ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day One)

Video Transcription

Video Summary

The talk reviews colonoscopy by breaking it into pre‑procedure, intra‑procedure, and post‑procedure phases, emphasizing patient selection, preparation, quality, and complications. Colonoscopy is highlighted as the only colorectal cancer screening test that can both detect and remove polyps in the same session.<br /><br />Pre‑procedure topics include confirming appropriate indications (screening/surveillance vs diagnostic symptoms such as bleeding, anemia, diarrhea, or abnormal imaging) and ensuring the procedure will change management. Timing matters: colonoscopy is often delayed after acute diverticulitis or ischemic colitis due to higher risk. Contraindications and risk–benefit assessment include severe cardiopulmonary disease, inability to consent, suspected perforation, fulminant colitis, and significant electrolyte abnormalities. Medication adjustments are reviewed (e.g., managing anticoagulants/antiplatelets; often holding GLP‑1 agents about a week and SGLT2 inhibitors 3–4 days prior). Bowel prep strategies include split dosing, choosing high- vs low-volume and isotonic vs hypertonic regimens based on comorbidities, and using tools like reminders for patients at risk of inadequate prep. Adequacy is documented with the Boston Bowel Prep Score.<br /><br />Intra‑procedure discussion covers scope selection, common interventions (biopsy, polypectomy, tattooing, hemostasis, dilation, decompression), and quality indicators (cecal intubation rate, withdrawal time, adenoma detection rate). Complications are uncommon but include sedation-related events, bleeding, and perforation; delayed post‑polypectomy bleeding most often occurs 5–7 days later. Post‑procedure care includes communicating findings, pathology follow-up, and surveillance intervals.<br /><br />Finally, AI is presented as an emerging tool that improves polyp detection and potentially polyp characterization, with ongoing financial and implementation challenges.

Asset Subtitle

Sumeet K. Tewani, MD, FASGE

Keywords

colonoscopy

colorectal cancer screening

bowel preparation

Boston Bowel Prep Score

adenoma detection rate

polypectomy complications

AI-assisted polyp detection