"Although the overall rate of severe complications, including perforation, myocardial infarction and death remained low, the true range of adverse events is much greater than typically appreciated, and the overall rate of one in 127 patients visiting the hospital due to an outpatient endoscopic procedure is a cause for concern, especially in the setting of screening and surveillance when otherwise healthy individuals are subjected to procedural risks," the authors said.

Around half of ER visits in the study were due to abdominal pain, and about one out of 10 to GI tract bleeding, the authors said. Only one death was judged linked to the procedures - a 75-year-old whose heart stopped eight days after stopping an aspirin regimen before getting an endoscopy for surveillance of Barrett esophagus. (ASGE no longer recommends stopping aspirin for routine endoscopies, the organization said.)

Millions more

A big concern of the hospital visits was their cost: they added around $48 on average to a colonoscopy screening program, increasing its cost around 4 percent, the researchers said. The total costs to the hospital from procedure-related visits reached around $1.4 million.

"Although on an individual basis this cost is relatively low, projected nationwide, this is a considerable and underreported cost to the medical system, which could exceed $650 million per year in the United States," the researchers said.

Still, the doctors said it's possible their numbers could be off. They might have underestimated complications by missing patients visiting other hospitals. To control for this, the researchers said they captured data from physician reports from outside hospitals and called 200 patients several weeks after the procedure. Only around 6 percent of the total events were recorded at outside hospitals, the doctors said, and only one patient called by the researchers went to the ER within the first two weeks of the procedure, when the medical literature shows most complications are likely to occur.

However, it's also possible the classification scheme might have roped in unrelated hospital visits. But the doctors say "related"-type reasons for hospital visits declined within two weeks of endoscopic procedures, as expected, while conditions obviously unrelated to the procedure remained level.

First step

"This is a good first step," Dr. Brian C. Jacobson, chair of the Health & Public Policy Committee, with the American Society for Gastrointestinal Endoscopy, told DOTmed News about the study. "It's evidence that proper use of electronic health records to track patient outcomes can potentially be very fruitful in helping inform physicians about the care we give."

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