Masterclass Colonoscopy: Trends and Recommendations Forward (Virtual) | February 2024-Safety in Colonoscopy Avoiding Complications and Medical Legal Risk

Safety in Colonoscopy Avoiding Complications and Medical Legal Risk

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This document discusses the importance of safety in colonoscopy procedures to avoid complications and medical-legal risk. It emphasizes safety measures during insertion, resection, and informed consent. In terms of insertion, it is important to avoid pushing against fixed resistance and switch to water in tight sigmoid areas to prevent barotrauma and diagnostic perforations. Care must also be taken to avoid forceful torque on the insertion tube to prevent splenic injury. Informed consent should cover potential risks such as perforation, missed lesion, delayed hemorrhage, splenic injury, and drug reaction or aspiration.<br /><br />During resection, the document suggests using hemostatic clips, over the scope clips, TTS suturing, or full thickness suturing to address muscle injuries. Different types of muscle injuries are described, and proper closure techniques are illustrated. Cold resection is recommended over hot resection, and snare size should be limited for conventional EMR. Additionally, the document emphasizes the importance of minimizing delayed hemorrhage through cold resection, closure of large pedunculated and EMR defects, and removal of lesions proximal to the splenic flexure using electrocautery.<br /><br />Proper dilation techniques are discussed, including not dilating asymptomatic strictures unnecessarily and considering stricture length as a predictor of perforation risk. A technique involving a sub-Q bleb or tattoo is described for marking sites. The document also emphasizes shared responsibility in avoiding wrong-site surgery, as well as correct management of malignant polyps including pedunculated and non-pedunculated lesions.<br /><br />Finally, the document highlights the importance of appropriate screening and surveillance intervals, with a system in place for reviewing lab, radiology, and pathology results. When a cancer diagnosis is made, proper communication, documentation, and coordination with other healthcare professionals is essential.

Keywords

safety measures

colonoscopy procedures

complications

medical-legal risk

informed consent

splenic injury

hemostatic clips

delayed hemorrhage

dilation techniques

malignant polyps