First Year Fellows Endoscopy Course (Aug 8-9)

1_Intro to Endoscopy
Pdf Summary
The ASGE First Year Fellows’ Endoscopy Course covers various topics related to endoscopy, including informed consent, patient preparation, antibiotics, anticoagulation, sedation, and complications. <br /><br />Informed consent is a crucial aspect of the endoscopy process. It involves full disclosure to the patient about the nature of the procedure, its benefits, risks, alternatives, and limitations. Physicians should explain the procedure using layman’s terms, encourage patient participation, and address any questions or concerns the patient may have. It is important to discuss the possible risks of the procedure and be transparent about the worst possible outcomes, such as ICU care, blood transfusions, surgery, and the remote possibility of death. Using witnesses and documenting the consent process is also recommended. <br /><br />Patient preparation involves guidelines for oral intake, such as continuing essential medications and complying with NPO (nothing by mouth) restrictions for a specified number of hours. Inadequate cleansing can hinder polyp detection and may lead to the need for a repeat procedure or increased risk of complications.<br /><br />Antibiotic prophylaxis is not recommended solely for the prevention of endocarditis in patients undergoing gastrointestinal procedures. The incidence of bacteremia during endoscopic procedures is outlined, as well as during routine daily activities like brushing/flossing and chewing food. Antibiotic prophylaxis is recommended for certain procedures, including PEG, ERCP with incomplete drainage, ERCP in the presence of pancreatic pseudocyst, endoscopic cystenterostomy, and EUS-FNA for cyst aspiration.<br /><br />The management of antithrombotic agents (antiplatelet medication and anticoagulants) before and after GI endoscopy is discussed. Discontinuation of aspirin or NSAIDs prior to endoscopic procedures is not supported by data. The recommendations for adjusting or continuing anticoagulation based on the risk of the procedure and the patient’s condition are outlined.<br /><br />Procedural monitoring during sedation includes pulse oximetry, blood pressure measurement, continuous lead monitoring, and observation of the patient. Tips for procedural sedation are provided, including assessing patient risk factors and medication requirements, decreasing the dose for certain patient populations, and being prepared with appropriate equipment and reversal agents.<br /><br />Complications of sedation and endoscopic procedures are discussed. Local and systemic allergic reactions, local skin reactions, and arterial oxygen desaturation are mentioned as common adverse events during sedation. The importance of prevention, detection, and treatment of complications is emphasized. Communication with the patient, family, and other providers plays a key role in managing complications.<br /><br />In conclusion, the ASGE First Year Fellows’ Endoscopy Course highlights the importance of informed consent, patient preparation, antibiotics, anticoagulation management, sedation, and complications in endoscopy procedures. Following guidelines, staying vigilant, and effectively communicating with patients and healthcare professionals can contribute to the success of the procedure and minimize complications.
Keywords
ASGE First Year Fellows' Endoscopy Course
informed consent
patient preparation
antibiotics
anticoagulation
sedation
complications
endoscopy process
patient participation
procedural monitoring