2024 Senior Fellows Program (2nd & 3rd Year) | September 2024-GAO

GAO_ASGE Complications
Pdf Summary
Dr. Tian Gao, Clinical Assistant Professor of Medicine and Chief of Endoscopy, presented a comprehensive discussion on managing complications in endoscopic procedures. Key objectives included understanding various endoscopic complications, identifying risk factors, and implementing strategies for prevention and management.<br /><br />**Adverse Events (AEs) and Complications:**<br />- Defined AEs as injuries resulting from medical management and not the underlying disease.<br />- Serious AEs include significant outcomes like death and disability.<br /><br />**Risk and Prevention:**<br />- Emphasized informed consent, detailing risks such as bleeding, perforation, and sedation-related issues.<br /><br />**Colonoscopy Complications:**<br />- Perforations: Occur at a pooled rate of 5.8 per 100,000 colonoscopies. Risk factors include IBD, steroid use, and prior abdominal surgery. Prevention strategies include careful scope handling and the use of water instead of air for insufflation.<br />- Bleeding: Occurs at 2.4 per 1000 colonoscopies, higher with polypectomies. Prevention includes using cold snare techniques for smaller polyps and adhering to anticoagulation guidelines.<br /><br />**Post-Procedure Issues:**<br />- Post-Polypectomy Syndrome: Characterized by abdominal pain and fever, managed with hydration and antibiotics.<br />- Splenic Injury: Rare but serious, often due to excessive scope maneuvering.<br /><br />**Other Endoscopic Procedures:**<br />- EGD: Perforation and bleeding risks, particularly with conditions like Zenkers and malignancies.<br />- ERCP: Common complications include pancreatitis, bleeding post-sphincterotomy, and infections like cholangitis.<br />  <br />**Medico-Legal Issues:**<br />- GI is the 6th most cited specialty in malpractice claims, particularly from colonoscopies and ERCPs.<br />- Malpractice education emphasizes prevention, thorough documentation, and adherence to guidelines.<br />- Building patient rapport and ensuring clear communication can significantly reduce malpractice risk.<br /><br />**Managing AEs:**<br />- Full disclosure and coordinated care are crucial.<br />- Providers involved in adverse events (second victims) often experience significant emotional impact, necessitating support and clear communication.<br /><br />Dr. Gao's presentation highlighted the importance of meticulous technique, risk assessment, patient communication, and preventive strategies to mitigate complications in gastrointestinal endoscopy.
Keywords
endoscopy
complications
risk factors
prevention
colonoscopy
adverse events
perforation
bleeding
malpractice
patient communication