Mistakes in colonoscopy and how to avoid them

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Mistakes in colonoscopy and how to avoid them

Manmeet Matharoo, Siwan Thomas-Gibson, Srivathsan Ravindran

Summary

AI Generated

This article identifies six common avoidable mistakes in colonoscopy that impact safety, quality, and post-colonoscopy colorectal cancer rates.

Colonoscopy is a complex procedure requiring technical and non-technical skills including manual and visuospatial abilities, pathology interpretation, patient communication, and use of advanced therapeutic technologies.
Each colonoscopy varies due to patient factors, sedation strategy, anatomical configuration, technical challenges, and endoscopist skills, requiring individualised clinical intention and team-based patient management.
Avoiding common mistakes can improve procedure safety and quality, reduce post-colonoscopy colorectal cancer rates, and enhance patient experience and adherence to surveillance programmes.
The article draws on evidence and the authors' collective clinical and research experience of endoscopy errors and patient safety.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6

Rees, C.J., et al., British Society of Gastroenterology position statement on patient experience of GI endoscopy. Gut, 2019: p. gutjnl-2019-319207. [Link]

Maurice, J.B., et al., Green endoscopy: using quality improvement to develop sustainable practice. Frontline Gastroenterology, 2021: p. flgastro-2021-101874. [Link]

British Society of Gastroenterology (BSG), Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) GUIDANCE ON THE INDICATIONS FOR DIAGNOSTIC UPPER GI ENDOSCOPY, FLEXIBLE SIGMOIDOSCOPY AND COLONOSCOPY. 2013. [Link]

Ravindran, S., et al., Development and impact of an endoscopic non-technical skills (ENTS) behavioural marker system. BMJ Simulation and Technology Enhanced Learning, 2021. 7(1): p. 17-25. [Link]

Hicks, C.W., et al., Improving Safety and Quality of Care With Enhanced Teamwork Through Operating Room Briefings. JAMA Surgery, 2014. 149(8): p. 863-868. [Link]

Matharoo, M., et al., Implementation of an endoscopy safety checklist. Frontline Gastroenterology, 2014. 5(4): p. 260-265. [Link]

Gralnek, I.M., et al., Guidance for the implementation of a safety checklist for gastrointestinal endoscopic procedures: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy, 2022. 54(2): p. 206-210. [Link]

Ching, H.-L., et al., Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy, 2022. 54(07): p. 712-722. [Link]

Everett, S.M., et al., Guideline for obtaining valid consent for gastrointestinal endoscopy procedures. Gut, 2016. 65(10): p. 1585. [Link]

10.

Anderson, R., N.E. Burr, and R. Valori, Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis. Gastroenterology, 2020. 158(5): p. 1287-1299.e2. [Link]

11.

Cadoni, S., et al., Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy. Clinical Gastroenterology and Hepatology, 2015. 13(11): p. 1972-1980.e3. [Link]

12.

Fuccio, L., et al., Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies. Gastrointestinal Endoscopy, 2018. 88(4): p. 589-597.e11. [Link]

13.

Choy, M.C., M. Matharoo, and S. Thomas-Gibson, Diagnostic ileocolonoscopy: getting the basics right. Frontline Gastroenterology, 2020. 11(6): p. 484. [Link]

14.

Gavin, D.R., et al., The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut, 2013. 62(2): p. 242. [Link]

15.

Kaminski, M.F., et al., Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterology Journal, 2017. 5(3): p. 309-334. [Link]

16.

Kaminski, M.F., et al., Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death. Gastroenterology, 2017. 153(1): p. 98-105. [Link]

17.

Manfredi, M.A., et al., Electronic chromoendoscopy. Gastrointestinal Endoscopy, 2015. 81(2): p. 249-261. [Link]

18.

Repici, A., et al., Artificial intelligence and colonoscopy experience: lessons from two randomised trials. Gut, 2022. 71(4): p. 757. [Link]

19.

Kröner, P.T., et al., Artificial intelligence in gastroenterology: A state-of-the-art review. World journal of gastroenterology, 2021. 27(40): p. 6794-6824. [Link]

20.

Messmann, H., et al., Expected value of artificial intelligence in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy, 2022. 54(12): p. 1211-1231. [Link]

21.

Siau, K., et al., Direct observation of procedural skills (DOPS) assessment in diagnostic gastroscopy: nationwide evidence of validity and competency development during training. Surgical endoscopy, 2020. 34(1): p. 105-114. [Link]

22.

Ravindran, S., et al., Teamworking in endoscopy: a human factors toolkit for the COVID-19 era. Endoscopy, 2020. 52(10): p. 879-883. [Link]

23.

Ravindran, S., et al., Development of the “Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills” (TEAM-ENTS) behavioral marker system. Endoscopy, 2022(EFirst). [Link]

24.

Lee, T.J., et al., Development of a national automated endoscopy database: The United Kingdom National Endoscopy Database (NED). United European gastroenterology journal, 2019. 7(6): p. 798-806. [Link]

25.

Rey, J.F., R. Lambert, and E.Q.A.C. and the, ESGE Recommendations for Quality Control in Gastrointestinal Endoscopy: Guidelines for Image Documentation in Upper and Lower GI Endoscopy. Endoscopy, 2001. 33(10): p. 901-903. [Link]

Abstract

Colonoscopy is a complex procedure requiring both technical and non-technical skills. Performing colonoscopy also requires manual and visuospatial skills, interpretation of pathology, patient communication and a wide range of advanced therapeutic technologies. The clinical intention of colonoscopy must be individualised, and diagnostic and/or therapeutic intent rationalised, given the procedures invasive nature and associated risks. Furthermore, each colonoscopy differs due to patient factors, sedation strategy, anatomical configuration, technical challenges and endoscopist skills. Endoscopists must, therefore, demonstrate a wide range of expertise whilst working effectively in a team to manage the patient safely. It is not, therefore, surprising that mistakes in colonoscopy can occur. This article focuses on six common mistakes in colonoscopy that can be avoided to improve the procedure's safety and deliver a high-quality procedure. This, in turn, can reduce the rates of post-colonoscopy colorectal cancer (PCCRC) and improve patient experience and adherence to colonoscopy surveillance programmes. This article is based on evidence in conjunction with our collective clinical and research experience of errors in endoscopy and patient safety.

Topics

Endoscopy

Citation

Matharoo M, Ravindran S and Thomas-Gibson S. Mistakes in colonoscopy and how to avoid them. UEG Education 2023; 23: 4-7.

Published

2023

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UEG Standards and Guidelines

New

Clinical Practice Guideline

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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

Laura Leeuwenburgh

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Summary is not available for this content yet.

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Guideline

ABSTRACT

Background

Pancreatic cancer remains one of the most lethal cancers despite extensive efforts and research conducted over the past decades. To effectuate groundbreaking improvements in pancreatic cancer treatment, interdisciplinary and international collaboration is essential. Evidence-based guidelines, including state-of-the-art evidence and expert opinion, are crucial to guide medical specialists, researchers, and patients, especially on issues where consensus is still lacking. This article describes the methodological protocol for the development of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer. The guideline aims to identify current knowledge gaps on pancreatic cancer management, develop questions based on these knowledge gaps, and answer these questions with evidence-based recommendations supplemented, when evidence is lacking, with expert advice for treatment and future research.

Methods

This guideline development protocol is developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The process is structured into six stages: First, 13 theme-based multidisciplinary working groups are established, comprising representatives from 30 European medical and patient societies. Second, these working groups identify the most relevant current knowledge gaps on pancreatic cancer within their theme and formulate key questions. Third, the available evidence to answer these key questions is obtained through systematic reviews and the certainty of evidence is assessed using the GRADE approach. Fourth, recommendations are developed based on the available evidence. Fifth, all participants reach consensus on the recommendations through a modified Delphi process. Sixth, the recommendations are discussed during an open conference, including an external validation committee.

Discussion

This methodological protocol of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer is designed to identify key knowledge gaps across 13 themes and formulate evidence-based recommendations. This guideline initiative unites 30 European medical and patient societies for pancreatic cancer.

Summary

Methodological protocol of an international multi-disciplinary guideline involving 30 European medical and patient societies.
This protocol highlights the six stages of the guideline development process, adhering to the key principles of the GRADE methodology, and thereby aims to maximise transparency and methodological quality.
With addressing knowledge gaps, this guideline will uncover areas with limited evidence. A priority rating for research needs, based on a survey, will be established, highlighting areas where future research is most warranted.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

Clinical and Public Health Guidelines 3 (2026)

Published

2026

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Mistakes in Pancreatic exocrine insufficiency and how to avoid them

Miroslav Vujasinovic, J. Enrique Domínguez Muñoz, Matthias Löhr

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6

Rees, C.J., et al., British Society of Gastroenterology position statement on patient experience of GI endoscopy. Gut, 2019: p. gutjnl-2019-319207. [Link]

Maurice, J.B., et al., Green endoscopy: using quality improvement to develop sustainable practice. Frontline Gastroenterology, 2021: p. flgastro-2021-101874. [Link]

Ravindran, S., et al., Development and impact of an endoscopic non-technical skills (ENTS) behavioural marker system. BMJ Simulation and Technology Enhanced Learning, 2021. 7(1): p. 17-25. [Link]

Hicks, C.W., et al., Improving Safety and Quality of Care With Enhanced Teamwork Through Operating Room Briefings. JAMA Surgery, 2014. 149(8): p. 863-868. [Link]

Matharoo, M., et al., Implementation of an endoscopy safety checklist. Frontline Gastroenterology, 2014. 5(4): p. 260-265. [Link]

Everett, S.M., et al., Guideline for obtaining valid consent for gastrointestinal endoscopy procedures. Gut, 2016. 65(10): p. 1585. [Link]

10.

Anderson, R., N.E. Burr, and R. Valori, Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis. Gastroenterology, 2020. 158(5): p. 1287-1299.e2. [Link]

11.

12.

13.

Choy, M.C., M. Matharoo, and S. Thomas-Gibson, Diagnostic ileocolonoscopy: getting the basics right. Frontline Gastroenterology, 2020. 11(6): p. 484. [Link]

14.

Gavin, D.R., et al., The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut, 2013. 62(2): p. 242. [Link]

15.

16.

Kaminski, M.F., et al., Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death. Gastroenterology, 2017. 153(1): p. 98-105. [Link]

17.

Manfredi, M.A., et al., Electronic chromoendoscopy. Gastrointestinal Endoscopy, 2015. 81(2): p. 249-261. [Link]

18.

Repici, A., et al., Artificial intelligence and colonoscopy experience: lessons from two randomised trials. Gut, 2022. 71(4): p. 757. [Link]

19.

Kröner, P.T., et al., Artificial intelligence in gastroenterology: A state-of-the-art review. World journal of gastroenterology, 2021. 27(40): p. 6794-6824. [Link]

20.

21.

22.

Ravindran, S., et al., Teamworking in endoscopy: a human factors toolkit for the COVID-19 era. Endoscopy, 2020. 52(10): p. 879-883. [Link]

23.

Ravindran, S., et al., Development of the “Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills” (TEAM-ENTS) behavioral marker system. Endoscopy, 2022(EFirst). [Link]

24.

25.

Abstract

Pancreatic exocrine insufficiency (PEI) is a common yet frequently under-recognised cause of maldigestion, malabsorption, and malnutrition. Although traditionally associated with primary pancreatic disorders such as chronic pancreatitis, cystic fibrosis, pancreatic cancer, or pancreatic surgery, it is now evident that PEI also occurs in a wide range of extra-pancreatic conditions and clinical settings. Advances in diagnostic testing and expanding clinical awareness have improved detection; however, significant misconceptions persist regarding when to suspect PEI; how to interpret diagnostic tests; and how to initiate, optimise, and monitor pancreatic enzyme replacement therapy (PERT). In everyday practice, these errors may lead to delayed diagnosis, inappropriate treatment, persistent symptoms, and preventable nutritional deficiencies. This “Mistakes in…” article highlights common pitfalls in the diagnosis and management of PEI, focusing on inappropriate reliance on faecal elastase testing, failure to recognise secondary causes, undertreatment with PERT, and inadequate nutritional assessment. By addressing these frequent mistakes, we aim to promote a more structured, patient-centred, and evidence-informed approach to PEI that improves clinical outcomes and quality of life.

Topics

Pancreas

Published

2026

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Mistakes in colorectal cancer and how to avoid them

Antoni Castells, Francesc Balaguer

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6

Rees, C.J., et al., British Society of Gastroenterology position statement on patient experience of GI endoscopy. Gut, 2019: p. gutjnl-2019-319207. [Link]

Maurice, J.B., et al., Green endoscopy: using quality improvement to develop sustainable practice. Frontline Gastroenterology, 2021: p. flgastro-2021-101874. [Link]

Ravindran, S., et al., Development and impact of an endoscopic non-technical skills (ENTS) behavioural marker system. BMJ Simulation and Technology Enhanced Learning, 2021. 7(1): p. 17-25. [Link]

Hicks, C.W., et al., Improving Safety and Quality of Care With Enhanced Teamwork Through Operating Room Briefings. JAMA Surgery, 2014. 149(8): p. 863-868. [Link]

Matharoo, M., et al., Implementation of an endoscopy safety checklist. Frontline Gastroenterology, 2014. 5(4): p. 260-265. [Link]

Everett, S.M., et al., Guideline for obtaining valid consent for gastrointestinal endoscopy procedures. Gut, 2016. 65(10): p. 1585. [Link]

10.

Anderson, R., N.E. Burr, and R. Valori, Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis. Gastroenterology, 2020. 158(5): p. 1287-1299.e2. [Link]

11.

12.

13.

Choy, M.C., M. Matharoo, and S. Thomas-Gibson, Diagnostic ileocolonoscopy: getting the basics right. Frontline Gastroenterology, 2020. 11(6): p. 484. [Link]

14.

Gavin, D.R., et al., The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut, 2013. 62(2): p. 242. [Link]

15.

16.

Kaminski, M.F., et al., Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death. Gastroenterology, 2017. 153(1): p. 98-105. [Link]

17.

Manfredi, M.A., et al., Electronic chromoendoscopy. Gastrointestinal Endoscopy, 2015. 81(2): p. 249-261. [Link]

18.

Repici, A., et al., Artificial intelligence and colonoscopy experience: lessons from two randomised trials. Gut, 2022. 71(4): p. 757. [Link]

19.

Kröner, P.T., et al., Artificial intelligence in gastroenterology: A state-of-the-art review. World journal of gastroenterology, 2021. 27(40): p. 6794-6824. [Link]

20.

21.

22.

Ravindran, S., et al., Teamworking in endoscopy: a human factors toolkit for the COVID-19 era. Endoscopy, 2020. 52(10): p. 879-883. [Link]

23.

Ravindran, S., et al., Development of the “Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills” (TEAM-ENTS) behavioral marker system. Endoscopy, 2022(EFirst). [Link]

24.

25.

Abstract

Colorectal cancer (CRC) is a common and deadly disease. Advances in understanding the disease have improved diagnosis, prevention, and treatment. Genetic factors play a role in some cases of CRC, and identifying hereditary disorders has helped reduce morbidity and mortality. Serrated polyps are also precursors of CRC, and colonoscopy is crucial for screening and prevention. However, colonoscopy is not perfect, and some lesions may be missed. Here we discuss common mistakes in CRC diagnosis, prevention, and treatment, and how to avoid them.

Topics

Digestive Oncology

Citation

Balaguer F and Castells A. Mistakes in colorectal cancer and how to avoid them. UEG Education 2016: 16: 7–10.

Published

2025

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Ten commandments of the colon

Egle Dieninyte - Misiune 1, Cesare Hassan 2

Affiliations

1 Center of hepatology, gastroenterology and dietetics, Vilnius university Santaros Klinikos, Lithuania

2 Humanitas University, Rome, Italy

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Topics

Endoscopy

Published

2024

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