**Author details**

Paul Miskovitz

GENERAL

any

antiplatelet agents

the preparation

colonic gas

equipment and technique

♥Avoid ensnaring colonic folds

available and in working order SEDATION RELATED COMPLICATIONS

and ASA Physical Status Classification

plasma coagulation device or heater probe

benefits of and alternatives to the proposed procedure ♥Be cognizant of your limitations as an endoscopist

206 Colonoscopy and Colorectal Cancer Screening - Future Directions

♥Obtain informed consent from the patient prior to the colonoscopy procedure with emphasis on the risks of,

♥Be certain that all necessary equipment to perform the colonoscopy procedure (diagnostic and therapeutic) is

♥Perform and document a medical history and physical examination prior to the initiation of the procedure. Include a review of the patient's current medications, known allergies, past experiences with anesthesia, Mallampati score

♥Ensure that the patient is properly monitored during the procedure including blood pressure, pulse, oximetry, capnography monitoring if available, cardiac rhythm monitoring, and airway management. If working with an anesthesiologist thoroughly discuss with your colleague the patient's medical history and the goals of the

♥Ensure that tracheal intubation and cardiac defibrillation equipment as well as resuscitation medications are

♥Take a history of the patient's anticoagulant use, antiplatelet agent use, and past history of bleeding diathesis if

♥Be thoroughly familiar with proper snare electrocautery polypectomy technique including the use of saline or

♥Have available for use if necessary clips, ligatures, epinephrine, a bipolar electrocautery device and/or an argon

♥Do not perform polypectomy when the anatomy is obscured by the size or shape of the lesion or the adequacy of

♥Have a predetermined "game plan" to expeditiously evaluate a patient suspected of having a perforation

♥Examine the patient in the recovery area post procedure to ensure that there has been adequate evacuation of

♥Keep abreast of the medical literature and ongoing technological advances associated with endoscopic

MISCELLANEOUS COMPLICATIONS OF COLONOSCOPY WITH AND WITHOUT POLYPECTOMY

♥Monitor the degree of abdominal distension by palpation throughout the procedure

♥Give specific written post-procedure instructions to the patient regarding the use of anticoagulants and

procedure. Maintain a dialogue with the anesthesiologist throughout the procedure

available and have up to date certification in Advanced Cardiac Life Support

epinephrine injection into the base of the polyp before initiating electrocautery ♥Avoid the use of the "hot biopsy" technique for small (several millimeter) polyps

COLONIC HEMORRHAGE ASSOCIATED WITH POLYPECTOMY

COLONIC PERFORATION ASSOCIATED WITH POLYPECTOMY

♥Cite the risk of colonic perforation when obtaining informed consent

♥Have training and familiarity with endoscopic clipping techniques

♥Be cognizant of and practice infection control measures routinely

**Table 1.** Recommendations to prevent specific colonoscopy complications

♥If available, use carbon dioxide for colonic insufflation

Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medi‐ cal College, New York-Presbyterian Hospital, New York, USA
