| Theme |
Risk Management in Colonoscopy |
| Title |
Risk Managements for Large Bowel Obstruction or Perforation Caused by Oral Polyethylene Glycol Administration during Bowel Preparation for Colonoscopy |
| Author |
Hideyuki Miyachi |
Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author |
Shin?ei Kudo |
Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author |
Yuichi Mori |
Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author |
Akihiro Yamauchi |
Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author |
Hatsumi Kamo |
Endoscopy Unit, Showa University Northern Yokohama Hospital |
| Author |
Sachi Saito |
Endoscopy Unit, Showa University Northern Yokohama Hospital |
| Author |
Yuri Maekawa |
Endoscopy Unit, Showa University Northern Yokohama Hospital |
| Author |
Kyoko Maki |
Endoscopy Unit, Showa University Northern Yokohama Hospital |
| Author |
Tomoko Okumura |
Endoscopy Unit, Showa University Northern Yokohama Hospital |
| Author |
Masahiro Chiba |
Endoscopy Unit, Showa University Northern Yokohama Hospital |
| Author |
Tomoko Horikoshi |
Outpatient Division,Showa University Northern Yokohama Hospital |
| Author |
Miyako Miura |
Endoscopy Center, Showa University Hospital |
| [ Summary ] |
In routine clinical practice, oral polyethylene glycol (PEG) is widely used for bowel preparation for colonoscopy. Large bowel obstruction or perforation (LBO/P) caused by PEG administration is one of the most severe adverse events associated with oral bowel preparation, and often requires emergency surgical treatment. Although LBO/P caused by PEG is rare, it is sometimes fatal. Hence, the use of oral PEG administration should be performed cautiously, by taking into account symptoms such as worsening constipation and prior abdominal computed tomography (CT) findings, among others. Contrary to our expectation, however, several LBO/P cases suddenly developed, even though we confirmed satisfactory bowel movements or CT findings in our institution. Therefore, we have gradually built up an institutional risk management protocol based on actual cases. First, we should "acknowledge" that LBO/P caused by PEG sometimes develops as a "waiting?to?happen adverse event," and monitor patient status and symptoms during PEG administration. Second, all staff working in the endoscopy unit and the outpatient division should occasionally re?evaluate the institutional risk management protocol, and establish an instructional system for novice doctors and nurses. |