreatography (ERCP) for imaging the biliopancreatic tract. With an increasing complexity of endoscopic procedures, the need for extensive knowledge of techniques and accessories has become paramount, and it is now clear that many of these procedures must be concentrated in specialized referral centers. Acquiring and maintaining experience in a multidisciplinary environment is essential to select the best procedure for a specific indication and to consequently reduce the risk of adverse events. Now that therapeutic endoscopy offers even more alternatives to open surgery, it is also important to disseminate information about the outcomes of these procedures in order to avoid inappropriate therapeutic approaches to manage known or suspected complications. For example, postprocedural management following submucosal and transmural endotherapy may result in imaging findings of incidental free air that may be inappropriately managed with aggressive surgery.2
Preprocedural patient education and informed consent (see Chapter 3) are paramount. Standardization of treatment, organization of the therapeutic endoscopy team and its training, and adherence to guidelines are also essential in order to minimize, prevent, and adequately manage adverse events. The most frequent complications of diagnostic and therapeutic endoscopy are reviewed in this chapter. Different modalities of medical, endoscopic, and surgical management are also considered.