MedStar Georgetown University Hospital Washington, DC
Introduction: The American Society for Gastrointestinal Endoscopy recommends that endoscopic intervention should occur within 24 hours to minimize complications in patients presenting with food impaction. The aim of our study was to ascertain whether complication rates were higher in patients undergoing endoscopy more than 6 hours after presentation compared to those undergoing intervention within 6 hours and to identify factors associated with patients that develop complications.
Methods: The electronic medical record at a single tertiary care center was queried for esophagogastroduodenoscopies (EGD) with food impaction over a ten-year period. Information on patient demographics, medical history, timing of presentation, timing of EGD, procedural and post-procedure complications was obtained. Rates of complications were compared between encounters in which a patient had an EGD within 6 hours from initial presentation versus greater than 6 hours. Data was compared using Fishers Exact test for categorical variables and a two-tailed t-test for continuous variables.
Results: This study received IRB approval. 127 records met the inclusion criteria, with 86 undergoing an EGD within 6 hours. Those undergoing EGD within 6 hours were younger (48.6 vs 60.4, p< .001), and less likely to have heart disease (5.8% vs 17.1%, p=.055). Patients that underwent an EGD within 6 hours had statistically significant fewer post-procedural complications (0% vs 12.2%, p=.0029) and fewer complications overall (3.5% vs 14.6%, p=.057). Amongst the 5 cases where post-procedural complications occurred, average age was 78.4 (range of 68 to 89) and average time from presentation to EGD was 30.7 hours (range 7.5 to 60). Two of the 5 were transferred from an outside facility, 3 of the 5 had heart or lung disease. The only post-procedural complication was aspiration pneumonia in all five patients.
Discussion: The rate of procedural complication was not affected by duration to endoscopy. There is a higher risk of post-procedural complications in elderly patients that received an EGD more than 6 hours after initial presentation. Those patients were more likely to have cardiopulmonary comorbidities and 40% of them were transferred from outside facilities. There should be an effort to reduce delays to endoscopy and to reduce inter-facility transfer time, especially amongst elderly patients with cardiopulmonary comorbidities. Endotracheal intubation for patients undergoing EGD more than 6 hours after presentation may reduce complications.
