Post-procedure pain. So this is the big and scary that we all have. So really ask any questions about the pain. If it's dull, consider that they have had overdistention, right? Maybe you put in too much air or CO2, or it was a prolonged procedure where sort of you found this big polyp, and you weren't expecting it, and you had extra time on your schedule, and you were in there for like an hour. These are the cases that you really want to think about distention. It happens more with air, much less so with CO2, but be mindful of that. If there's sharp pain, then you really need to consider strongly perforation, or if you use any sort of thermal therapies, transmural thermal injury. So I really think the take-home message, and I have it here on the right in yellow, which is use CO2 and or manage air very well. So be very mindful. Insufflate only what you need to, and then use suction limberly. And so really be cognitive of how much you're putting in and taking out. So if somebody has post-procedure pain, if you ever have any questions of what's going on, get a CT scan. It's better to get that CT scan and put the issue of potential perforation to rest rather than causing the patient undue harm or having you even stay up all night worrying about it. If it causes you not to sleep at night and the patient you might even consider perforation, get the imaging. Make sure it's not that perforation, right? We own what we do. So if we took out that polyp, the adverse event is ours. Be confident in your management and own that and discuss with the patient. And so what about post-polypectomy coagulation syndrome? So there's some causes, right? It's usually local peritoneal irritation from thermal injury, a transmural thermal injury that irritates the serosa. It ranges depending on different settings, how long you've sat there on your coagulation, anywhere from a half percent to a little over 1%. It can present anywhere from one day to five days after colonoscopy and the symptoms are very similar to perforation, right? Fever, localized abdominal pain, some peritoneal signs and some leukocytosis. The difference is that you don't see free air on your imaging. So how do you treat it? Low peros, antibiotics, and then monitor them. Do serial exams, monitor for elevated white counts and fevers. They usually resolve spontaneously without surgical treatment or intervention. But if symptoms continue, you know, sometimes these patients might need additional exploration.

post-procedure pain

colonoscopy

CO2 management

perforation

post-polypectomy coagulation syndrome