First Year Fellows Endoscopy Course (July 30-31)

1_Intro to Endoscopy
Pdf Summary
The ASGE First Year Fellows' Endoscopy Course includes content on informed consent, patient preparation, antibiotics, anticoagulation, sedation, and complications. Informed consent is a process that includes disclosing information about the procedure, its benefits, potential risks and adverse events, alternatives, and the potential harms of not proceeding. Full disclosure strengthens the physician-patient relationship. Informed consent should discuss the "worst possible outcomes" such as ICU care, blood transfusions, surgery, and the remote possibility of death. It is important to use layman's terms and involve the patient, significant other, and family in the discussion.<br /><br />Patient preparation involves guidelines for oral intake before the procedure, including continuing essential medications and following NPO guidelines. Inadequate cleansing can hinder polyp detection, necessitate repeat procedures, increase procedure time, and increase the risk and severity of complications.<br /><br />Antibiotic prophylaxis is recommended 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. However, the administration of antibiotics solely to prevent endocarditis is not recommended.<br /><br />For patients on antiplatelet medication, there is no data supporting discontinuation of aspirin or NSAIDs prior to endoscopic procedures. However, for high-risk procedures, discontinuing Plavix (clopidogrel) 7 days prior may be considered, weighing the risk of thrombosis against the bleeding risk.<br /><br />Procedural sedation should be monitored with pulse oximetry, blood pressure, continuous lead monitoring, and the observation of the patient. Before the procedure, assess patient risk factors and medication requirements, conduct an airway assessment, and adjust sedation doses for specific patient conditions.<br /><br />Complications of sedation can include local and systemic allergic reactions, local skin reactions, and arterial oxygen desaturation. Prevention, detection, and treatment of complications are key, including proper patient assessment, maintaining a high level of suspicion, and communicating promptly and honestly with the patient and other providers if concerns arise.<br /><br />In conclusion, informed consent, patient preparation, appropriate use of antibiotics and anticoagulation, and vigilant monitoring and management of sedation and complications are essential for successful endoscopic procedures.
Keywords
informed consent
patient preparation
antibiotics
sedation
complications
oral intake guidelines
anticoagulation
endocarditis prevention
procedural sedation
complication detection