Absence of Complications after Endoscopic Mucosal Biopsy

Abstract

Background: There is no clarity with regard to the occurrence of serious complications from EGD-driven mucosal biopsy. This is important for considering both clinically indicated procedures and mucosal sampling for research. Methods: We sought to quantify rates of serious complications from esophagogastroduodenoscopy (EGD) with biopsy. We studied 13,233 patients undergoing outpatient EGD with biopsy over 5 years in 2 North Dakota community hospitals, based on the reasoning that serious complications would cause hospitalization within 30 days. We reviewed the records of all patients with a diagnostic or procedure code or admission within 30 days after the outpatient EGD with biopsy. Results: Of the 13,233 patients who underwent outpatient EGD with biopsy, 411 were admitted within 30 days, most of them because of their underlying diagnosis. Two patients were admitted due to complications that resulted because of additional simultaneous procedures. No patient was admitted because of complications that could be ascribed to conscious sedation, upper GI endoscopic access, or mucosal biopsy. Conclusions: These data confirm that EGD biopsy is safe within community settings and suggest that the risk/benefit ratio for performing EGD biopsy for research is likely to be favorable if the research has scientific merit. Serious complications or perforation following EGD biopsy did not occur in 13,233 patients in community hospitals in North Dakota.

Adverse events associated with EGD and EGD-related techniques

“…9 Similarly, in a 2018 retrospective analysis of over 13,000 EGDs with biopsy sampling, no perforations occurred within 30 days of the index procedure. 19 These contemporary estimates are similar in magnitude but even more encouraging than prior estimates of perforation risk ranging between 1 in 2500 and 1 in 11,000 3 that were based on considerably older studies. 20,21…”

“…The ASGE guideline on the management of antithrombotic agents for endoscopy describes both PEG and PEJ as highrisk procedures overall and recognizes that aspirin alone does not portend an increased risk of bleeding. 19 Risk factors associated with a higher risk of bleeding after PEG placement are as follows:…”

Optimal number of endoscopic biopsies for diagnosis of early gastric cancer

“…However, these guidelines were mainly intended to diagnose advanced GC, not early GC. Although many studies concluded that antithrombotics did not increase risk of bleeding 18 19 , biopsy can cause local fibrosis, which may make endoscopic treatment difficult. As most early GC now can be effectively treated by endoscopy 20 , this might become a major problem.…”

Guía de manejo de terapia antitrombótica durante procedimientos endoscópicos

“…En un estudio de 13,233 pacientes sometidos a endoscopia superior a los que se les realizó biopsia de la mucosa no se reportó hemorragia o perforación. Estos datos confirman que el riesgo/beneficio de realizar una biopsia es favorable 43 . Sin embargo, hasta el momento no existen estudios que evalúen la seguridad de la toma de biopsias de la mucosa en pacientes tratados con los nuevos antiplaquetarios (prasugrel, ticagrelor, vorapaxar) o ACOD.…”