Mistakes in cases on call and how to avoid them

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Mistakes in cases on call and how to avoid them

Xavier Dray, Marine Camus

Summary

AI Generated

On-call gastroenterology, hepatology and endoscopy practice involves managing acute life-threatening presentations with decision-making based on phone information, clinical experience and available resources.

On-call specialists face a wide range of gastrointestinal, liver and pancreatic emergencies requiring evaluation and management of potentially life-threatening presentations.
Decision-making on call relies mainly on information received over the phone, medical knowledge, clinical experience and available resources.
The degree of confidence in information given on call may vary.
Precise documentation with timing of all communications, proposals and decisions with multiple caregivers including nurses, emergency physicians, intensive care physicians, surgeons and radiologists is of tremendous importance.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021. Endoscopy 2021; 53: 300-332.

Becq A, Camus M and Dray X. Foreign body ingestion: dos and don’ts. Frontline Gastroenterol 2021; 12: 664-670.

Ali Zargar S, Kochhar R, Mehta S, et al. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointestinal Endoscopy 1991; 37: 165-169.

Chirica M, Resche-Rigon M, Zagdanski AM, et al. Computed Tomography Evaluation of Esophagogastric Necrosis After Caustic Ingestion. Annals of Surgery 2016; 264: 107-113.

Assalino M, Resche-Rigon M, Corte H, et al. Emergency computed tomography evaluation of caustic ingestion. Diseases of the Esophagus 2022; 35: doac032.

Birk M, Bauerfeind P, Deprez P, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 489-496.

De Benito Sanz M, Tejedor-Tejada J, Mangas-Sanjuan C, et al. Double-Blind Multicenter Randomized Clinical Trial Comparing Glucagon vs Placebo in the Resolution of Alimentary Esophageal Impaction. American Journal of Gastroenterology 2023.

Bodkin RP, Weant KA, Baker Justice S, et al. Effectiveness of glucagon in relieving esophageal foreign body impaction: a multicenter study. The American Journal of Emergency Medicine 2016; 34: 1049-1052.

Ikenberry SO, Jue TL, Anderson MA, et al. Management of ingested foreign bodies and food impactions. Gastrointestinal Endoscopy 2011; 73: 1085-1091.

10.

Mosca S, Manes G, Martino R, et al. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: Report on a Series of 414 Adult Patients. Endoscopy 2001; 33: 692-696.

11.

Gajjar R and Gupta P. Foreign body in the rectum: A challenge for the emergency physician. J Family Med Prim Care 2016; 5: 495.

12.

Pearigen PD. UNUSUAL CAUSES OF ABDOMINAL PAIN. Emergency Medicine Clinics of North America 1996; 14: 593-614.

13.

Blauw JTM, Bulut T, Oderich GS, et al. Mesenteric vascular treatment 2016: from open surgical repair to endovascular revascularization. Best Practice & Research Clinical Gastroenterology 2017; 31: 75-84.

14.

Tilsed JVT, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 2016; 42: 253-270.

15.

Terlouw LG, Moelker A, Abrahamsen J, et al. European guidelines on chronic mesenteric ischaemia – joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia. UEG Journal 2020; 8: 371-395.

16.

Harbord M, Eliakim R, Bettenworth D, et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 2: Current Management. Journal of Crohn's and Colitis 2017; 11: 769-784.

17.

Moreau R, Tonon M, Krag A, et al. EASL Clinical Practice Guidelines on acute-on-chronic liver failure. Journal of Hepatology 2023; 79: 461-491.

Abstract

It is a difficult task and a great responsibility to evaluate and manage patients with acute - and potentially life-threatening - clinical presentations. It is even more complex to achieve high standards of care for cases on call. Indeed, on-call gastroenterologists, hepatologists and endoscopists are faced with a wide and protean range of gastrointestinal, liver and pancreatic emergencies. The decision-making process for cases on call is mainly based on information received over the phone, on medical knowledge and clinical experience, and on the resources available. As the degree of confidence in any information given on call may vary, it is of tremendous importance to note, and to document, with precise timing, what has been communicated by, proposed to, and eventually decided with, multiple caregivers (i.e. nurses, emergency physicians, intensive care physicians, surgeons, radiologists etc.)

Topics

Endoscopy Surgery

Citation

Dray X and Marteau P. Mistakes in cases on call and how to avoid them. UEG Education 2017; 17: 30–32

Published

2024

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European Interdisciplinary Guidelines on Pain Management in Acute Pancreatitis: UEG, EPC, EDS, ESDO, EAGEN, ESPGHAN, ESGAR, and ESPCG Evidence-Based Recommendations

Sanjay Pandanaboyana

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Guideline

ABSTRACT

Pain is often the presenting symptom of acute pancreatitis (AP) and has a prognostic significance, with poorly treated pain affecting patient outcomes. Despite this, there are currently no international recommendations for pain management in patients admitted with AP. This current guideline was developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. Nine working groups were formed to develop statements on pain management in AP from admission to discharge. After systematic literature reviews, the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted using three rounds of Delphi method. The guidelines concluded that acute postoperative pain management guidelines are applicable for treating acute pain due to AP. The numerical rating scale is preferred for pain assessment because of better compliance. Opioids currently form the cornerstone of severe pain management. Potent opioids such as buprenorphine and pentazocine provide superior pain relief over non-opioid medications and decrease the need for rescue analgesia. Current evidence does not consistently demonstrate harm from opioids in AP. In patients with severe pain, safety concerns should not delay the timely use of opioids to ensure adequate pain management. Specific recommendations concerning the use of epidural analgesia, acupuncture and management of pain in the paediatric population and during pregnancy are provided based on evidence and expert opinions. Finally, the unmet needs for future research were discussed and proposed.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

United European Gastroenterology Journal, 2026

Published

2026

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UEG Podcast Episode

UEG Podcast

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Coeliac disease with David Sanders

David S. Sanders, Pradeep Mundre

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Abstract

Topics

Small Intestine & Nutrition

Published

2026

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UEG Mistakes In Articles

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Mistakes in gastrostomy insertion in children and adolescents and how to avoid them

Christos Tzivinikos, Ilse Broekaert, Jorge Amil Dias, Matjaz Homan

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Becq A, Camus M and Dray X. Foreign body ingestion: dos and don’ts. Frontline Gastroenterol 2021; 12: 664-670.

Chirica M, Resche-Rigon M, Zagdanski AM, et al. Computed Tomography Evaluation of Esophagogastric Necrosis After Caustic Ingestion. Annals of Surgery 2016; 264: 107-113.

Assalino M, Resche-Rigon M, Corte H, et al. Emergency computed tomography evaluation of caustic ingestion. Diseases of the Esophagus 2022; 35: doac032.

Ikenberry SO, Jue TL, Anderson MA, et al. Management of ingested foreign bodies and food impactions. Gastrointestinal Endoscopy 2011; 73: 1085-1091.

10.

Mosca S, Manes G, Martino R, et al. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: Report on a Series of 414 Adult Patients. Endoscopy 2001; 33: 692-696.

11.

Gajjar R and Gupta P. Foreign body in the rectum: A challenge for the emergency physician. J Family Med Prim Care 2016; 5: 495.

12.

Pearigen PD. UNUSUAL CAUSES OF ABDOMINAL PAIN. Emergency Medicine Clinics of North America 1996; 14: 593-614.

13.

14.

Tilsed JVT, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 2016; 42: 253-270.

15.

16.

17.

Moreau R, Tonon M, Krag A, et al. EASL Clinical Practice Guidelines on acute-on-chronic liver failure. Journal of Hepatology 2023; 79: 461-491.

Abstract

Adequate nutrition is essential for the homeostasis of fluids and nutrients, growth and thriving, especially in children. While the underlying principle of percutaneous endoscopic gastrostomy (PEG) placement is the same for both adults and children—providing a means of enteral feeding through the stomach—the indications, considerations and techniques differ owing to anatomical differences, age-dependent physiological concerns, and the age- and disease-specific needs of the child.

If feeding via nasogastric tube (NGT) or naso-jejunal tube (NJT) is necessary for a prolonged time, placement of a PEG or percutaneous endoscopic gastro-jejunal (PEG-J) tube should be considered. A PEG tube also allows the delivery of medications and venting of the stomach when needed. Nutrition via PEG facilitates the transition to out-of-hospital care and improves the quality of life (QoL) for children and families while improving the outcome of children with chronic diseases.

There are recent clinical guidelines providing guidance for PEG tube placement in children, but little advice on, e.g., choosing the right device for the right patient, details on postoperative management, removal of the PEG tube and other specific cases. The following article provides a combination of evidence-based data and the authors’ clinical experience.

Topics

Paediatrics Small Intestine & Nutrition Stomach & H. Pylori

Citation

Broekaert I.J, Dias J.A, Homan M and Tzivinikos C. Mistakes in gastrostomy insertion in children and adolescents and how to avoid them. UEG Education 2024; 24: 34-38.

Published

2024

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UEG Mistakes In Articles

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Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

Summary

AI Generated

Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Becq A, Camus M and Dray X. Foreign body ingestion: dos and don’ts. Frontline Gastroenterol 2021; 12: 664-670.

Chirica M, Resche-Rigon M, Zagdanski AM, et al. Computed Tomography Evaluation of Esophagogastric Necrosis After Caustic Ingestion. Annals of Surgery 2016; 264: 107-113.

Assalino M, Resche-Rigon M, Corte H, et al. Emergency computed tomography evaluation of caustic ingestion. Diseases of the Esophagus 2022; 35: doac032.

Ikenberry SO, Jue TL, Anderson MA, et al. Management of ingested foreign bodies and food impactions. Gastrointestinal Endoscopy 2011; 73: 1085-1091.

10.

Mosca S, Manes G, Martino R, et al. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: Report on a Series of 414 Adult Patients. Endoscopy 2001; 33: 692-696.

11.

Gajjar R and Gupta P. Foreign body in the rectum: A challenge for the emergency physician. J Family Med Prim Care 2016; 5: 495.

12.

Pearigen PD. UNUSUAL CAUSES OF ABDOMINAL PAIN. Emergency Medicine Clinics of North America 1996; 14: 593-614.

13.

14.

Tilsed JVT, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 2016; 42: 253-270.

15.

16.

17.

Moreau R, Tonon M, Krag A, et al. EASL Clinical Practice Guidelines on acute-on-chronic liver failure. Journal of Hepatology 2023; 79: 461-491.

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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Mario Dinis-Ribeiro

UEG Standards and Guidelines

Position Paper

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Quality in diagnostic upper gastrointestinal endoscopy for the detection and surveillance of gastric cancer precursor lesions: position paper of the AEG, SEED and SEAP

Maria Gloria Fernández-Esparrach

Summary

AI Generated

Summary is not available for this content yet.

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Guideline

Abstract

This position paper, sponsored by the Asociación Espanola de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Espa˜nola de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] y the Sociedad Espanola de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of Gastric Cancer Precursor Lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.

Keywords: Gastroscopy; Upper gastrointestinal endoscopy; Quality; Intestinal metaplasia; Dysplasia; Early gastric cancer

Guideline

Position Paper

Topics

Digestive Oncology Endoscopy Histopathology Stomach & H. Pylori

Citation

Gastroenterol Hepatol. 2021;44:448-464.

Published

2021

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Pradeep Mundre

Mistakes in gastrostomy insertion in children and adolescents and how to avoid them

Christos Tzivinikos

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Quality in diagnostic upper gastrointestinal endoscopy for the detection and surveillance of gastric cancer precursor lesions: position paper of the AEG, SEED and SEAP

Maria Gloria Fernández-Esparrach

Mistakes in the management of chronic gastritis and how to avoid them

Mario Dinis-Ribeiro

UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Mistakes in the management of chronic gastritis and how to avoid them

Mario Dinis-Ribeiro, Pierluigi Fracasso

Summary

AI Generated

Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Becq A, Camus M and Dray X. Foreign body ingestion: dos and don’ts. Frontline Gastroenterol 2021; 12: 664-670.

Chirica M, Resche-Rigon M, Zagdanski AM, et al. Computed Tomography Evaluation of Esophagogastric Necrosis After Caustic Ingestion. Annals of Surgery 2016; 264: 107-113.

Assalino M, Resche-Rigon M, Corte H, et al. Emergency computed tomography evaluation of caustic ingestion. Diseases of the Esophagus 2022; 35: doac032.

Ikenberry SO, Jue TL, Anderson MA, et al. Management of ingested foreign bodies and food impactions. Gastrointestinal Endoscopy 2011; 73: 1085-1091.

10.

Mosca S, Manes G, Martino R, et al. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: Report on a Series of 414 Adult Patients. Endoscopy 2001; 33: 692-696.

11.

Gajjar R and Gupta P. Foreign body in the rectum: A challenge for the emergency physician. J Family Med Prim Care 2016; 5: 495.

12.

Pearigen PD. UNUSUAL CAUSES OF ABDOMINAL PAIN. Emergency Medicine Clinics of North America 1996; 14: 593-614.

13.

14.

Tilsed JVT, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 2016; 42: 253-270.

15.

16.

17.

Moreau R, Tonon M, Krag A, et al. EASL Clinical Practice Guidelines on acute-on-chronic liver failure. Journal of Hepatology 2023; 79: 461-491.

Abstract

Chronic gastritis is a common condition that occurs when an inflammatory infiltrate is present in the gastric mucosa. Diverse factors can cause such inflammation to develop, including food, common bacteria (particularly Helicobacter pylori) and even some viruses. Although the inflammatory infiltrate itself may not cause a disease per se, in some cases gastritis will evolve into atrophic gastritis, ulcers or gastric cancer. Clinicians therefore need to be aware of when gastritis is a harmless condition that can be left alone and when further action is required. In addition, many patients and some clinicians use the term ‘chronic gastritis’ to describe symptoms, mostly those of dyspepsia. This misuse of the terminology can lead to the erroneous conclusion that a diagnosis is being discussed and not a symptom. Here we address these mistakes and some of the others that are frequently made when managing patients with chronic gastritis. We discuss how to avoid making the mistakes to ensure that patients are managed adequately while reducing over treatment.

Topics

Stomach & H. Pylori

Citation

Fracasso P and Dinis-Ribeiro M. Mistakes in the management of chronic gastritis and how to avoid them. UEG Education 2022; 22: 8–10.

Published

2022

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Gonçalo Alexandrino

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Maria Gloria Fernández-Esparrach

Mistakes in the management of chronic gastritis and how to avoid them

Mario Dinis-Ribeiro