Correlation Engine 2.0
Clear Search sequence regions


  • abdomen soft (2)
  • abort (6)
  • antral (4)
  • back pain (3)
  • behavior (8)
  • bladder (3)
  • blood (5)
  • blood urea nitrogen (3)
  • brain (2)
  • calcium (1)
  • cardiac arrhythmia (2)
  • cardiac ischemia (2)
  • case reports (11)
  • cases (14)
  • chloral (1)
  • chronic back pain (1)
  • clients (1)
  • cognitive (3)
  • cognitive impairment (1)
  • colon (1)
  • consults (1)
  • diagnosis (1)
  • diazepam (2)
  • drunken (1)
  • dry skin (1)
  • duodenum (3)
  • ekg (2)
  • electrocardiogram (1)
  • electrolytes (1)
  • emergencies (13)
  • expert opinion (1)
  • factor (1)
  • frailties (2)
  • gastric antrum (1)
  • gastric lesions (1)
  • gastric polyps (3)
  • guaiac (1)
  • hematuria (1)
  • hemoglobin normal (1)
  • hydronephrosis (1)
  • hydroureteronephrosis (3)
  • illicit drug (2)
  • impaired (28)
  • impaired physicians (3)
  • inform (1)
  • ketonuria (2)
  • ketosis (1)
  • lactic acid (1)
  • left lower quadrant pain (1)
  • levels serum electrolytes (1)
  • membranes absent (1)
  • mental status (13)
  • motrin (8)
  • mucous membranes (2)
  • nephrolithiasis 2 (1)
  • neutrophils (2)
  • nurses (5)
  • ovid (1)
  • pain after (2)
  • pain treatment (1)
  • patient (19)
  • physician (8)
  • pile (1)
  • polyps (3)
  • prostate (2)
  • protect (1)
  • pylorus (1)
  • rate breaths (2)
  • rectum (1)
  • relates (1)
  • screen (3)
  • serum (2)
  • skin turgor (2)
  • stone (8)
  • stone ureter (3)
  • sweat (2)
  • tender (1)
  • thyroid function tests normal (1)
  • toxic (13)
  • trimethoprim (1)
  • troponin (2)
  • ureter (3)
  • urinalysis (2)
  • urosepsis (5)
  • visual agnosia (1)
  • walk (1)
  • washington (1)
  • wheelchair (1)
  • wife (1)
  • within normal limits (3)
  • Sizes of these terms reflect their relevance to your search.

    Although deficient procedures performed by impaired physicians have been reported for many specialists, such as surgeons and anesthesiologists, systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy. Yet gastroenterologists, like any individual, can rarely suffer acute-changes-in-mental-status from medical disorders, and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday. Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak, two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy. Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps, and absurdly "pressed" endoscopic steering dials to "take" endoscopic photographs; Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum, and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall. Endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager. She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies (fulfilling ethical imperative of "physician, first-do-no-harm"), and go to emergency room for medical evaluation. Both endoscopists complied. In-hospital-work-up revealed toxic encephalopathy in both from: case-1-urosepsis and left-ureteral-impacted-nephrolithiasis; and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger. Endoscopists rapidly recovered with medical therapy. This rare syndrome (0.0011% of endoscopies) may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy. Recommended management (followed in both cases): 1-recognize incident as medical emergency demanding immediate action to prevent iatrogenic patient injury; 2- inform Chief-of-Gastroenterology; and 3-immediately intervene to abort endoscopy to protect patient. Syndromic features require further study. ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

    Citation

    Mitchell S Cappell. Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm World journal of gastroenterology. 2020 Mar 07;26(9):984-991

    Expand section icon Mesh Tags

    Expand section icon Substances


    PMID: 32206008

    View Full Text