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A prospective analysis of 3525 esophagogastroduodenoscopies performed by surgeons

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Abstract

Background: This study was undertaken to evaluate the safety and efficacy of surgeons performing esophagogastroduodenoscopy (EGD) and to use these results to assess existing credentialing guidelines for surgeons. Methods: A prospective outcomes study was designed to accept input from members of SAGES. End points were the time taken and rate of success in reaching the duodenum, the frequency of arriving at a diagnosis, and complications of EGD as related to operator experience. Results: Information from a total of 3,525 EGDs was prospectively entered into a database between December 2001 and December 2002. Common indications were abdominal pain/nausea/vomiting (34.8%), gastroesophageal reflux disease (24.9%) and dysphagia (17.4%). The findings were inflammation in 1,895 (53.8%), hiatus hernia in 1,010 (28.7%), nonbleeding ulcer in 462 (13.1%), bleeding ulcer in 59 (1.7%), stricture in 344 (9.8%), and polyp/tumor in 206 (5.8%). Biopsies were obtained in 2080 (59.0%). Concomittant procedures performed were dilation in 253 (7.2%), removal of a foreign body (FB) or removal/insertion of a percutaneous endoscopic gastrostomy tube (PEG) in 190 (5.4%), and polypectomy in 59 (1.7%). The EGD was completed to the duodenum in 3282 patients (93.1%) with a mean procedure time of 9.2 min (range 1–60 min). Examination of the duodenum was not attempted in 231 patients for reasons such as previous gastric surgery (n = 119), obstruction (n = 58) or because the EGD was done for FB/PEG removal or PEG placement (n = 36). Attempted EGD could not be completed in 12 patients (0.3%). The most common complication was hypoxia (n = 57, 1.6%), which was treated with supplemental oxygen and observation. New bleeding occurred in eight patients and the procedure failed to control bleeding in three others. No complications occurred in 3447 patients (97.8%). Completion rates and major complications were not correlated to experience, but there was a significant association between experience and the time required for completion of the procedure (p < 0.0001). Conclusions: This study shows that surgeons can perform EGD with a high degree of success and low morbidity. On the basis of this large prospective study, no minimum number of cases could be proposed for credentialing surgeons to safely perform either diagnostic or therapeutic esophagogastroduodenoscopy.

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Acknowledgments

This study was funded in part by an educational grant from Olympus America. Statistical analysis was provided by Martin Feuerman, Biostatistics Division, Office of Academic Affairs, Winthrop University Hospital. We also thank Helen Mouyiaris and Erin Simmons for data collection. The SAGES EGD Outcomes Study Group consisted of the following: Cunningham James, Dolay Kunal, Causton Norman, Mincheff Thomas, Evans William, Stauffer Jay, Stelzer Mark, Gusz John, Acuna David, Guttman Richard, Heili Michael, Champion JK, Tilney Robert, Duppler David, Lipshy Kenneth, Zlothik Richard, Collins Jay, Arcovedo Rodolfo, Hoekstra Suzanne, Anderson Robert, Gunther Eric, Bell Christopher, Ziegler Daniel, Ghanta Guru, Giss Steven, Craig Anderson, Pearl Laurence, Bakalakos Efthimios, Himal Harry, Sawyer Samuel, Matthews Brent, Idjadi Farhad, Barrett William, Pearson Jerry, Takemura Masashi, Marshall Tom, Dobradin Andrew, Stevens Gary, Hagen Jeffrey, Ripepi Antonio, Gollish, Hinton Carl, Van Houden Charles, Koo Kenny, Wheeler William, Chang Craig, Mistry Bhargav, Monajjem Navid, Para Daniel, Aghazarian Sarkis, Greene Frederick, Pennings J, Tielszen Myles, Cattie John, Muscareka, Petrick Anthony, Fanelli Robert, Mayer John, Scheeres David, Eyman Craig, Narain PK, Giuseffi Steven, Chu Uyen, Dunkin Brian, Hogg Paul, Shapiro Andrew, Chadwick Eustis, Stader Eric, Appel Michael, Chabenne Bernard, Gamagami RA, Jenkins Jeff, Kandula Ravindra, Quispe Guillermo, Wilson David, Glen David, Hashizume Makoto, Pashikov Dmitry, Stafford Doughlas, Stoiber PO, McKay Robert, Horattas Mark, Marks Jeffrey, Sarkis Antoine, Swanstrom Lee, White Thomas, Rodriguez Jorge, Well Wilson, Barret William, Daniels Daryl, Hemadeh Ossama, McCormick James, Aye Ralph, Legget Philip, Palani Colathur, Beaver Jason, Blake Hu, Cacchione Robert, Hall Terrence, Reed William, Skaryak, Asriyev Vladimir, Carlton Lynwood, Eddy William, McLaughlin Anthony, McThomas Bruce, Rajdeo Heena, Swartz Dan.

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  1. Department of Surgery, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA

    W. P. Reed & C. E. Dias

  2. Department of Surgery, University of Florida, Jacksonville, FL, USA

    J. W. Kilkenny

  3. Department of Surgery, Cleveland Clinic Florida, Weston, FL, USA

    S. D. Wexner

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  1. W. P. Reed
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Reed, W., Kilkenny, J., Dias, C. et al. A prospective analysis of 3525 esophagogastroduodenoscopies performed by surgeons. Surg Endosc 18, 11–21 (2004). https://doi.org/10.1007/s00464-003-8913-3

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