Techniques in Gastrointestinal Endoscopy
Volume 9, Issue 2 , Pages 90-103 , April 2007

Complications of Therapeutic Endoscopy: A Review of the Incidence, Risk Factors, Prevention, and Endoscopic Management

  • Daniel A. Ringold, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Daniel A. Ringold, MD, Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Mail Stop 8124, St. Louis, MO 63110.
  • ,
  • Sreenivasa Jonnalagadda, MD

References 

  1. Cappell MS, Abdullah M. Management of gastrointestinal bleeding induced by gastrointestinal endoscopy. Gastroenterol Clin North Am. 2000;29:125–167
  2. Gilbert DA. Epidemiology of upper gastrointestinal bleeding. Gastrointest Endosc. 1990;36:8–13
  3. Lee JG, Lieberman DA. Complications related to endoscopic hemostasis techniques. Gastrointest Endosc Clin North Am. 1996;6:305–321
  4. Therapeutic endoscopy and bleeding ulcers. Natl Inst Health Consens Dev Conf Consens Statement. 1989;7:1–7
  5. Consensus Development Panel. Consensus statement on therapeutic endoscopy and bleeding ulcers. Gastrointest Endosc. 1990;36(suppl):62–65
  6. Sacks HS, Chalmers TC, Blum AL, et al. Endoscopic hemostasis (An effective therapy for bleeding peptic ulcers). J Am Med Assoc. 1990;264:494–499
  7. Cook DJ, Guyatt GH, Salena BJ, et al. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology. 1992;102:139–148
  8. Lai KC, Swain CP. The size of vessels in patients dying from bleeding gastric ulcer. Gastroenterology. 1993;104:A202
  9. Randall GM, Jensen DM, Hirabayashi K, et al. Controlled study of different sclerosing agents for coagulation of canine gut arteries. Gastroenterology. 1989;96:1274–1281
  10. Swain CP, Mills TN, Shemesh E, et al. Which electrode? (A comparison of four endoscopic methods of electrocoagulation in experimental bleeding ulcers). Gut. 1984;25:1424–1431
  11. Johnston JH, Jensen DM, Mautner W. Comparison of endoscopic electrocoagulation and laser photocoagulation of bleeding canine gastric ulcers. Gastroenterology. 1982;82:904–910
  12. Johnston JH, Jensen DM, Auth D. Experimental comparison of endoscopic yttrium-aluminum-garnet laser, electrosurgery, and heater probe for canine gut arterial coagulation (Importance of compression and avoidance of erosion). Gastroenterology. 1987;92:1101–1108
  13. Hepworth CC, Kadirkamanathan SS, Gong F, et al. A randomised controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels. Gut. 1998;42:462–469
  14. Golder S, Strotzer M, Grune S, et al. Combination of colonoscopy and clip application with angiography to mark vascular malformation in the small intestine. Endoscopy. 2003;35:378
  15. Sone Y, Nakano S, Takeda I, et al. Massive hemorrhage from a Dieulafoy lesion in the cecum: successful endoscopic management. Gastrointest Endosc. 2000;51:510–512
  16. Nelson DB, McQuaid KR, Bond JH, et al. Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc. 2002;55:307–314
  17. Dobrowolski S, Dobosz M, Babicki A, et al. Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2006;63:1004–1009
  18. Polkowski M, Regula J, Wronska E, et al. Endoscopic ultrasonography for prediction of postpolypectomy bleeding in patients with large nonpedunculated rectosigmoid adenomas. Endoscopy. 2003;35:343–347
  19. Kim HS, Kim TI, Kim WH, et al. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am J Gastroenterol. 2006;101:1333–1341
  20. Hui AJ, Wong RM, Ching JY, et al. Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc. 2004;59:44–48
  21. Eisen GM, Baron TH, Dominitz JA, et al. Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures. Gastrointest Endosc. 2002;55:775–779
  22. Zuckerman MJ, Hirota WK, Adler DG, et al. ASGE guideline: the management of low-molecular-weight heparin and nonaspirin antiplatelet agents for endoscopic procedures. Gastrointest Endosc. 2005;61:189–194
  23. Tappero G, Gaia E, De Giuli P, et al. Cold snare excision of small colorectal polyps. Gastrointest Endosc. 1992;38:310–313
  24. Quigley EM, Donovan JP, Linder J, et al. Delayed, massive hemorrhage following electrocoagulating biopsy (“hot biopsy”) of a diminutive colonic polyp. Gastrointest Endosc. 1989;35:559–563
  25. Dyer WS, Quigley EM, Noel SM, et al. Major colonic hemorrhage following electrocoagulating (hot) biopsy of diminutive colonic polyps: relationship to colonic location and low-dose aspirin therapy. Gastrointest Endosc. 1991;37:361–364
  26. Wadas DD, Sanowski RA. Complications of the hot biopsy forceps technique. Gastrointest Endosc. 1988;34:32–37
  27. Gilbert DA, DiMarino AJ, Jensen DM, et al. American Society for Gastrointestinal Endoscopy Technology Assessment Committee Status evaluation: hot biopsy forceps. Gastrointest Endosc. 1992;38:753–756
  28. Mann NS, Mann SK, Alam I. The safety of hot biopsy forceps in the removal of small colonic polyps. Digestion. 1999;60:74–76
  29. Shirai M, Nakamura T, Matsuura A, et al. Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine solution. Am J Gastroenterol. 1994;89:334–338
  30. Macrae FA, Tan KG, Williams CB. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut. 1983;24:376–383
  31. Waye JD. Management of complications of colonoscopic polypectomy. Gastroenterologist. 1993;1:158–164
  32. Van Gossum A, Cozzoli A, Adler M, et al. Colonoscopic snare polypectomy: analysis of 1485 resections comparing two types of current. Gastrointest Endosc. 1992;38:472–475
  33. Parra-Blanco A, Kaminaga N, Kojima T, et al. Colonoscopic polypectomy with cutting current: is it safe. Gastrointest Endosc. 2000;51:676–681
  34. Dobrowolski S, Dobosz M, Babicki A, et al. Prophylactic submucosal saline-adrenaline injection in colonoscopic polypectomy: prospective randomized study. Surg Endosc. 2004;18:990–993
  35. Hsieh YH, Lin HJ, Tseng GY, et al. Is submucosal epinephrine injection necessary before polypectomy? (A prospective, comparative study). Hepatogastroenterology. 2001;48:1379–1382
  36. Shioji K, Suzuki Y, Kobayashi M, et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2003;57:691–694
  37. Friedland S, Soetikno R. Colonoscopy with polypectomy in anticoagulated patients. Gastrointest Endosc. 2006;64:98–100
  38. Iishi H, Tatsuta M, Narahara H, et al. Endoscopic resection of large pedunculated colorectal polyps using a detachable snare. Gastrointest Endosc. 1996;44:594–597
  39. Katsinelos P, Kountouras J, Paroutoglou G, et al. Endoloop-assisted polypectomy for large pedunculated colorectal polyps. Surg Endosc. 2006;20:1257–1261
  40. Matsushita M, Hajiro K, Takakuwa H, et al. Ineffective use of a detachable snare for colonoscopic polypectomy of large polyps. Gastrointest Endosc. 1998;47:496–499
  41. Rey JF, Marek TA. Endoloop in the prevention of the postpolypectomy bleeding: preliminary results. Gastrointest Endosc. 1997;46:387–389
  42. Di Giorgio P, De Luca L, Calcagno G, et al. Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study. Endoscopy. 2004;36:860–863
  43. Paspatis GA, Paraskeva K, Theodoropoulou A, et al. A prospective, randomized comparison of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps. Am J Gastroenterol. 2006;101:2805
  44. Slivka A, Parsons WG, Carr-Locke DL. Endoscopic band ligation for treatment of post-polypectomy hemorrhage. Gastrointest Endosc. 1994;40:230–232
  45. Smith RE, Doull J. Treatment of colonic post-polypectomy bleeding site by endoscopic band ligation. Gastrointest Endosc. 1994;40:499–500
  46. Parra-Blanco A, Kaminaga N, Kojima T, et al. Hemoclipping for postpolypectomy and postbiopsy colonic bleeding. Gastrointest Endosc. 2000;51:37–41
  47. Geenen JE, LoGuidice JA. Endoscopic sphincterotomy for diseases of the biliary tree. Adv Surg. 1980;14:31–51
  48. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918
  49. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393
  50. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48:1–10
  51. Gorelick A, Cannon M, Barnett J, et al. First cut, then blend: an electrocautery technique affecting bleeding at sphincterotomy. Endoscopy. 2001;33:976–980
  52. Perini RF, Sadurski R, Cotton PB, et al. Post-sphincterotomy bleeding after the introduction of microprocessor-controlled electrosurgery: does the new technology make the difference. Gastrointest Endosc. 2005;61:53–57
  53. Kohler A, Maier M, Benz C, et al. A new HF current generator with automatically controlled system (Endocut mode) for endoscopic sphincterotomy: preliminary experience. Endoscopy. 1998;30:351–355
  54. Kim HJ, Kim MH, Kim DI, et al. Endoscopic hemostasis in sphincterotomy-induced hemorrhage: its efficacy and safety. Endoscopy. 1999;31:431–436
  55. Foutch PG. A prospective assessment of results for needle-knife papillotomy and standard endoscopic sphincterotomy. Gastrointest Endosc. 1995;41:25–32
  56. Mellinger JD, Ponsky JL. Bleeding after endoscopic sphincterotomy as an underestimated entity. Surg Gynecol Obstet. 1991;172:465–469
  57. Nelson DB, Freeman ML. Major hemorrhage from endoscopic sphincterotomy: risk factor analysis. J Clin Gastroenterol. 1994;19:283–287
  58. Wilcox CM, Canakis J, Monkemuller KE, et al. Patterns of bleeding after endoscopic sphincterotomy, the subsequent risk of bleeding, and the role of epinephrine injection. Am J Gastroenterol. 2004;99:244–248
  59. Hui CK, Lai KC, Yuen MF, et al. Does withholding aspirin for one week reduce the risk of post-sphincterotomy bleeding?. Aliment Pharmacol Ther. 2002;16:929–936
  60. Leung JW, Chan FK, Sung JJ, et al. Endoscopic sphincterotomy-induced hemorrhage: a study of risk factors and the role of epinephrine injection. Gastrointest Endosc. 1995;42:550–554
  61. Bardaxoglou E, Campion JP, Maddern G, et al. A simple method to control intractable bleeding after endoscopic sphincterotomy. Am J Surg. 1994;167:277–278
  62. Staritz M, Ewe K, Goerg K, et al. Endoscopic balloon tamponade for conservative management of severe hemorrhage following endoscopic sphincterotomy. Z Gastroenterol. 1984;22:644–646
  63. Sherman S, Hawes RH, Nisi R, et al. Endoscopic sphincterotomy-induced hemorrhage: treatment with multipolar electrocoagulation. Gastrointest Endosc. 1992;38:123–126
  64. Kuran S, Parlak E, Oguz D, et al. Endoscopic sphincterotomy-induced hemorrhage: treatment with heat probe. Gastrointest Endosc. 2006;63:506–511
  65. Katsinelos P, Paroutoglou G, Beltsis A, et al. Endoscopic hemoclip placement for postsphincterotomy bleeding refractory to injection therapy: report of two cases. Surg Laparosc Endosc Percutan Tech. 2005;15:238–240
  66. Lin LF, Siauw CP, Ho KS, et al. Hemoclip treatment for post-endoscopic sphincterotomy bleeding. J Chin Med Assoc. 2004;67:496–499
  67. Oviedo JA, Barrison A, Lichtenstein DR. Endoscopic argon plasma coagulation for refractory postsphincterotomy bleeding: report of two cases. Gastrointest Endosc. 2003;58:148–151
  68. Dwivedi M, Misra SP. Mallory-Weiss syndrome: clinical features and management. J Assoc Physicians India. 1999;47:397–399
  69. Montalvo RD, Lee M. Retrospective analysis of iatrogenic Mallory-Weiss tears occurring during upper gastrointestinal endoscopy. Hepatogastroenterology. 1996;43:174–177
  70. Penston JG, Boyd EJ, Wormsley KG. Mallory-Weiss tears occurring during endoscopy: a report of seven cases. Endoscopy. 1992;24:262–265
  71. Peng YC, Tung CF, Chow WK, et al. Efficacy of endoscopic isotonic saline-epinephrine injection for the management of active Mallory-Weiss tears. J Clin Gastroenterol. 2001;32:119–122
  72. Park CH, Min SW, Sohn YH, et al. A prospective, randomized trial of endoscopic band ligation vs. epinephrine injection for actively bleeding Mallory-Weiss syndrome. Gastrointest Endosc. 2004;60:22–27
  73. Huang SP, Wang HP, Lee YC, et al. Endoscopic hemoclip placement and epinephrine injection for Mallory-Weiss syndrome with active bleeding. Gastrointest Endosc. 2002;55:842–846
  74. Llach J, Elizalde JI, Guevara MC, et al. Endoscopic injection therapy in bleeding Mallory-Weiss syndrome: a randomized controlled trial. Gastrointest Endosc. 2001;54:679–681
  75. Bataller R, Llach J, Salmeron JM, et al. Endoscopic sclerotherapy in upper gastrointestinal bleeding due to the Mallory-Weiss syndrome. Am J Gastroenterol. 1994;89:2147–2150
  76. Norton ID, Petersen BT, Sorbi D, et al. Management and long-term prognosis of Dieulafoy lesion. Gastrointest Endosc. 1999;50:762–767
  77. Lin HJ, Lee FY, Kang WM, et al. Heat probe thermocoagulation and pure alcohol injection in massive peptic ulcer haemorrhage: a prospective, randomised controlled trial. Gut. 1990;31:753–757
  78. Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med. 1994;331:717–727
  79. Higuchi N, Akahoshi K, Sumida Y, et al. Endoscopic band ligation therapy for upper gastrointestinal bleeding related to Mallory-Weiss syndrome. Surg Endosc. 2006;20:1431–1434
  80. Matsui S, Kamisako T, Kudo M, et al. Endoscopic band ligation for control of nonvariceal upper GI hemorrhage: comparison with bipolar electrocoagulation. Gastrointest Endosc. 2002;55:214–218
  81. Yamaguchi Y, Yamato T, Katsumi N, et al. Endoscopic hemoclipping for upper GI bleeding due to Mallory-Weiss syndrome. Gastrointest Endosc. 2001;53:427–430
  82. Carsen GM, Casarella WJ, Spiegel RM. Transcatheter embolization for treatment of Mallory-Weiss tears of the esophagogastric junction. Radiology. 1978;128:309–313
  83. Younes Z, Johnson DA. The spectrum of spontaneous and iatrogenic esophageal injury: perforations, Mallory-Weiss tears, and hematomas. J Clin Gastroenterol. 1999;29:306–317
  84. Gedebou TM, Wong RA, Rappaport WD, et al. Clinical presentation and management of iatrogenic colon perforations. Am J Surg. 1996;172:454–457
  85. Anderson ML, Pasha TM, Leighton JA. Endoscopic perforation of the colon: lessons from a 10-year study. Am J Gastroenterol. 2000;95:3418–3422
  86. Farley DR, Bannon MP, Zietlow SP, et al. Management of colonoscopic perforations. Mayo Clin Proc. 1997;72:729–733
  87. Iqbal CW, Chun YS, Farley DR. Colonoscopic perforations: a retrospective review. J Gastrointest Surg. 2005;9:1229–1235
  88. Cappell MS, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complications. Med Clin North Am. 2002;86:1253–1288
  89. Araghizadeh FY, Timmcke AE, Opelka FG, et al. Colonoscopic perforations. Dis Colon Rectum. 2001;44:713–716
  90. Makharia GK, Madan K, Garg PK, et al. Colonoscopic barotrauma treated by conservative management: role of high-flow oxygen inhalation. Endoscopy. 2002;34:1010–1013
  91. Yoshikane H, Hidano H, Sakakibara A, et al. Endoscopic repair by clipping of iatrogenic colonic perforation. Gastrointest Endosc. 1997;46:464–466
  92. Mana F, De Vogelaere K, Urban D. Iatrogenic perforation of the colon during diagnostic colonoscopy: endoscopic treatment with clips. Gastrointest Endosc. 2001;4:258–259
  93. Raju GS, Ahmed I, Brining D, et al. Endoluminal closure of large perforations of colon with clips in a porcine model (with video). Gastrointest Endosc. 2006;64:640–646
  94. Celestino C, Harz C, Decaestecker J, et al. Endoscopic treatment of an iatrogenic perforation of the colon by using endoloop. Gastrointest Endosc. 2006;64:653–654
  95. Pham BV, Raju GS, Ahmed I, et al. Immediate endoscopic closure of colon perforation by using a prototype endoscopic suturing device: feasibility and outcome in a porcine model (with video). Gastrointest Endosc. 2006;64:113–119
  96. Stapfer M, Selby RR, Stain SC, et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg. 2000;232:191–198
  97. Enns R, Eloubeidi MA, Mergener K, et al. ERCP-related perforations: risk factors and management. Endoscopy. 2002;34:293–298
  98. Howard TJ, Tan T, Lehman GA, et al. Classification and management of perforations complicating endoscopic sphincterotomy. Surgery. 1999;126:658–663
  99. Hans de Vries J, Duijm LE, Dekker W, et al. CT before and after ERCP: detection of pancreatic pseudotumor, asymptomatic retroperitoneal perforation, and duodenal diverticulum. Gastrointest Endosc. 1997;45:231–235
  100. Thatcher BS, Sivak MV, Tedesco FJ, et al. Endoscopic sphincterotomy for suspected dysfunction of the sphincter of Oddi. Gastrointest Endosc. 1987;33:91–95
  101. Chung RS, Sivak MV, Ferguson DR. Surgical decisions in the management of duodenal perforation complicating endoscopic sphincterotomy. Am J Surg. 1993;165:700–703
  102. Aliperti G. Complications related to diagnostic and therapeutic endoscopic retrograde cholangiopancreatography. Gastrointest Endosc Clin North Am. 1996;6:379–407
  103. Pereira-Lima JC, Jakobs R, Winter UH, et al. Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis (Multivariate analysis of prognostic factors for the recurrence of biliary symptoms). Gastrointest Endosc. 1998;48:457–464
  104. Hawes RH, Cotton PB, Vallon AG. Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy. Gastroenterology. 1990;98:1008–1012
  105. Seifert E. Long-term follow-up after endoscopic sphincterotomy (EST). Endoscopy. 1988;20(suppl):232–235
  106. Saito M, Tsuyuguchi T, Yamaguchi T, et al. Long-term outcome of endoscopic papillotomy for choledocholithiasis with cholecystolithiasis. Gastrointest Endosc. 2000;51:540–545
  107. Bourke MJ, Elfant AB, Alhalel R, et al. Sphincterotomy-associated biliary strictures: features and endoscopic management. Gastrointest Endosc. 2000;52:494–499

PII: S1096-2883(07)00006-X

doi: 10.1016/j.tgie.2007.02.005

Techniques in Gastrointestinal Endoscopy
Volume 9, Issue 2 , Pages 90-103 , April 2007