Endoscopists strive to never have complications, but they will occur, and it’s important to be prepared for them and to be open and honest when they happen—to prevent them from happening again and reduce medical liabilities.

Although the field of endoscopy is young, with the first fiberoptic gastroscopy performed in 1958 and the first cold-snare polypectomy in 1969, it is moving at a breakneck pace as new interventions are developed to handle a host of bodily conditions and disorders, according to Andrew Storm, MD, the Director of Device Trials and Endoscopic Innovation at Wake Forest University School of Medicine, in Winston-Salem, North Carolina. With all this development, Dr. Storm said, adverse events can happen.

Some adverse events are complications such as bleeding or perforation, but they also include simply missing something, noted Megan Adams, MD, JD, MSc, an associate professor at the University of Michigan Medical School, in Ann Arbor. About 25% of adenomas and serrated polyps and 9% of advanced adenomas are missed during colonoscopy, she said (Gastroenterology 2019;156[6]:1661-1674.e11; Am J Gastroenterol 2020;115[9]:1525-1531). Thus, the risk may not be due to what is done but what is missed, despite a doctor’s best intentions.

In a session at DDW 2025, Drs. Storm and Adams and other experts discussed best practices for managing adverse events in endoscopy, providing recommendations for communicating with patients and colleagues before and after procedures.

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Informed Consent

Dr. Adams stressed the importance of true informed consent, actively asking patients whether they know what various parts of their procedure will entail and educating them about the risks and benefits. She said this is especially important for high-risk patients and older patients, who may have a higher likelihood of a complication or be less able to recover from one, to ensure that the patient is fully aware of all the risks of a procedure and physically and mentally prepared.

A significant element of informed consent is paying attention to language. Try to talk to patients “without too much medical jargon,” Dr. Adams said. Each patient is different, so Dr. Adams recommended tailoring the communication and consent process to individual patients and their informational needs.

Braden Kuo, MD, the chief of gastroenterology at Columbia University Irving Medical Center, in New York City, said every doctor develops their own personalized script as they gain more clinical experience that helps them authentically and succinctly communicate the risks and benefits of a procedure. For new gastroenterologists, it is extremely important to take the time to do that, even with pressures on time and productivity.

“The more time you invest with a patient, especially with negative outcomes, the better you can manage potential legal actions in the future,” he said. “Investing in communication is key.”

Dealing With Complications And Legal Fallout

If a patient experiences a complication, it’s important to be present and talk with them. Check in with patients after a procedure to assure them and their families that you care about their outcomes, Dr. Adams said, and offer to answer any questions and discuss the postprocedural management plan to help monitor the situation and ensure the patient recovers.

Interacting with patients after a complication in a procedure can be challenging, but being transparent in conversations with patients and carefully documenting those conversations create a culture of safety and accountability, Dr. Adams said, adding that failing to to communicate with patients and fully document these interactions can lead to medical liabilities.

In the unfortunate event a patient files a legal claim after a procedure, Dr. Adams added, careful documentation in real time in an electronic medical record will pay off. Do not alter any historical records, and if you must, be sure to include a time stamp when you alter the record and document why you are doing so.

About 12% of gastroenterologists face a legal claim annually, Dr. Adams said (Clin Gastroenterol Hepatol 2008;6[6]:677-681; N Engl J Med 2011;365[7]:629-636). “One in four of these are endoscopy related, with colonoscopies [constituting] the highest amount of paid claims. … Studies of closed claims related to complications of GI endoscopy indicate that the risk of a paid claim is much higher in cases involving poor communication than in those alleging poor technical skill alone.”

For this reason, she added, it’s important to go the extra mile to educate and communicate well with your patients. She recommended that endoscopists use educational materials and be mindful of socioeconomic factors or language barriers that may necessitate additional resources. From there, she said, push to create a culture of nonpunitive reporting and analysis of adverse events within your institution (Am J Gastroenterol 2020;115:1460-1465).

Team-Based Approach

Dr. Storm spoke about remembering his first complication “like it was yesterday” when a patient’s diseased colon was perforated during a biopsy. Such accidents can be uncomfortable to discuss with colleagues, but they’re opportunities to learn, and preparing sufficiently to prevent complications is beneficial for a host of reasons that benefit all parties involved, he said.

Dr. Storm recommended that all endoscopists work with their teams to confirm whether patients have any allergies to medications every time they perform a routine procedure. Some of the worst complications stem from medication allergies, he said. He also recommended locating all the scopes and equipment needed before a procedure, anticipating how patients are going to feel afterward to order the appropriate medications beforehand, and physically moving rescue devices into a cabinet in the procedure room so that if a complication arises, no one has to search the supply room for the appropriate equipment. He also recommended training with numerous tools, such as the Boston Scientific OverStitch device, which is used to manage various procedural complications.

Toby Zuchelli, MD, a gastroenterologist at Henry Ford Health, in Detroit, said much of the physical risk factors for GIs on a daily basis stem from fatigue and musculoskeletal injuries. It’s a procedure-heavy specialty that requires repetitive movements, consistent radiation, and the donning of heavy lead aprons.

Dr. Zuchelli also recalled a previous rebleeding complication with clarity. The patient underwent an endoscopic submucosal dissection to remove an early gastric cancer, and the sutures opened 48 hours later, necessitating a blood transfusion. Dr. Zuchelli pointed to the case as an example of why it’s important to be forthright with patients and their families before procedures to ensure they know all the risks. He also said he provides his cellphone number and instructions to call with any complications.

“Dealing with complications is a stark reality in our field, especially in the realm of therapeutic endoscopy,” Dr. Zuchelli said. “Explaining adverse events to our teams shouldn’t be uncomfortable. … What damages credibility isn’t having a complication. It’s poor communication, delayed recognition, or trying to cover things up.”

—Karen Fischer

Drs. Adams and Kuo reported no relevant financial disclosures. Dr. Storm reported financial relationships with Apollo Endosurgery, Boston Scientific, Cook, Endogenex, Endo-Tagss, EnteraSense, EnVision, Fujifilm, GI Dynamics, Intuitive, Lean Medical, Medtronic, MGI Medical, Micro-Tech, Motion Medical/Mayo Clinic Ventures, Olympus, OnePass, SofTac, and Sotelix. Dr. Zuchelli reported a financial relationship with Boston Scientific.

This article is from the November 2025 print issue.