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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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UEG Mistakes In Articles
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Mistakes in transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis and how to avoid them

Kymentie Ferdinande, Alberto Zanetto, Virginia Hernández-Gea, Marco Senzolo

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

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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.
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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

TIPS success is rarely about the procedure alone. It depends on decisions made across the entire clinical pathway.

New in the UEG "Mistakes in…" series: Ferdinande et al., present 10 common mistakes in TIPS for cirrhosis, from referral to long-term follow-up.

Key themes:
• Screen the heart first: cardiac decompensation follows TIPS in up to 20% of patients.
• Refer early: delay costs survival in refractory ascites and high-risk variceal bleeding.
• Prevent encephalopathy by design: careful selection, nutrition, rifaximin, and controlled underdilation.
• Individualise haemodynamic targets and follow up structurally.

Topics

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Published

2026

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Summary

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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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Abstract

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Abstract

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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.
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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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UEG Standards and Guidelines
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ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease

Henit Yanai

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Guideline

Introduction

The therapeutic landscape of inflammatory bowel disease [IBD] has undergone a profound transformation with the advent of novel immunosuppressive and biologic agents. These advancements have revolutionised the management of Crohn’s disease [CD] and ulcerative colitis [UC], enabling tighter control of inflammation and significantly improved patient outcomes. However, while older treatment strategies, including prolonged corticosteroids, purine analogues, and anti-tumour necrosis factor [TNF]/thiopurine combination therapy, carried a substantial immunosuppressive burden, the expanding therapeutic armamentarium introduces new agents with distinct infection risk profiles that require updated, evidence-based guidance. By definition, opportunistic infections are infections caused by organisms that infrequently induce disease in immunocompetent hosts but can result in significant morbidity or mortality in immunocompromised individuals. As treatment strategies increasingly rely on potent modulation of the immune system, ranging from traditional thiopurines to advanced small molecules, a structured, evidence-based approach to infection prevention, diagnosis, and management has become indispensable for the clinician. The European Crohn’s and Colitis Organisation [ECCO] has long recognised this clinical imperative, previously publishing consensus statements in 2009 and 2014, followed by a comprehensive guideline in 2021. This 2026 update is warranted by the rapid expansion of the therapeutic armamentarium, specifically the introduction of newer small molecules, advanced biologics, and evolving vaccination strategies. This update integrates the most recent data on risk stratification, viral, bacterial, mycobacterial, and vaccine-preventable infections, emphasising a preventative strategy tailored to the contemporary IBD treatment paradigm.

Publisher

European Crohn’s and Colitis Organisation logo
European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 7, July 2026

Published

2026

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Henit Yanai Henit Yanai

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