First Year Fellows Endoscopy Course (August 4-5)

1_Intro to Endoscopy
Pdf Summary
The document provides an overview of several important aspects of endoscopy procedures. The first section focuses on informed consent, emphasizing the importance of disclosure, including a description of the procedure, potential risks and adverse events, alternatives, and potential harms of not proceeding. It also stresses the need for full disclosure to strengthen the physician-patient relationship. Additionally, it suggests discussing "worst possible outcomes," such as ICU care, blood transfusions, surgery, and the remote possibility of death.<br /><br />The next section discusses patient preparation and highlights the importance of following NPO (nothing by mouth) guidelines, which include specific timeframes after consuming solid food, milk, or clear liquids. It emphasizes the consequences of inadequate cleansing, such as hindering polyp detection and increasing the risk and severity of complications.<br /><br />The document also addresses the use of antibiotic prophylaxis, stating that it is not recommended solely for the prevention of endocarditis in gastrointestinal procedures. It provides data on the incidence of bacteremia in endoscopic and routine daily activities. It recommends antibiotic prophylaxis for certain procedures, such as PEG or D-PEJ placement, ERCP with incomplete drainage, EUS-FNA of mediastinal cysts, EUS-FNA for pancreatic cyst aspiration, and cirrhosis with acute GI bleeding.<br /><br />Regarding anticoagulation management, the document advises against discontinuing aspirin or NSAIDs prior to endoscopic procedures, but suggests considering discontinuing Plavix (clopidogrel) 7 days before high-risk procedures after weighing the risk of thrombosis versus bleeding risk.<br /><br />The section on sedation discusses procedural monitoring, assessment of patient risk factors and medication requirements, airway assessment, and recommendations for decreasing sedation doses in certain populations. It also mentions complications of sedation, including allergic reactions, local skin reactions, and arterial oxygen desaturation.<br /><br />Lastly, the document emphasizes the prevention, detection, and treatment of complications. It stresses the importance of remaining vigilant, taking patient characteristics and limitations into account, and promptly addressing any concerns. It also highlights the need for honest and prompt communication with patients, families, and other providers.<br /><br />Overall, the document provides a comprehensive overview of important considerations in endoscopy procedures, including informed consent, patient preparation, antibiotic prophylaxis, anticoagulation management, sedation, and complications.
Keywords
endoscopy procedures
informed consent
patient preparation
antibiotic prophylaxis
anticoagulation management
sedation
complications
NPO guidelines
polyp detection
honest communication