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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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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UEG Mistakes In Articles

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Mistakes in acute jaundice and how to avoid them

Spyridon Siakavellas, Georgios Papatheodoridis

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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

Jaundice can be caused by abnormalities in any of the steps comprising the formation, metabolism and excretion of bilirubin. In addition, these processes may be functioning properly, but jaundice can be seen because of an obstruction of the biliary tree at any point, from its intrahepatic origins to its end at the ampulla of Vater. For this reason, it is clear that numerous conditions can result in jaundice. When faced with a patient presenting with jaundice a reasonable and careful diagnostic approach is, therefore, warranted to elucidate the underlying cause of this sign. Conventional wisdom may be that “jaundice by itself never killed anyone,” but it is imperative to find the cause as soon as possible, as prompt intervention saves lives in many cases.

Topics

Hepatobiliary

Citation

Siakavellas S and Papatheodoridis G. Mistakes in acute jaundice and how to avoid them. UEG Education 2018; 18: 24–26.

Published

2025

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UEG Podcast Episode

Journal Podcast

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Episode 6: UEG Journal October Spotlight

Mohsan Subhani, Maria Manuela Estevinho

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Abstract

Topics

Endoscopy Hepatobiliary IBD Pancreas

Published

2025

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

Laura Leeuwenburgh

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis

Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in coagulation in liver disease and how to avoid them

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Mistakes in gastrostomy insertion and how to avoid them

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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

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

Laura Leeuwenburgh

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Georgios Papatheodoridis

Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in coagulation in liver disease and how to avoid them

Edoardo G. Giannini

Mistakes in gastrostomy insertion and how to avoid them

Tom Welbank

UEG Mistakes In Articles

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Mistakes in coagulation in liver disease and how to avoid them

Edoardo G. Giannini

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

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

Alteration of common coagulation tests and thrombocytopenia represent an integral part of the clinical picture of patients with advanced chronic liver disease. As such, the International Normalised Ratio (INR) for prothrombin time is part of the Model for End-stage Liver Disease (MELD) score, which is commonly used to assess prognosis and the need for liver transplantation in patients with cirrhosis. Thrombocytopenia—being mainly related to hypersplenism and decreased synthesis of thrombopoietin by the liver—can also be used to identify the presence of portal hypertension and decreased liver function in patients with chronic liver disease.

Topics

Hepatobiliary

Citation

Giannini EG and Caldwell SH. Mistakes in coagulation in liver disease and how to avoid them. UEG Education 2021; 21: 29–34.

Published

2021

More Like This:

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

Laura Leeuwenburgh

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis

Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in coagulation in liver disease and how to avoid them

Edoardo G. Giannini

Mistakes in gastrostomy insertion and how to avoid them

Tom Welbank

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.

Not sure what you can access? Learn more about account types.

Mistakes in gastrostomy insertion and how to avoid them

Tom Welbank

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

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

Long-term enteral nutrition via gastrostomy is a relatively common medical intervention for patients at risk of malnutrition who have an accessible and functioning gastrointestinal tract. There are clear clinical guidelines describing the principles of practice as well as numerous retrospective and non-randomised controlled studies and case series. However, fewer publications impart advice and guidance regarding the management and ‘patient selection’ for these interventions. The following article provides a combination of the author’s views and the evidence base.

Topics

Small Intestine & Nutrition Stomach & H. Pylori

Citation

Welbank T, Mistakes in gastrostomy insertion ingestion and how to avoid them. UEG Education 2024; 24: 8-11.

Published

2024

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