Concept: Complications from a Gastrointestinal Endoscopy (GIE) Procedure

Introduction

Gastrointestinal Endoscopy (GIE) procedures are performed for a variety of reasons, including to screen individuals who are potentially at risk for colorectal cancer (CRC) or other gastrointestinal cancers, and to diagnose and monitor individuals who have gastrointestinal conditions such as inflammatory bowel disease (IBD).

In Lix et al. (2021), they investigated GIE procedures in Manitoba with an aim to provide insights about the patient, physician, and procedure characteristics associated with trends in utilization, wait times, and procedure outcomes. Although rare, one of these outcomes is the potential complications that arise within seven and 30 days after a GIE procedure.

Data Sources

The data source used to identify complications from a GIE Procedure is the Hospital Abstracts data.

Complications from a GIE Procedure

The following is a list of complications from a GIE procedure that were identified and investigated in Lix et al. (2021). The list of complications is divided into four different tables: gastrointestinal perforations, cardiac complications, cerebrovascular complications and pulmonary complications, and includes the ICD / CCI codes used to identify each complication.

NOTE: The list of these codes can be found on-line in Appendix 3: Appendix Table 3.4 Diagnosis and procedure codes for complications of a GIE procedure of the deliverable. The original tables presented in the deliverable have been modified and re-organized in this concept presentation.

1. Gastrointestinal Perforations

ICD-9-CM Code	Description	ICD-10-CA Code	Description
569.83	Perforation of intestine	K63.1	Non-traumatic perforation of intestine
998.2	Accidental puncture and laceration during a procedure, not elsewhere classified	T81.2	Accidental puncture and laceration during a procedure, not elsewhere classified
E870.8	Accidental cut or hemorrhage during medical care - other specified	Y60.8	Accidental cut - Other specified medical care
E870.9	Accidental cut or hemorrhage during medical care - unspecified	Y60.9	Accidental cut - Unspecified medical care
E870.4	Accidental cut or hemorrhage during endoscopic examination	Y60.4	Accidental cut - Endoscopic examination

2. Cardiac Complications

ICD-9-CM Code	Description	ICD-10-CA Code	Description
394.*	Diseases of the mitral valve	I05	Rheumatic mitral valve diseases
395.*	Diseases of the aortic valve	I06	Rheumatic aortic valve diseases
396.*	Diseases of the mitral and aortic valves	I08.0	Rheumatic disorders of both mitral and aortic valves
397.*	Diseases of other endocardial structures	I07	Rheumatic tricuspid valve diseases
		I08	Multiple valve diseases
		I36	Nonrheumatic tricuspid valve disorders
		I37	Pulmonary valve disorders
		I38	Endocarditis, valve unspecified
		I39.*	Endocarditis and heart valve disorders in diseases classified elsewhere
398.91	Rheumatic heart failure (congestive)	I09.9	Rheumatic heart disease, unspecified
402.01	Hypertensive HD malignant with congestive heart failure	I10.1	Malignant hypertension
402.11	Hypertensive HD benign with congestive heart failure	I10.0	Benign hypertension
402.91	Hypertensive HD unspecified with congestive heart failure	I11	Hypertensive heart disease
404.03	Hypertensive heart and renal disease, malignant, CKD stage V or end stage	I13	Hypertensive heart and renal disease
404.11	Hypertensive heart and renal disease, benign, CKD stages I through IV
404.13	Hypertensive heart and renal disease, benign, CKD stage V or end stage
404.91	Hypertensive heart and renal disease, unspecified, CKD stages I through IV
404.93	Hypertensive heart and renal disease, unspecified, CKD stage V or end stage
410	Acute myocardial infarction	I21.*	Acute myocardial infarction
411	Other acute and subacute forms of IHD	I25.1	Atherosclerotic heart disease
412	Old myocardial infarction	I25.2	Old myocardial infarction
413	Angina Pectoris	I20.*	Angina Pectoris
414	Other forms of chronic IHD
415	Acute Pulmonary heart disease	I26.0	Pulmonary embolism with mention of acute cor pulmonale
424.*	Other diseases of the endocardium
426.*	Atrioventricular block, complete	I44	Atrioventricular and left bundle-branch block
426.1	Atrioventricular block, other and unspecified	I34	Nonrheumatic mitral valve disorders
426.4	Right bundle-branch block	I35	Nonrheumatic aortic valve disorders
427.*	Cardiac dysrhythmias
427.3	Atrial fibrillation and flutter	I48.*	Atrial fibrillation and flutter
427.5	Cardiac arrest	I46.*	Cardiac arrest
427.9	Cardiac dysrhythmia, unspecified
428	Heart failure	I50.*	Heart failure
428.0	Congestive heart failure, unspecified
428.1	Left heart failure
428.2	Systolic heart failure
428.3	Diastolic heart failure
428.4	Combined systolic and diastolic heart failure
428.9	Heart Failure, unspecified
429.2	Cardiovascular disease unspecified
785	Tachycardia unspecified	R00.0	Tachycardia unspecified
		I47.*	Paroxysmal tachycardia
785.1	Palpitations	R00.2	Palpitations
		I49.*	Other cardiac arrhythmias
996.71	Other complications due to heart valve prosthesis	T82.8	Other specified complications of cardiac and vascular prosthetic devices, implants and grafts
996.74	Other complications due to other vascular device	T82.9	Unspecified complication of cardiac and vascular prosthetic device, implant and grafts
		T82.*	Complications of cardiac and vascular prosthetic devices, implants and grafts
997.1	Cardiac complications during/resulting from a procedure	I97.8	Cardiac complications (Post procedural disorders of circulatory system, not elsewhere classified)
		I97.9	Postprocedural disorder of circulatory system, unspecified
V12.53	Personal history of diseases of the circulatory system	Z86.7	Personal history of diseases of the circulatory system
V45.81	Aortocoronary bypass status	Z95.1	Presence of aortocoronary bypass graft
V45.82	Percutaneous transluminal coronary angioplasty status	Z95.5	Presence of coronary angioplasty implant and graft
		I45.*	Other conduction disorders
		1.IJ.50	Dilation, coronary arteries (CCI procedure)


NOTE: * includes all sub-codes

3. Cerebrovascular Complications

ICD-9-CM Code	Description	ICD-10-CA Code	Description
346.0*	Classical migraine	G43	Migraine
346.6*	Common migraine	I65	Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction
433.*	Occlusion and stenosis of precerebral arteries	I63	Cerebral infarction
434	Occlusion of cerebral arteries	I66	Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction
436	Acute but ill-defined cerebrovascular disease	I67	Other cerebrovascular diseases
437.*	Other and ill-defined cerebrovascular disease	I68	Cerebrovascular disorders in diseases classified elsewhere
438.*	Late effects of cerebrovascular disease	I69	Sequelae of cerebrovascular disease
430	Subarachnoid hemorrhage	I60	Subarachnoid hemorrhage
431	Intracerebral hemorrhage	I61	Intracerebral hemorrhage
432	Other and unspecified intracranial hemorrhage - nontraumatic extradural	I62.1	Nontraumatic extradural hemorrhage
432.1	Other and unspecified intracranial hemorrhage - subdural	I62.0	Subdural hemorrhage (acute) (nontraumatic)
432.9	Other and unspecified intracranial hemorrhage - unspecified	I62.9	Intracranial hemorrhage (nontraumatic), unspecified
		I64	Stroke, not specified as hemorrhage or infarction
435.*	Transient cerebral ischemia	G45	Transient cerebral ischemic attacks and related syndromes
V12.53	Personal history of diseases of the circulatory system	Z86.7	Personal history of diseases of the circulatory system
780.6	Pyrexia of unknown origin	R50.9	Fever, unspecified
780.62	Fever and other physiologic disturbances of temperature regulation	R50.8	Other specified fever
389	Unspecified septicemia	A41.9	Septicemia, unspecified


NOTE: * includes all sub-codes

4. Pulmonary Complications

ICD-9-CM Code	Description	ICD-10-CA Code	Description
507	Pneumonitis due to solids and liquids	J69	Pneumonitis due to solids and liquids
507.0	Pneumonitis due to inhalation of food or vomitus	J69.0	Pneumonitis due to inhalation of food or vomitus
997.32	Respiratory complications, postprocedural aspiration pneumonia	J95.88	Other postprocedural respiratory disorders
997.39	Respiratory complications, other	J95.9	Postprocedural respiratory disorder, unspecified
486	Pneumonia, organism unspecified	J18	Pneumonia, organism unspecified
485	Bronchopneumonia, organism unspecified
466	Acute bronchitis and bronchiolitis
490	Bronchitis, not specified as acute or chronic	J41.0	Simple chronic bronchitis
491.21	Obstructive chronic bronchitis, with acute exacerbation
491.22	Obstructive chronic bronchitis, with acute bronchitis
494.1	Bronchiectasis with acute exacerbation	J47.1	Bronchiectasis with acute exacerbation
496	Chronic airway obstruction, not elsewhere classified	J44.9	Chronic obstructive pulmonary disease, unspecified
		J44	Other chronic obstructive pulmonary disease
491	Simple chronic bronchitis	J41.8	Mixed simple and mucopurulent chronic bronchitis
491.1	Mucopurulent chronic bronchitis	J41.1	Mucopurulent chronic bronchitis
491.2	Obstructive chronic bronchitis	J44	Other chronic obstructive pulmonary disease
491.20	Obstructive chronic bronchitis, without exacerbation
491.8	Other chronic bronchitis
491.9	Unspecified chronic bronchitis	J42	Unspecified chronic bronchitis
492.0	Emphysematous bleb	J43.9	Emphysema, unspecified
492.8	Other emphysema
494	Bronchiectasis	J47	Bronchiectasis


NOTE: * includes all sub-codes

Research Findings

In Lix et al. (2021), they investigated the frequencies of hospitalization for gastrointestinal complications (i.e., intestinal perforations) and non-gastrointestinal complications (cardiac, cerebrovascular, infection, pulmonary) within 30 days after a GIE procedure. They examined complications for both cases and non-cases, and conducted separate analysis for upper GIE procedures, all lower GIE procedures, and for colonoscopies only.

For more information on the findings from this research, see the section titled: Gastrointestinal Perforations and Non-Gastrointestinal Complications in the on-line report, including:


• Table 5.3: Hospitalizations for Complications Within 30 Days of a Gastrointestinal Endoscopy (GIE) Procedure, 1985/86 to September 30, 2016;
  
• several figures that estimate the difference between GIE procedure cases and non-cases in the odds of having a non-gastrointestinal complication, and the results of analysis for factors (i.e., age, sex, Charlson Comorbidity Index score) associated with hospitalization for complications amongst GIE procedure cases.