Gastrointestinal (GI) endoscopy has now been part of conventional medical practice for over thirty years following the development of useable flexible fibreoptic endoscopes in the early 1970’s. Initially just used for diagnostic examination of the upper GI tract with biopsies, the technique was initially extended to the lower GI tract and then began the expansion of therapeutic techniques which continues to the present time.
Although using natural portals and not needing to cross tissue planes to gain access, this new technology was nevertheless invasive of the human body and so, like all invasive techniques, accompanied by attendant risks and complications. Sedation-related complications predominated in the early days but the expansion of therapeutic endoscopy dramatically widened the scope for complications. The potential benefits of therapeutic endoscopy need to be weighed against the potential to do harm. Two large audits of UK endoscopic practice (References 2 and 3 – Cardio-pulmonary and Sedation-related Complications) have shown a surprisingly high incidence of both morbidity and mortality following upper and lower GI diagnostic and therapeutic endoscopy. More recently, the National Confidential Enquiry into Post-operative deaths (NCEPOD) report into therapeutic GI endoscopy has also found further prima facie evidence of suboptimal endoscopic practice.
As these large audits show, many of the complications that occur are preventable. Some relatively simple precautions can be applied in most cases to bring about a dramatic reduction in the incidence of complications – as has been best illustrated with respect to reducing the complications associated with sedation (vide infra).
In order to apply risk reduction more widely, the Endoscopy Committee of the British Society of Gastroenterology in 2005 commissioned a group of experienced endoscopists under the chairmanship of Dr Jonathan Green to review the incidence of common endoscopy-related complications and to provide simple, practical and (where possible) evidence-based advice for the prevention, recognition and management of these complications and adverse events.