Egyptian Journal of Chest Diseases and Tuberculosis 66 (2017) 729–734
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Thoracic complications of upper gastrointestinal endoscopy in Zagazig University Hospitals. A cross-sectional single center study A. Lotfy a, A.E. Elgazzar a,⇑, M. Awad a, A. Yusuf a, Talaat Fathy b a b
Chest Department, Faculty of Medicine, Zagazig University, Egypt Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt
a r t i c l e
i n f o
Article history: Received 27 August 2017 Accepted 24 September 2017 Available online 7 October 2017 Keywords: Thoracic complications Upper GI endoscopy Hematemesis Melena
a b s t r a c t Upper Gastro Intestinal Endoscopy (UGIE) is a commonly performed diagnostic and/or therapeutic procedure for evaluation of patients with various abdominal complaints. UGIE complications vary including; pneumonia, mediastinitis, oesophago-pleural fistula. The reported complications of UGIE are diverse and vary from one center to another. Aim: The study aimed to report the thoracic complications in patients underwent UGIE during the period between July and December 2016. Patients and methods: One hundred and twenty patients, candidates for UGIE were included in the study. All patients were subjected to: thorough medical history, complete general and local chest and abdominal examination, routine laboratory investigations, chest X-ray and chest computed tomography (CT) if needed, spirometric pulmonary function tests (PFT), arterial blood gases (ABGs), pre and post UGIE. Results: Patients were 84 males and 36 female, age ranged from 25 to 70 years old, hematemesis and/or melena was the most common presentation (65%). Oesophageal varices was the most common endoscopic finding (50% of cases). Chest pain, cough and bronchitis were more common among Oesophageal Varices Sclerotherapy (OVS) patients. Pneumonia, atelectasis, pleural effusion and mediastinitis were reported after OVS. There was significant difference regarding spirometric parameters before, 2 days and 3 weeks after the procedure in patients underwent OVS and Gastric Varices Sclerotherapy (GVS), while no significant difference was reported in patients underwent Oesophageal Varices (OV) band ligation and peptic ulcer diagnosis before, 2 days and 3 weeks after the procedure. Conclusions: Thoracic complications were more common in OVS and GVS than in OV band ligation. Ó 2017 The Egyptian Society of Chest Diseases and Tuberculosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).
Introduction Upper gastro-intestinal endoscopy (UGIE) is a commonly performed diagnostic and/or therapeutic procedure for evaluation of patients with abdominal complaints [1]. UGIE had a lot of complications, which vary from nil, up to major pulmonary diseases including; pneumonia, atelectasis, mediastinitis, chylothorax, oesophago-pleural fistula, Esophago-bronchial fistula, and expectoration of sclerosant material [2]. The reported complications of both diagnostic and therapeutic UGIE are relatively diverse and vary from
one center to another [3]. So the current study aimed to report the thoracic complications in patients underwent upper GI endoscopy in tropical medicine endoscopy unit Zagazig university hospitals. Patients and methods Study design This is a cross-sectional single center study, carried out at tropical medicine and chest departments, Zagazig University Hospitals between July and December 2016.
Abbreviations: CT, computed tomography; GVS, gastric varices sclerotherapy; PFT, pulmonary function tests; ABGs, arterial blood gases; OV, oesophageal varices; OVS, oesophageal varices sclerotherapy; UGIE, upper gastro intestinal endoscopy.
The study population
Peer review under responsibility of The Egyptian Society of Chest Diseases and Tuberculosis. ⇑ Corresponding author. E-mail address:
[email protected] (E. A.E.).
One hundred and twenty patients, aged from 25 to 70 years old, 84 males and 36 females indicated for diagnostic and /or therapeutic upper GIT endoscopy were included in the study.
https://doi.org/10.1016/j.ejcdt.2017.09.002 0422-7638/Ó 2017 The Egyptian Society of Chest Diseases and Tuberculosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Inclusion criteria All patients referred to tropical medicine department (inpatient and outpatient) indicated for diagnostic and /or therapeutic upper GIT endoscopy.
Exclusion criteria 1- Patients experiencing any chest complaint before the procedure. 2- Fever or chest X- ray abnormality before the procedure. 3- Patients with history of chronic lung disease. 4- Patient unfit for upper G.I.T endoscopy (encephalopathy, active bleeding until resuscitation and hemoglobin concentration 0.05). Atelectasis was reported in 8 patients (6.6%) and it was equal among all procedures with no significant difference (P > 0.05). Pneumonia was reported in 6 patients (5%)
and it was more common among OVS patients (3/20, 15%) and was equal among other procedures with no significant difference (P > 0.05) (Table 3). One of patients who develop pneumonia was unresolved after two weeks of proper antibiotics and fibro-optic bronchoscope was done and revealed small foreign body in the form of whitish solid material was impacted in the right lower lobe bronchus. After detailed history taking it was discovered that, this was a tooth filling acrylic which was driven down into the lung during introduction of the UGIE. Pleural effusion and mediastinitis were reported in 2 and 1 patients respectively and both complications were reported only among OVS patients with no significant difference among procedures (P > 0.05 for each complication) (Table 3). There was no significant difference in spirometric and gasometric parameters among patients underwent OV band ligation before, 2 days and 3 weeks after the procedure (Table 4). Also, there was no significant difference in spirometric and gasometric parameters among patients underwent peptic ulcer diagnosis (P > 0.05). There were high significant differences in most of spirometric and gasometric parameters among patients underwent OVS and
Table 3 Comparison between thoracic complications among the endoscopic maneuvers in studied patients. Complications
Total
%
OV Sclero-Therapy (OVS) (N = 20)
%
OV Band Ligation (N = 40)
%
Gastric Varices sclerotherapy (GVS) (N = 21)
%
Diagnosis of Peptic Ulcer and others (N = 39)
%
P. value
Pleural effusion Mediastinitis Atelectasis Bronchitis Pneumonia
2 1 8 9 6
1.6 0.8 6.6 7.5 5
2 1 2 3 3
10 5 10 15 15
0 0 2 2 1
0 0 5 5 2.5
0 0 2 2 1
0 0 9.5 9.5 4.7
0 0 2 2 1
0 0 5.1 5.1 2.5
0.163 0.131 0.171 0.134 0.215
(N.S) (N.S) (N.S) (N.S) (N.S)
Gastric Varices Sclerotherapy (GVS), Oesophageal Varices (OV), Oesophageal Varices Sclerotherapy (OVS). NS non significant.
Table 4 Spirometric and gasometric parameters in patients underwent OV band ligation before, 2 days and 3 weeks after the procedure. Data
Before OV band ligation (N = 40)
2 days after OV band ligation (N = 40)
3 weeks after OV band ligation (N = 0)
Test
p-value (Sig.)
FEV1 Mean ± SD
81.87 ± 2.11
81.53 ± 1.97
81.76 ± 2.12
0.627
0.627 (NS)
FVC Mean ± SD
79.83 ± 5.99
74.68 ± 6.17
78.76 ± 4.92
0.536
0.536 (NS)
PEF Mean ± SD
83.17 ± 5.14
82.92 ± 4.84
83.08 ± 5.07
0.642
0.642 (NS)
PaO2 Mean ± SD
91.87 ± 1.81
91.63 ± 2.07
91.71 ± 1.02
0.547
0.547 (NS)
PaCO2 Mean ± SD
39.72 ± 1.77
35.76 ± 1.84
38.92 ± 1.32
0.529
0.529 (NS)
O2 Sat Mean ± SD
96.11 ± 1.65
95.98 ± 1.37
95.96 ± 0.05
0.670
0.670 (NS)
FEV1; forced expiratory volume in the 1st second. FVC; fored Vital Capacity. PEF; Peak expiratory flow rate. PaO2; arterial oxygen tension. PaCO2; arterial carbon dioxide tenstion. O2Sat; Oxygen satuaration in the arterial blood. SD, standard deviation. NS, non significant.
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Table 5 Spirometric and gasometric parameters in patients underwent Oesophageal varices sclerotherapy OVS before, 2 days and 3 weeks after the procedure. Data
Before OVS (N = 20)
2 days after OVS (N = 20)
3 weeks after E.V.S (N = 20)
Test
p-value (Sig.)
FEV1 Mean ± SD
82.56 ± 2.11
61.60 ± 1.47
75.93 ± 2.12
9.323
