AllMed Helps Hospital Quality and Risk Management Professionals Learn How to Manage Risk in Colonoscopy and EGD Procedures

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Although rare, complications associated with these common gastroenterology procedures can be life-threatening. A recent AllMed webinar helped risk management professionals understand how to monitor performance and decrease risk in their hospitals.

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“About 1 complication occurs for every 1,000 EGD procedures, and the overall serious adverse event rate is about 2.9 per 1,000 colonoscopy procedures.” - Dr. Anca Pop

Both EGD (upper endoscopy) and colonoscopy carry the risk of cardiopulmonary complications that range from minor fluctuations in oxygen saturation or heart rate, to significant complications such as respiratory arrest, cardiac arrhythmias, myocardial infarction, stroke, and shock. Although rare, these complications can be life-threatening when they do occur, which is an area of concern for hospital quality and risk management professionals. During a recent AllMed webinar, Dr. Anca Pop, board-certified gastroenterologist, discussed how hospitals can monitor physician performance and minimize risk associated with these common gastroenterology procedures.

In her presentation, Dr. Pop gave an overview of colonoscopy and EGD indications developed by a number of professional societies, including the American Cancer Society, the American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy (ASGE), and the National Comprehensive Cancer Network. According to Dr. Pop, “About 1 complication occurs for every 1,000 EGD procedures, and the overall serious adverse event rate is about 2.9 per 1,000 colonoscopy procedures.”

She added that the risk of some complications may be higher with colonoscopy if it is performed for an indication other than screening. Absolute contraindications for colonoscopy include a competent patient who is unwilling to give consent, an uncooperative patient in whom consent has been given but in whom adequate sedation cannot be achieved, toxic megacolon, fulminant colitis, and known free colonic perforation.

Diagnostic and uncomplicated, therapeutic upper endoscopy and colonoscopy are successfully performed with moderate sedation, with most patients receiving conscious sedation with benzodiazepines and narcotics. Dr. Pop noted that the use of anesthesia services for colonoscopy and EGD has doubled in recent years and that this trend is projected to continue. Although anesthesiologist-monitored sedation, with or without propofol, is recommended only for high-risk patients, propofol sedation is sometimes given unnecessarily to low-risk patients who request it in order to be totally unconscious during the procedure.

Quality indicators for EGD and colonoscopy include proper indication, informed consent, and risk stratification. In addition to affecting reimbursement, incomplete documentation can also affect patient outcomes and may increase risk of liability and malpractice claims. Complications arising from procedures and unplanned operations and admissions are important factors to review in order to assess patient outcomes. However, it is important to consider the nature and extent of the surgery being performed.

Fortunately, the risk for complications with EGD and colonoscopy can be avoided or minimized by adhering to surgical principles and meticulous technique and by optimizing the patient selection process for these procedures. In reviewing these cases, hospitals not only need to consider the evolving medical evidence, but also must take into account any conflicts of interest involving friendships and/or competition among the members of the medical staff. External peer review facilitates the objective review of sensitive cases and allows for hospitals and physicians to honor their commitment to safe, timely, appropriate, and compliant care for every patient.

About AllMed
AllMed Healthcare Management provides external peer review solutions to leading hospital groups and ASCs nationwide. AllMed offers MedEval (sm) and MedScore(sm), which help facilities improve physician performance through both periodic and ongoing case reviews at the individual or departmental levels. Services are deployed through PeerPoint®, AllMed’s state-of-the-art medical review portal. For more information on how AllMed can help your organization improve the quality and integrity of healthcare, contact us today at info(at)allmedmd(dot)com, or visit us at

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Kiki Grant
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