ABPS GI Endoscopy common mistakes
ABPS GI Endoscopy · Understand the traps and how to avoid them.
Selects sodium phosphate or magnesium citrate bowel preparation for a patient with stage 4 CKD, heart failure, or a current ACE inhibitor/ARB, without checking renal function or the medication list first.
Low-volume preparations are memorised as 'better tolerated' and the osmotic/nephrotoxic contraindication screen is skipped, so the choice is made on palatability rather than safety.
What to do instead
Before prescribing, screen eGFR, heart failure, cirrhosis, age >65 and ACEi/ARB use; default to split-dose PEG-3350 with an antiemetic, and document the contraindication check in the pre-procedure note.
Titrates midazolam and fentanyl to a standard adult dose in a 78-year-old with OSA while relying on pulse oximetry alone, and applies supplemental oxygen before assessing ventilation.
Pulse oximetry lags hypoventilation and supplemental oxygen masks desaturation, while dose requirements fall with age and comorbidity, so oversedation is recognised late.
What to do instead
Reduce starting doses by 30–50% in patients over 70 or with OSA, add capnography, and reassess respiratory rate and end-tidal CO2 before every increment; titrate to a validated sedation scale.
Calls a short segment of columnar-lined oesophagus with an irregular Z-line 'normal' and does not systematically photograph the Z-line, incisura and duodenal sweep.
Landmark photography is treated as documentation for its own sake rather than as the detection set for Barrett's, gastric metaplasia and ampullary lesions.
What to do instead
Use a fixed photo protocol (hypopharynx, Z-line axial and retroflexed, cardia, fundus, body, angulus, antrum, D1 and D2), measure the circumferential and maximal Barrett's extent, and biopsy per the Seattle protocol.
Assigns a 10-year surveillance interval after removing three 6-mm tubular adenomas, or after piecemeal resection of a 20-mm laterally spreading lesion.
The old 'one adenoma equals ten years' heuristic persists and ignores polyp number, size, histology and resection completeness.
What to do instead
Stratify with the current USMSTF table: 1–2 tubular adenomas <10 mm → 7–10 years; 3–4 → 3–5 years; ≥5 or any advanced lesion → 3 years; piecemeal lesion ≥20 mm → 6 months.
Treats a Forrest Ia spurting peptic ulcer with epinephrine injection alone and discharges the patient on oral PPI.
Epinephrine is familiar and temporarily stops bleeding, so the need for mechanical or thermal coaptation plus high-dose acid suppression is overlooked.
What to do instead
Use combination therapy (dilute epinephrine plus hemoclip or thermal probe), start high-dose intravenous PPI for 72 hours, and arrange second-look endoscopy per protocol.
Proceeds to ERCP in a patient with typical biliary colic, normal liver tests and a non-dilated duct, without prior MRCP or EUS.
ERCP is over-selected as the definitive biliary test and post-ERCP pancreatitis risk is discounted when the pre-test probability of duct stones is low.
What to do instead
Risk-stratify with ASGE likelihood criteria; use MRCP or EUS first when probability is low or intermediate, reserve ERCP for high probability or cholangitis, and place a prophylactic pancreatic stent after difficult cannulation.
Describes a 3-cm pancreatic cyst as benign because it is small and the patient is asymptomatic, while ignoring a 9-mm main duct and a mural nodule.
Size alone is used as the risk criterion, so worrisome features and high-risk stigmata are never systematically elicited or recorded.
What to do instead
Apply Fukuoka criteria explicitly: main duct ≥10 mm, enhancing nodule or jaundice are high-risk; growth, thickened wall, size ≥3 cm or duct 5–9 mm are worrisome; document each feature and refer to multidisciplinary review.
Schedules video capsule endoscopy in a patient with known stricturing Crohn's disease without a patency capsule or cross-sectional imaging first.
Capsule endoscopy is perceived as non-invasive, so capsule retention risk in stricturing disease is underestimated and not discussed.
What to do instead
Confirm small-bowel patency with a patency capsule or MR enterography, and document the retention risk and retrieval plan in the consent discussion.
Sends the endoscope to the automated reprocessor after wiping only the insertion tube, omitting the bedside channel flush and manual brushing of all channels.
The washer-disinfector is assumed to compensate for pre-cleaning, and turnover time pressure reinforces the shortcut.
What to do instead
Follow the multi-society sequence: bedside wipe and detergent flush, leak test, manual brush every channel including the elevator, then high-level disinfection, alcohol flush and forced-air drying before vertical storage.
Discharges a patient with severe abdominal pain and rigidity two hours after a difficult colonoscopy as 'trapped gas' without imaging or a surgical discussion.
Post-procedure pain is attributed to insufflation by default, and perforation is treated as a rare event rather than a time-critical diagnosis.
What to do instead
Treat severe or worsening pain, fever or haemodynamic change as perforation until excluded: erect chest and abdominal imaging or CT, intravenous fluids and antibiotics, and immediate surgical consultation.