**6. Conclusion**

It is incumbent upon physicians performing colonoscopy to stay current in their field, keep abreast of the medical literature and the ongoing technological advances associated with endoscopic equipment and technique, and to be meticulous in their approach to detail in caring for their patients, particularly when gastrointestinal endoscopic diagnostic and ther‐ apeutic procedures are involved.

#### GENERAL

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

**Author details**

Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medi‐

The Major Complications of Colonoscopy: Sedation-Related, Hemorrhage Associated with Polypectomy and...

http://dx.doi.org/10.5772/51958

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[2] Jover, R., Herrálz, M., Alarcón, O., Brullet, E., Bujanda, L., Bustamante, M., Campo, R., Carreño, R., Castells, A., Cubiella, J., Garcia-Iglesias, P., Hervás, A.J., Menchén, P., Ono, A., Panadés, A., Parra-Blanco, A., Pellisé, M., Ponce, M., Quintero, E., Reñé, J.M., Sánchez del Rio, A., Seoane, A., Serradesanferm, A., Soriano Izquierdo, A., Váz‐ quez Sequeiros, E., Spanish Society of Gastroenterology (AEG) and Spanish Society of Gastrointestinal Endoscopy (SEED) Working Group. (2012) Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy. Vol.44,

[3] Stunkel, L., Benson, M., McLellan, L., Sinaii, N., Bedarida, G., Emanuel, E., Grady, C. (2010) Comprehension and informed consent: assessing the effect of a short consent

[5] Miskovitz, P. Gibofsky, A. (1995) Risk management in endoscopic practice. Gastro‐ intest Endosc Clin North Am. Vol.5, No.2, (April 1995) pp. 391-401. ISSN 1052-5157

[6] Warren, J.L., Klabunde, C.N., Mariotto, A.B., Meekins, A., Topor, M., Brown, M.L., Ransohoff, D.F. (2009) Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. Vol.150, No.12., (June 2009) pp. 849-57. W152 ISSN

[7] Baudet, J.S., Diaz-Bethencourt, D., Avilès, J., Aguirre-Jaime, A. (2009) Minor adverse events of colonoscopy on ambulatory patients: the impact of moderate sedation. Eur J Gastroenterol Hepatol. Vol.21, Issue.6, (June 2009) pp. 656-61. ISSN 1473-5687

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Paul Miskovitz

**References**

1539-3704

1365-2036

♥Be cognizant of your limitations as an endoscopist

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

SEDATION RELATED COMPLICATIONS

♥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 and ASA Physical Status Classification

♥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

procedure. Maintain a dialogue with the anesthesiologist throughout the procedure

♥Ensure that tracheal intubation and cardiac defibrillation equipment as well as resuscitation medications are available and have up to date certification in Advanced Cardiac Life Support

COLONIC HEMORRHAGE ASSOCIATED WITH POLYPECTOMY

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

♥Be thoroughly familiar with proper snare electrocautery polypectomy technique including the use of saline or epinephrine injection into the base of the polyp before initiating electrocautery

♥Avoid the use of the "hot biopsy" technique for small (several millimeter) polyps

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

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

COLONIC PERFORATION ASSOCIATED WITH POLYPECTOMY

♥Cite the risk of colonic perforation when obtaining informed consent

♥Avoid ensnaring colonic folds

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

♥Have training and familiarity with endoscopic clipping techniques

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

MISCELLANEOUS COMPLICATIONS OF COLONOSCOPY WITH AND WITHOUT POLYPECTOMY

♥If available, use carbon dioxide for colonic insufflation

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

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

♥Be cognizant of and practice infection control measures routinely

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

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