A High Quality Approach to Addressing Complications of Endoscopy and Optimizing Risk Management Strategies

Endoscopy is generally safe, well tolerated, and important for both diagnosis and therapeutic interventions. Endoscopic procedures are important for the prevention of colon cancer, the control of active hemorrhage, symptomatic improvement for dysphagia, prevention of cancer in Barrett's esophagus and treatment of pancreatic and hepatobiliary disorders, etc. There has been an ongoing trend towards expansion of uses of therapeutic endoscopic procedures, including minimally invasive procedures, (such as per oral endoscopic myotomy (POEM), gastric per oral endoscopic myotomy, anti-reflux procedures, and bariatric procedures) which may offer a less invasive approach to common diseases than traditional surgical approaches, thus expanding the opportunity to help patients, including older and increasingly frail patients. There is also increased capacity of standard procedures such as colonoscopy to remove larger polyps and flat lesions, which also reduces the need for surgery (and attendant surgical complications), but with the potential for increased colonoscopic complications. Thus, advances in endoscopy come with potential costs, particularly as the complexity of the procedure and the frailty of the patient increase. Despite risk reduction interventions and endoscopic expertise, complications are essentially inevitable given the procedural volume and complexity of procedures provided by most gastroenterologists. The awareness of complications has been accompanied by increased attention for prevention and managing endoscopic complications, as well as the need for ethical disclosure of complications in a transparent manner and the development of programmatic approaches to complication management. This article will explore: (1) actions to prevent complications, (2) understanding how to manage complications that will inevitably arise, (3) understanding legal liability that may result from complications, and (4) discuss strategies to minimize liability. This article is meant for educational purposes and does not constitute specific legal advice. Please consult with your healthcare attorney for specific legal advice.