Post-Endoscopy Self-Limited Unspecified Fever. Rare or Common Adverse Event after Endoscopy? An Observational, Cross-Sectional Study

Abstract

Introduction: Although post-endoscopy fever (PEF) without colon perforation or haemorrhage is believed to be rare, incidence, risk factors and the causes in the adult population have not been fully investigated. Endogenous immune response, bacteria translocation, contaminated endoscopes, or drug-induced fever are all protentional reasons that can lead to elevated temperature. The purpose of the present study was to investigate the incidence of PEF and identify the risk factors associated with the development of PEF and its outcomes.Material and Methods: Over a three-month period, 1054 non-hospitalised patients who had an endoscopic procedure at Cleveland Clinic Abu Dhabi received a post-procedure phone call within the first 24 hours. After identifying patients with fever and obtaining verbal consent, patients were enrolled in the study using a standardised telephone interview.Results: Thirty-four patients with PEF were identified. The highest temperature measured was 39.8 degrees Celsius. The most common single procedure performed was oesophagogastroduodenoscopy (41.2%). Colonoscopy was performed as a single procedure in 17.6% and double procedure (oesophagogastroduodenoscopy and colonoscopy) in 41.2% of patients. Polypectomy was performed in only 5 patients (14.7%). Multiple biopsies were performed in 26 of the 34 patients (76.5%). Propofol was used in all endoscopy procedures and the dose was directly related to the duration of the procedure. Logistic regression revealed that no significant group differences across procedure types existed in terms of adjusted odds of fever. However, results also indicated that age has a significant negative relationship with fever – higher age is associated with lower odds of fever (b= -0.033, p = 0.024).Conclusion: PEF is an unpleasant side effect and it is associated with patient discomfort, dissatisfaction and fear during the post-endoscopy recovery. Although our findings do not fully explain the possible mechanisms underlying post-endoscopy fever, this study data should increase awareness about PEF as a common side effect related to endoscopy.