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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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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6
1.
Rees, C.J., et al., British Society of Gastroenterology position statement on patient experience of GI endoscopy. Gut, 2019: p. gutjnl-2019-319207. [Link]
2.
Maurice, J.B., et al., Green endoscopy: using quality improvement to develop sustainable practice. Frontline Gastroenterology, 2021: p. flgastro-2021-101874. [Link]
3.
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]
4.
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]
5.
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]
6.
Matharoo, M., et al., Implementation of an endoscopy safety checklist. Frontline Gastroenterology, 2014. 5(4): p. 260-265. [Link]
7.
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]
8.
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]
9.
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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Abstract

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Summary

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Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6
1.
Rees, C.J., et al., British Society of Gastroenterology position statement on patient experience of GI endoscopy. Gut, 2019: p. gutjnl-2019-319207. [Link]
2.
Maurice, J.B., et al., Green endoscopy: using quality improvement to develop sustainable practice. Frontline Gastroenterology, 2021: p. flgastro-2021-101874. [Link]
3.
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]
4.
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]
5.
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]
6.
Matharoo, M., et al., Implementation of an endoscopy safety checklist. Frontline Gastroenterology, 2014. 5(4): p. 260-265. [Link]
7.
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]
8.
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]
9.
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

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

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Published

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

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

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Mistakes in colorectal cancer and how to avoid them

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Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6
1.
Rees, C.J., et al., British Society of Gastroenterology position statement on patient experience of GI endoscopy. Gut, 2019: p. gutjnl-2019-319207. [Link]
2.
Maurice, J.B., et al., Green endoscopy: using quality improvement to develop sustainable practice. Frontline Gastroenterology, 2021: p. flgastro-2021-101874. [Link]
3.
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]
4.
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]
5.
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]
6.
Matharoo, M., et al., Implementation of an endoscopy safety checklist. Frontline Gastroenterology, 2014. 5(4): p. 260-265. [Link]
7.
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]
8.
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]
9.
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

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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UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

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 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
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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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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.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Endoscopy

Published

2024

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

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Cesare Hassan Cesare Hassan, Egle Dieninyte - Misiune

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