First Year Fellows Endoscopy Course (July 30-31)

1_Intro to Endoscopy
Pdf Summary
The ASGE First Year Fellows' Endoscopy Course covers various aspects of endoscopy, including informed consent, patient preparation, antibiotics, anticoagulation, sedation, and complications. Informed consent involves disclosing the nature of the procedure, its benefits, risks, alternatives, and limitations. It is important to use layman's terms and encourage patient participation. The risks of the procedure should be explained in relation to their frequency. "Worst possible outcomes" should also be discussed, including ICU care, blood transfusions, surgery, and the remote possibility of death. Missed lesions should be discussed as well, and witnesses should be present during the consent process.<br /><br />Patient preparation involves oral intake guidelines, such as continuing essential medications and following fasting guidelines. Adequate cleansing is important to facilitate polyp detection and avoid the need for repeated procedures. Antibiotic prophylaxis is not recommended solely to prevent endocarditis for gastrointestinal procedures. The rates of bacteremia during endoscopic procedures are higher compared to routine daily activity. Antibiotics may be recommended for certain procedures, such as PEG, ERCP with incomplete drainage, and EUS-FNA for cyst aspiration.<br /><br />There is no data supporting discontinuation of aspirin or NSAIDs prior to endoscopic procedures, but Plavix may be discontinued 7 days prior to high-risk procedures. The management of anticoagulants depends on the risk level of the procedure and the patient's condition. Low-risk procedures do not require any changes in anticoagulation, while high-risk procedures may require discontinuation or adjustment of anticoagulation based on specific guidelines.<br /><br />Procedural sedation should be monitored carefully, with regular assessment of the patient before the procedure. Dosing may need to be adjusted for certain patient populations. Monitoring tools such as pulse oximetry, blood pressure measurement, continuous lead monitoring, and the availability of resuscitation equipment should be in place. Complications of sedation may include local and systemic allergic reactions, local skin reactions, and arterial oxygen desaturation.<br /><br />Overall, prevention, detection, and treatment of complications are important principles to follow. Prompt communication with the patient, family, and other providers is crucial in managing complications. In conclusion, informed consent, patient preparation, appropriate use of antibiotics and anticoagulation, careful monitoring during sedation, and thorough management of complications are key aspects of endoscopy.
Keywords
endoscopy
informed consent
patient preparation
antibiotics
anticoagulation
sedation
complications
oral intake guidelines
antibiotic prophylaxis
procedural sedation