Publication Name	World Journal of Gastroenterology
Manuscript ID	52110
Country	United States

Category	Gastroenterology & Hepatology
Manuscript Type	Case Report
Article Title	Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm!
Manuscript Source	Invited Manuscript
All Author List	Mitchell S Cappell
Funding Agency and Grant Number
Corresponding Author	Mitchell S Cappell, MD, PhD, Chief Doctor, Professor, Division of Gastroenterology and Hepatology, William Beaumont Hospital, Thirteen Mile Rd, Royal Oak, MI 48073, United States. mitchell.cappell@beaumont.edu
Key Words	Endoscopy; Iatrogenic injury; Medical ethics; Hippocratic Oath; Quality improvement; Medical malpractice
Core Tip	Two novel cases are reported of impaired endoscopists manifesting bizarre-endoscopic-interpretation-and-technique due to toxic encephalopathy among 181767 endoscopies performed at William-Beaumont-Hospital-Royal-Oak. Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps, and absurdly “pressed” endoscopic steering dials to photograph gastric lesions. Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum, and erratically turned steering dials and bumped endoscopic tip against antral wall. Endoscopists were advised to terminate their esophagogastroduodenoscopies, fulfilling ethical imperative: “physician-first-do-no-harm”. In-hospital-work-up revealed toxic encephalopathies from urosepsis, or inadvertently ingesting “illicit drug”. Both endoscopists rapidly recovered with medical therapy. These potential-medical-emergencies require aborting endoscopy to prevent iatrogenic patient injury.
Citation	Cappell MS. Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm! World J Gastroenterol 2020;26(9): 984-991

Received	2019-10-16 23:35
Peer-Review Started	2019-10-16 23:36
To Make the First Decision
Return for Revision	2019-11-22 03:47
Revised	2019-12-04 19:39
Second Decision	2020-02-20 13:10
Accepted by Journal Editor-in-Chief
Accepted by Company Editor-in-Chief	2020-02-21 06:06
Articles in Press	2020-02-21 06:06
Publication Fee Transferred
Edit the Manuscript by Language Editor
Typeset the Manuscript	2020-03-04 12:05

ISSN	1007-9327 (print) and 2219-2840 (online)
Open Access	This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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