Canadian Association of Gastroenterology Communique: After-Hours Endoscopy Cart

Mandip Rai; Mary Cooper; Scott Shulman; Dan Kottachchi; Sandra Nelles; Mark Macmillan; Steven Heitman; Alan Barkun; Frances Tse; Lawrence Hookey

doi:10.1093/jcag/gwz032

Canadian Association of Gastroenterology Communique: After-Hours Endoscopy Cart

J Can Assoc Gastroenterol. 2020 Oct;3(5):222-227. doi: 10.1093/jcag/gwz032. Epub 2019 Nov 21.

Authors

Mandip Rai¹, Mary Cooper², Scott Shulman³, Dan Kottachchi⁴, Sandra Nelles⁵, Mark Macmillan⁶, Steven Heitman⁷, Alan Barkun⁸, Frances Tse⁹, Lawrence Hookey¹⁰

Affiliations

¹ Division of Gastroenterology, Queen's University, Kingston, Ontario, Canada.
² Division of Gastroenterology, North Ontario School of Medicine, Thunder Bay, Ontario, Canada.
³ Division of Gastroenterology, North Bay Regional Health Centre, North Bay, Ontario, Canada.
⁴ Division of Gastroenterology, Guelph General Hospital, Guelph, Ontario, Canada.
⁵ Division of Gastroenterology, Trillium Health Partners, Mississauga, Ontario, Canada.
⁶ Division of Gastroenterology, Dalhousie University, Memorial University, Fredericton, New Brunswick, Canada.
⁷ Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.
⁸ Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Quebec, Canada.
⁹ Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada.
¹⁰ Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada.

Abstract

Background: Endoscopic procedures performed after-hours often require therapeutic interventions that are technically demanding for the endoscopist. The aim of this position paper is to provide guidance on the minimum standard of equipment that should be available on a mobile endoscopy cart for provision of a safe and effective after-hours emergency endoscopy service. The guidance is based on consensus among academic and community gastroenterologists in Canada.

Methods: A modified Delphi process was used to establish consensus among 9 participants. A list of statements was prepared by an expert panel of endoscopists. The statements were divided into three broad sections for what should be on an after-hours endoscopy cart including medications, nonendoscopic tools and therapeutic/diagnostic equipment. Consensus for being on the endoscopy cart was achieved when 75% or more of voting members indicated 'agree'.

Results: For nonendoscopic tools, there was agreement for having sterile saline, sterile water, endoscope lubricant, various syringes, bite blocks (paediatric and adult size), a water pump with foot peddle, formalin jars for biopsy specimens, digital photo and printing capability and an overtube. For medications, there was agreement for having hyoscine butylbromide and epinephrine on the cart. For therapeutic/diagnostic tools, there was agreement for having biopsy forceps (standard and jumbo), polypectomy snares, sclerotherapy needles and agent (for a variceal bleed), band ligation kit, multipolar electrocautery probes, heater probe catheter, endoscopic clips, hemostatic powder and retrieval devices.

Interpretation: This position paper provides guidance on the minimum standard of items that should be on an after-hours endoscopy cart. Standardization of equipment may help improve safety and quality of after-hours endoscopic procedures.

Keywords: After-hours endoscopy; Therapeutic endoscopy; Upper gastrointestinal bleed.