322 GASTROINTESTINAL ENDOSCOPY VOLUME 50, NO. 3, 1999 Colonoscopy has revolutionized the practice of medicine and the field of gastroenterology. With the benefits of this procedure come inevitable complica- tions. 1 Survey studies conducted by the American Society for Gastrointestinal Endoscopy (ASGE), 2 the American Society of Colon and Rectal Surgeons, 3 and the Southern California Society for Gastrointestinal Endoscopy 4 characterized the nature and frequency of endoscopic complications. These studies, although essential, were retrospec- tive in nature and relied on endoscopic reports and physician recollection. Waye et al. 5 performed a prospective study of complications among patients referred for office colonoscopy. This report advanced our understanding of complications, but patients were not systematically contacted after their proce- dures and one endoscopist performed all procedures. It is unclear whether these studies accurately rep- resent all complications that occur. The basic definition of what constitutes a compli- cation and how to grade its severity have been sub- jective, and this has made it difficult to accurately assess complication rates. Terms such as “major” and “minor” complications have different meanings for different investigators. This makes it difficult to compare complications from one study to the next. The standards of practice committee of the ASGE recommended that endoscopic complications be evaluated through a procedure-review process such as a morbidity and mortality conference. 6 The com- mittee also recommended use of procedure reports and an endoscopic unit logbook. Fleischer et al. 7 showed the benefits of such a review process in iden- tifying quality assurance issues and determining complication rates. It is not certain, however, whether the complications documented in endo- scopic reports and endoscopic unit logbooks under- estimate the number of actual complications that occur. For surgical specialties a standard period of 30 days has been recommended for assessing proce- dure-related complications. No clear standard has been established for endoscopic procedures. The purpose of this study was to prospectively deter- mine whether patients reported more complications Prospective analysis of complications 30 days after outpatient colonoscopy Richard Zubarik, MD, David E. Fleischer, MD, Chris Mastropietro, Jennifer Lopez, John Carroll, MD, Stanley Benjamin, MD, Glenn Eisen, MD, MPH Washington, D.C., and Memphis, Tennessee Background: Our objective was to (1) determine whether more complications are reported by patients 30 days after outpatient colonoscopy than are discussed at our monthly morbidity and mortality conferences, (2) identify complications resulting in visits to the emergency department or physician’s office or leading to hospitalization, and (3) assess which factors put patients at highest risk. A secondary goal was to determine the rate of work lost after outpatient colonoscopy. Methods: Trained interviewers performed standardized telephone interviews of consecutive out- patients undergoing colonoscopy at Georgetown University Hospital over a 1-year period. Results: One thousand one hundred ninety-six patients were contacted 30 days after outpatient colonoscopy and participated in our study.Twenty patients had complications that required a visit to an emergency department or physician. Ninety percent of these cases (18) were detected at 30 days, but 15% (3) were discussed at morbidity and mortality conferences. All seven complications that necessitated hospitalization were identified at 30 days, but only two were discussed at our morbidity and mortality conference. The most common complications reported by patients were abdominal discomfort (5.4%) and rectal bleeding (2.1%). Conclusion: More complications are detected by means of contacting patients 30 days after out- patient colonoscopy than are discussed at our morbidity and mortality conferences. (Gastrointest Endosc 1999;50:322-8.) Received July 17, 1998. For revision September 24, 1998. Accepted January 14, 1999. From the Department of Gastroenterology, Georgetown University Hospital, Washington, DC, and Gastroenterology Section, Veterans Affairs Medical Center, Memphis, Tennessee. Presented at the annual meeting of the American College of Gastroenterology May, 1997, Chicago, Illinois, and poster presen- tation at Digestive Disease Week, May 17-20, 1998, New Orleans, Louisiana. Supported by a grant from the American College of Gastroenterology. Reprint requests: Richard Zubarik, 8987 Shady Leaf Cove, Cordova, TN 38018; e-mail: Rzubarik@aol.com. 37/1/97111