152 153 Intestinal Disease Meeting Berlin 2006 - Dr. Falk Pharma ...

Session 5
Prevention and Management
of Complications
Chair:
F. Schreiber, Graz
P.A. Testoni, Milan
20
Endoscopic procedures are associated
with low overall mortality
The overall mortality associated with diagnostic
endoscopic procedures is reported as 0.3–0.5
per 1000 procedures, of which about 50% of
deaths are due to cardiopulmonary complications,
the majority of which develop as a result
of pre-medication. “The risks of endoscopic
procedures are overall very low,” said M. Jung
(Mainz).
In his opinion, it is important to consider the
dangers of premedication. It is common practice
before a procedure to administer a short-acting
benzodiazepine either alone or in combination
with an opiate. Most commonly used agents are
midazolam or propofol. Both agents are characterized
by a short elimination half-life and corresponding
short duration of action. Propofol has
advantages over benzodiazepines, especially
because patients recover very quickly from the
medication.
M. Jung W. Schmitt
Propofol: Does an anesthesiologist
need to be present?
On the other hand, this hypnotic agent induces
a certain amount of cardiac and respiratory depression
and there is no antagonist that can be
administered if the situation becomes critical.
Nevertheless, M. Jung does not consider justified
those recommendations that propofol be used
only in the presence of an anesthesiologist. Experience
to date suggests that, with the proper
training, this agent can be safely used in patients
undergoing endoscopic interventions.
Low rate of complications
associated with polypectomy
The rate of complications is also comparatively
low with polypectomy, explained W. Schmitt
(Munich). Overall morbidity stands at 0.36–4.8%,
of which bleeding makes up 0.6–3.4% of cases.
In second place are perforations at 0.08–0.83%.
Mortality associated with the procedure is reported
as 0.006–0.03%.
Under discussion is the question of prophylactic
clipping as a means of reducing the risk of
bleeding. “Convincing data supporting its use
have yet to be published,” said W. Schmitt. If
bleeding does occur, it can be treated with sclerotherapy,
clipping or by means of coagulation.