An endoscopy is a common procedure used to diagnose and treat a variety of gastrointestinal (GI) conditions such as gastroesophageal reflux disease (GERD), Barrett’s esophagus, and colon cancer. This procedure encompasses two categories: upper endoscopies, which visualize the upper digestive tract – including the esophagus, stomach, and duodenum – and lower endoscopies, which look at the lower digestive track – including the colon and the rectum.1 Although both procedures fall under the category of “endoscopy,” they differ in a number of ways. One such difference is in the recovery process, and the potential discomfort experienced by patients following endoscopy.
While colonoscopies may result in serious or even fatal complications such as hemorrhage or perforation, these events are extremely rare – according to the American Gastroenterological Association (AGA), the incidence rate is only 0.28% of cases.2 More often, lower endoscopy patients will experience less severe side effects, such as abdominal pain, bloating, and discomfort. These symptoms typically only last for up to one to two weeks following the colonoscopy, and can be mediated or lessened by a number of factors, such as using CO2 insufflation and sedation during the procedure.3
Much like colonoscopies, upper endoscopies also have a minimal, but non-zero, risk of serious complications, including a perforated bowel and peritonitis.4 Other less severe post-procedure symptoms include a sore throat and abdominal bloating. These symptoms, while uncomfortable, are typically minor and tend to dissipate over time.5
Although abdominal discomfort and a sore throat are the most common symptoms following an endoscopy, some studies have also found that patients may experience respiratory issues following the procedure – especially as sedation during the procedure becomes more widespread. While sedation for these procedures is beneficial, helping to alleviate pain and trigger temporary amnesia, it comes with certain risks.6 Following the procedure, patients may experience symptoms such as coughing, for instance.8 In some cases, patients may develop more serious complications such as hypoxia or arrythmias.4
One of the most important actions clinicians can take against cardiopulmonary complications is pre-procedure assessments. By evaluating patients and assessing any preexisting morbidities – such as chronic obstructive pulmonary disease (COPD) or certain heart conditions – clinicians can direct patients to the appropriate endoscopy centers and anticipate any adverse events. Other actions clinicians can take to mediate both severe and moderate post-procedure symptoms include using appropriate procedural techniques and monitoring patients closely post-procedure.6
As alluded to above, one common cause of discomfort or adverse events following an endoscopy procedure is sedation itself. Another cause of discomfort is the endoscopic equipment and how it is utilized. For example, the tube inserted through the esophagus during an upper endoscopy might irritate the throat, and the tube inserted through the rectum during a lower endoscopy may irritate the rectum.4 Of note, abdominal pain or discomfort can often be attributed to the introduction of air into the GI tract during the procedure.5
Despite the adverse events and potential discomfort associated with endoscopies, they are still incredibly safe. They present minimal risk to the patient, and any associated discomfort usually goes away within a couple of weeks after the procedure.3 Regardless, more research should be done so these risks can be further reduced and to minimize the discomfort experienced by patients following their endoscopy procedure.
References
- Nguyen, V. X., Le Nguyen, V. T., & Nguyen, C. C. (2010). Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers. International journal of general medicine, 3, 345–357. https://doi.org/10.2147/IJGM.S14555.
- Erstad, D. J., Krowsoski, L. S., & Kaafarani, H. M. A. (2017). Abdominal pain after colonoscopy. Gastroenterology, 152(3), 486–487. https://doi.org/10.1053/j.gastro.2016.08.060
- Steffenssen, M. W., Al-Najami, I., & Baatrup, G. (2019). Patient-reported minor adverse events after Colonoscopy: A systematic review. Acta Oncologica, 58(sup1). https://doi.org/10.1080/0284186x.2019.1574979
- Ahlawat, R., Hoilat, G. J., & Ross, A. B. (2022). Esophagogastroduodenoscopy. In StatPearls. StatPearls Publishing.
- Cohen, J. (n.d.). Patient education: Upper endoscopy (beyond the basics). UpToDate. Retrieved November 7, 2022, from https://www.uptodate.com/contents/upper-endoscopy-beyond-the-basics/print
- Amornyotin S. (2013). Sedation-related complications in gastrointestinal endoscopy. World journal of gastrointestinal endoscopy, 5(11), 527–533. https://doi.org/10.4253/wjge.v5.i11.527
- Yom-Tov, E., & Lebwohl, B. (2019). Adverse events associated with colonoscopy; an examination of online concerns. BMC Gastroenterology, 19(1). https://doi.org/10.1186/s12876-019-1127-5
