Division of Gastroenterology & Hepatology, William Beaumont Hospital, Royal Oak, MI 48073, United States.
World J Gastroenterol. 2020 Mar 7;26(9):984-991. doi: 10.3748/wjg.v26.i9.984.
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.
尽管已经报道了许多专家（如外科医生和麻醉师）的操作缺陷，但由于中毒性脑病，系统文献综述未能发现任何由胃肠病学家进行的内镜检查操作缺陷的报告。然而，与任何个体一样，胃肠病学家也可能很少因医疗障碍而出现急性精神状态变化，这些障碍可能首先在进行胃肠道内镜检查时表现出来，因为内镜检查构成了他们工作日的大部分。
在威廉-博蒙特-奥克皇家医院进行的 181767 例内镜检查中，有两名内镜检查医生在进行内镜检查时，由于中毒性脑病而表现出奇异的内镜解释和技术。病例 1 内镜医生反复坚持胃息肉是结肠息肉，并荒谬地“按压”内镜转向拨盘以“获取”内镜照片；病例 2 内镜医生反复坚持在进行幽门前区插管时已经插管到十二指肠，并疯狂地转动转向拨盘并用力撞击内镜尖端到幽门前区壁。内镜护士识别出操作医生的操作能力受损，并通知内镜单元护士经理。她打电话给胃肠病学主任，主任建议操作医生终止他们的食管胃十二指肠镜检查（履行“医生，首先不伤害”的伦理义务），并去急诊室进行医学评估。两名内镜医生都遵从了建议。院内检查显示两名内镜医生均患有中毒性脑病：病例 1 为尿路感染和左侧输尿管结石；病例 2 为脱水和意外摄入不明身份陌生人提供的疑似非法药物。内镜医生通过医学治疗迅速康复。
这种罕见的综合征（内镜检查的 0.0011%）可能由于中毒性脑病导致内镜医生的操作能力受损而突然表现为奇异的内镜解释和技术。建议的管理方案（在两种情况下都遵循）：1-将事件识别为需要立即采取行动以防止医源性患者伤害的医疗紧急情况；2-通知胃肠病学主任；3-立即介入终止内镜检查以保护患者。该综合征的特征需要进一步研究。
