ETHICS IN

ENDOSCOPY
 Introduction

Ladas S, Novis B, Triantafyllou K, Schoefl R, Rokkas T, Stanciu C, et al. Ethical issues in endoscopy: Patient satisfaction, safety in elderly patients, palliation, and
relations with industry. Endoscopy. 2007;39(06):556–65.
Seidman MD, Shapiro DP, Shirwany NA. Ethical issues for otolaryngology and surgery in the Elderly. Ear, Nose & Throat Journal. 1999;78(6):422–8.
 Patient Satisfaction

Ladas S, Novis B, Triantafyllou K, Schoefl R, Rokkas T, Stanciu C, et al. Ethical issues in endoscopy: Patient satisfaction, safety in elderly patients, palliation, and
relations with industry. Endoscopy. 2007;39(06):556–65.
Ladas S, Novis B, Triantafyllou K, Schoefl R, Rokkas T, Stanciu C, et al. Ethical issues in endoscopy: Patient satisfaction, safety in elderly patients, palliation, and relations with industry. Endoscopy.
2007;39(06):556–65.
 Safety Of Endoscopy
■ Includes the issue of:
- Informed consent
- Sedative and analgesics choices
- The debate between high risk endoscopic procedure or surgery

■Especially important in high risk groups, including elderly

Ladas S, Novis B, Triantafyllou K, Schoefl R, Rokkas T, Stanciu C, et al. Ethical issues in endoscopy: Patient satisfaction, safety in elderly patients, palliation, and
relations with industry. Endoscopy. 2007;39(06):556–65.
 - An autonomous authorization by a
patient or subject
- Includes competence, disclosure,
comprehension, and voluntary
choice
Informed Consent - Obtained before an endoscopic
intervention
-In elderly patient can be
complicated (cognitive function and
barriers to communication)

Ladas S, Novis B, Triantafyllou K, Schoefl R, Rokkas T, Stanciu C, et al. Ethical issues in endoscopy: Patient satisfaction, safety in elderly patients, palliation, and
relations with industry. Endoscopy. 2007;39(06):556–65.
Seidman MD, Shapiro DP, Shirwany NA. Ethical issues for otolaryngology and surgery in the Elderly. Ear, Nose & Throat Journal. 1999;78(6):422–8.
 Safe Medications

■ The use of sedation/analgesia varies between centers

■ Sedation is not risk-free
– Age-related disorders and rapid sedation contribute to complication in
cardiovascular and pulmonar
■ These risks should be discussed in informed consent
■ If a sedation is deemed needed, for at-risk patient (elderly)
– Less sedation at a lower dose (half normal adult)
– Slower rate
– Must be administered by qualified personnel

Ladas S, Novis B, Triantafyllou K, Schoefl R, Rokkas T, Stanciu C, et al. Ethical issues in endoscopy: Patient satisfaction, safety in elderly patients, palliation, and
relations with industry. Endoscopy. 2007;39(06):556–65.
 Endoscopy vs Surgery

■ Only nonabdominal surgery in elderly has similar mortality rate to that of younger
patient
■ Endoscopic procedure if applicable usually favored
■ Main consideration in choosing
– Mortality of the procedure
– Other risks such as delirium and depression
■ Must be discussed with patient or closest relatives if impaired

Ladas S, Novis B, Triantafyllou K, Schoefl R, Rokkas T, Stanciu C, et al. Ethical issues in endoscopy: Patient satisfaction, safety in elderly patients, palliation, and
relations with industry. Endoscopy. 2007;39(06):556–65.
 Palliative Endoscopy

Ladas S, Novis B, Triantafyllou K, Schoefl R, Rokkas T, Stanciu C, et al. Ethical issues in endoscopy: Patient satisfaction, safety in elderly patients, palliation, and
relations with industry. Endoscopy. 2007;39(06):556–65.
 Training Practitioners

■ Endoscopic procedures requires complex setting and a team with knowledge and skills
■ Requires a learning curve
– Ongoing process of practice is necessary beginning with basics to continuous
training and competency assessment
– Endoscopy performance should be evaluated regularly
■ Apprenticeship model is the foundation
– Each individual honing skill accompanied by supervisor
■ Should be explicitly discussed with patient that a trainee is going to do the examination
in informed consent

Bailoor K, Adams MA. Medical Ethics in Endoscopy. American Journal of Gastroenterology. 2019;115(2):158–9.
Zorila MV, Gheonea I, Ciurea ME, Zavoi RE, Ungureanu BS. Ethical issues in therapeutic endoscopy – can communication between patient and physician make a
difference? Romanian Journal of Morphology and Embryology. 2015Sep18;
Conclusion
■ Ethics is the study of perfect conduct
■ Main consideration for Ethics in Endoscopy should always
adhered to patient satisfaction, patient safety and preferences, the
usage in palliative care, and the usage when training trainee
Thank You