Management of code status in the periendoscopic period: a national survey of current practices and beliefs of U.S. gastroenterologists

Background and Aims This study aims to assess current practices and perspectives of gastroenterologists on approaches to code status before inpatient endoscopy. Methods Self-reported data were obtained through a voluntary, anonymous survey of gastroenterologists and gastroenterology trainees in the United States (U.S.). The survey assessed respondents’ approach to, beliefs, and knowledge regarding inpatient periprocedural code status discussions. Results Four hundred thirty-six gastroenterologists and 83 trainees completed the survey. In patients with an existing do not resuscitate (DNR) order, respondents reversed the code status before endoscopy either all (40.8%, n = 212) or most of the time (18.3%, n = 95). When asked their personal opinion, 32.6% (n =169) supported automatic DNR reversal to full resuscitation attempt during a procedure, 18.5% (n = 96) supported that DNR orders could be sustained, and 48.7% (n = 253) supported offering limited resuscitation. Many gastroenterologists were unaware of institutional (40.7%, n = 211) or national (80.7%, n = 419) policies and a majority reported that a gastroenterology-specific guideline would be helpful (88.6%, n = 460). Conclusions Although the majority of gastroenterologists reverse DNR orders more than 75% of the time before endoscopy, many also believe patients should be allowed to remain DNR during a procedure and supported a third option for limited resuscitation. Most gastroenterologists were unaware of institutional policies or existing national guidelines. These findings suggest considerable variation in knowledge and current approaches regarding periendoscopic code status reversal.