What are the contraindications to post-endoscopy care?

From the Guidelines

Contraindications to standard post-endoscopy care include severe sedation-related complications, active bleeding, perforation of the gastrointestinal tract, and severe adverse reactions to medications used during the procedure, as well as conditions that may increase the risk of bleeding or other complications, such as the use of anticoagulants or antiplatelet agents, pregnancy, and certain underlying medical conditions.

Key Considerations

• Patients with compromised cardiopulmonary status may require modified recovery protocols with extended monitoring 1.
• Those who have undergone complex therapeutic procedures such as large polyp removal or endoscopic mucosal resection should avoid certain activities and medications that increase bleeding risk, including NSAIDs, aspirin, and other anticoagulants unless specifically directed otherwise by their physician 1.
• Patients with post-procedure pain unrelieved by mild analgesics, persistent vomiting preventing oral intake, fever above 101°F, or signs of peritonitis should not be discharged and require immediate medical evaluation 1.
• Endoscopy is contraindicated in cases of placental abruption, imminent birth, ruptured membranes, or hypertensive disease of pregnancy, and caution should be exercised when performing endoscopy during pregnancy, with consideration of the risks and benefits of the procedure and the use of sedation or anesthesia 1.
• A surveillance colonoscopy may be performed after successful treatment of iatrogenic colonoscopy perforation, but only once the colonic wall has completely healed, and the timing of the surveillance endoscopy should be based on the initial indication and type of the primary colonoscopy, as well as the risk-benefit ratio of performing an endoscopic exam 1.

Bleeding Risk

• The risk of bleeding after endoscopic procedures is increased in patients with certain underlying medical conditions, such as hypertension, diabetes, coronary artery disease, and chronic obstructive pulmonary disease 1.
• The use of anticoagulants or antiplatelet agents also increases the risk of bleeding, and the management of these medications should be carefully considered before and after endoscopic procedures 1.

Pregnancy Considerations

• Endoscopy during pregnancy requires careful consideration of the risks and benefits of the procedure, as well as the use of sedation or anesthesia, and caution should be exercised to minimize the risks to the mother and fetus 1.
• The use of sedation or anesthesia during endoscopy in pregnant women should be carefully managed, with consideration of the potential risks to the fetus, and the American Society for Gastrointestinal Endoscopy recommends meperidine as the preferred agent, followed by small doses of midazolam as needed 1.

From the Research

Contraindications to Post-Endoscopy Care

There are several contraindications to post-endoscopy care that healthcare providers should be aware of, including:

• Bleeding risks: Patients taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) may be at a higher risk of bleeding after endoscopic procedures, although the risk of significant gastrointestinal bleeding is small (< 1%) 2, 3.
• Infection risks: Patients may be at risk of infection after endoscopic procedures, particularly if the endoscope is not properly reprocessed 4.
• Anticoagulant or antiplatelet therapy: Patients on anticoagulant or antiplatelet therapy may need to have their medication managed before and after endoscopy to minimize the risk of bleeding or thrombosis 5.

Specific Contraindications

Some specific contraindications to post-endoscopy care include:

• High-dose nonsteroidal anti-inflammatory drug use: Patients taking high-dose NSAIDs may be at a higher risk of bleeding after endoscopy 6.
• Anticoagulant use: Patients on anticoagulant therapy may need to have their medication managed before and after endoscopy to minimize the risk of bleeding or thrombosis 5.
• Older age: Older patients may be at a higher risk of complications after endoscopy, including bleeding and infection 6.

Management of Contraindications

Healthcare providers should carefully manage contraindications to post-endoscopy care by:

• Assessing the patient's risk factors for bleeding and infection before the procedure 2, 4.
• Managing the patient's medication regimen before and after the procedure 5.
• Monitoring the patient closely after the procedure for signs of bleeding or infection 6.
• Providing clear instructions to the patient on how to manage their condition after the procedure 6.