Cases of mortality within 30 days of the endoscopic procedure
| Procedure type | Patient age (years) | Indication for procedure | ASA grade documented | Sedation used | Reason for reversal | Factors contributing to mortality |
|---|---|---|---|---|---|---|
| ERCP | 80 | Obstructive jaundice | Severe systemic | Midazolam 2 mg, Fentanyl 75 μg | Persistent hypoxia | Intracranial event, sepsis secondary to pneumonia, acute renal failure |
| OGD | 81 | Melaena | Fit (*Severe systemic) | Midazolam 1 mg | Hypotension | Recurrent GI bleed with no bleeding source identifiable. Pulmonary oedema, aspiration pneumonia, cellulitis |
| ERCP | 59 | Stent insertion (pancreatic cancer with gastric outlet obstruction) | Severe systemic (*Life-threatening) | Midazolam 3 mg, Fentanyl 50 μg | Deep sedation and food residue in stomach (risk of aspiration in recovery) | Metastatic pancreatic adenocarcinoma |
| OGD | 85 | PEG placement (unsafe swallow) | Severe systemic | Midazolam 2 mg | Hypoxia, reduced responsiveness | Aspiration pneumonia, acute mesenteric ischaemia likely embolic in origin secondary to AF |
| ERCP | 45 | CBD stricture, stent insertion | Severe systemic (*Life-threatening) | Midazolam 4 mg, Fentanyl 50 μg | Low respiratory rate | Advanced metastatic breast carcinoma |
| OGD | 66 | PEG placement (unsafe swallow) | Mild systemic (*Severe systemic) | Midazolam 2 mg, Pethidine 50 mg | Reduced responsiveness, not rousable postprocedure | Pneumonia, poor compliance with treatment secondary to dementia |
| OGD | 76 | Haematemesis | Mild systemic (*Life-threatening) | Midazolam 4 mg | Food residue in stomach (aspiration risk) | Advanced metastatic oesophageal cancer, persisting GI bleed (patient refused further intervention) |
| OGD | 56 | PEG placement | Severe systemic | Pethidine 50 mg | Reduced responsiveness postprocedure | HIV-associated progressive multifocal leucoencephalopathy |
| OGD | 86 | Melaena | Severe systemic | Midazolam 2.5 mg | Hypoxia | GI bleed with no bleeding source identifiable, pulmonary oedema, worsening acute on chronic renal failure |
| OGD | 90 | PEG placement | Severe systemic | Midazolam 1 mg | Hypoxia | Hospital-acquired pneumonia, Clostridium difficile infection, GI bleeding, congestive cardiac failure |
*Pre-endoscopy patient ASA grade deemed to be different after review of individual patient medical case notes.
ASA, American Society of Anesthesiologists; AF, atrial fibrillation; CBD, common bile duct; ERCP, endoscopic retrograde cholangiopancreatography; GI, gastrointestinal; OGD, oesophago-gastro-duodenoscopy; PEG, percutaneous endoscopic gastrostomy.