Upper and lower gastrointestinal endoscopy mortality: the medical examiner’s perspective

Abstract

Fiberoptic endoscopy is utilized to diagnose and treat a wide variety of gastrointestinal tract diseases and is currently one of the most commonly performed invasive medical procedures. Though generally considered to be safe, the procedure may be associated with serious complications including death. Herein, we correlate the clinical history with the autopsy findings in gastrointestinal endoscopy (GIE) related fatalities that were reported to the New York City Medical Examiner Office over a 5 year period. The complication rate is higher in therapeutic procedures when compared to diagnostic procedures. Though fatalities following iatrogenic complications are four times more common, emphasis is placed on patients who died following a cardiorespiratory event during or immediately following the procedure. Of 41 upper and 36 lower GIE related fatalities, 10 and 9 respectively, fit this category. The comorbidities frequently associated with fatal cardiorespiratory events were: hypertension and obesity with associated cardiac hypertrophy, diabetes mellitus and coronary artery atherosclerosis. For colonoscopies, the approximate incidence of perforation was 0.00625% and the procedure-related fatality rate was 0.014%. The literature on anesthesia for GIE is also discussed.

Perforations and bleeding in a population‐based cohort of all registered colonoscopies in Sweden from 2001 to 2013

“…In a recent study, the death rate as a result of bleeding or perforation was estimated to be 0.013% in a Swedish cohort study of 593,315 colonoscopies from 2001 to 2013. 2 This is consistent with another study by deRoux and Sgarlato, which showed the colonoscopy death rate in a small population in New York City to be 0.014% between 2005 and 2009 3 . In Sweden, there are few studies concerning colonoscopy‐related AEs.…”

“…2 This is consistent with another study by deRoux and Sgarlato, which showed the colonoscopy death rate in a small population in New York City to be 0.014% between 2005 and 2009. 3 In Sweden, there are few studies concerning colonoscopy-related AEs. 2,4,5…”

Role of MicroRNA Molecules in Colon Cancer Etiology

“…This approach is based on the observation that some miRNAs can also downregulate mRNA levels in addition to down regulating protein levels of their target genes [136]. An experimental validation of miRNA target sites has been to express a miRNA in vivo while simultaneously expressing and monitoring the target mRNA linked to a reporter gene, i.e., Luciferase [134,[137][138][139][140][141][142][143][144].…”

“…An additional approach towards data integration aimed at the identification of conserved changes to reduce background noise in expression profiling studies, and subsequently in miRNA studies, is represented by cross-species comparison of tumors from human patients and animal models of cancer [143]. This approach is expected to pinpoint genes of conserved functional relevance in the process of tumor formation and progression in mammalian intestinal tumorigenesis.…”