First Year Fellows Endoscopy Course (August 7 - 8)

1_Intro to Endoscopy
Pdf Summary
The ASGE First Year Fellows' Endoscopy Course provides an introduction to endoscopy and covers topics such as informed consent, patient preparation, antibiotics, anticoagulation, sedation, and complications.<br /><br />Informed consent is a crucial process that involves disclosing information about the procedure, including its benefits, potential risks and adverse events, alternatives, and potential needs for intubation, resuscitation, hospitalization, and blood transfusion. Full disclosure strengthens the physician-patient relationship, and discussing "worst possible outcomes" and missed lesions, using layman's terms and involving the patient, significant other, and family, is important.<br /><br />Patient preparation involves guidelines for oral intake before the procedure, such as continuing essential medications and following NPO guidelines for solid food or milk and clear liquids. Inadequate cleansing can hinder polyp detection and increase the risk and severity of complications.<br /><br />Antibiotic prophylaxis is not recommended solely for the prevention of endocarditis in patients undergoing gastrointestinal procedures. Bacteremia rates during endoscopic procedures are low compared to routine daily activities like brushing/flossing and chewing food. Antibiotic prophylaxis is recommended for specific procedures such as PEG or D-PEJ placement, ERCP with incomplete drainage, and EUS-FNA of mediastinal cysts or pancreatic cyst aspiration.<br /><br />The management of antithrombotic agents for patients undergoing GI endoscopy depends on the bleeding risk and thromboembolic risk of the procedure. Low bleeding risk procedures may not require adjustment, while high bleeding risk procedures may require stopping anticoagulation or bridging with heparin or LMWH. Discontinuation of aspirin or NSAIDs prior to endoscopic procedures is not supported by data, but discontinuing Plavix (clopidogrel) may be considered for high-risk procedures.<br /><br />Procedural sedation requires careful assessment of patient risk factors and medication requirements. Monitoring during the procedure should include pulse oximetry, blood pressure, continuous lead monitoring, and knowing the location of resuscitation equipment. Complications of sedation can include allergic reactions, skin reactions, and arterial oxygen desaturation.<br /><br />General principles for complications include prevention (knowing patient characteristics and limits), detection (maintaining a high suspicion level and using imaging if necessary), and treatment (bedside assessment, NPO, fluids, antibiotics, honest communication, and contacting the surgeon and other providers if necessary).<br /><br />In conclusion, informed consent, patient preparation, antibiotics, anticoagulation, sedation, and complications are all important aspects to consider in endoscopy procedures. Good communication, thorough preparation, and adherence to guidelines can help ensure successful procedures and patient safety.
Keywords
ASGE First Year Fellows' Endoscopy Course
endoscopy introduction
informed consent
patient preparation
antibiotics
anticoagulation
sedation
complications
endoscopy guidelines
patient safety