All endoscopic procedures are invasive and carry risk. Accordingly, all endoscopists
should involve the patient in the decision-making process about the most appropriate
endoscopic procedure for that individual, in keeping with a patient's right to self-determination
and autonomy. Recognition of this has led to detailed guidelines on informed consent
for endoscopy in some countries, but in many no such guidance exists; this may lead
to variations in care and exposure to risk of litigation. In this document, the European
Society of Gastrointestinal Endoscopy (ESGE) sets out a series of statements that
cover best practice in informed consent for endoscopy. These statements should be
seen as a minimum standard of practice, but practitioners must be aware of and adhere
to the law in their own country. 1: Patients should give informed consent for all
gastrointestinal endoscopic procedures for which they have capacity to do so. 2:
The healthcare professional seeking consent for an endoscopic procedure should ensure
that the patient has the capacity to consent to that procedure. 3: For patients who
lack capacity, healthcare personnel should at all times try to engage with people
close to the patient, such as family, friends, or caregivers, to achieve consensus
on the appropriateness of performing the procedure. 4: Where a patient lacks capacity
to provide informed consent, the best interest decision should be clearly documented
in the medical record. This should include information about the capacity assessment,
reason(s) that the decision cannot be delayed for capacity recovery (or if recovery
is not expected), who has been consulted, and where relevant the form of authority
for the decision. 5: There should be a systematic and transparent disclosure of the
expected benefits and harms that may reasonably affect patient choice on whether or
not to undergo any diagnostic or interventional endoscopic procedure. Information
about possible alternatives, as well as the consequences of doing nothing, should
also be provided when relevant. 6: The information provided on the benefit and harms
of an endoscopic procedure should be adapted to the procedure and patient-specific
risk factors, and the preferences of the patient should be central to the consent
process. 7: The consent discussion should be undertaken by an individual who is familiar
with the procedure and its risks, and is able to discuss these in the context of the
individual patient. 8: Patients should confirm consent to an endoscopic procedure
in a private, unrushed, and non-coercive environment. 9: If a patient requests that
an endoscopic procedure be discontinued, the procedure should be paused and the patient's
capacity for decision making assessed. If a competent patient continues to object
to the procedure, or if a conclusive determination of capacity is not feasible, the
examination should be terminated as soon as it is safe to do so. 10: Informed consent
should be sufficiently detailed to cover all findings that can be reasonably anticipated
during an endoscopic examination. The scope of this consent should not be expanded,
nor a patient's implicit consent for additional interventions assumed, unless failure
to proceed with such interventions would result in immediate and predictable harm
to the patient.
