Endoscopy (OGD, colonoscopy, ERCP) is generally safe.
But complications do occur — and can deteriorate quickly if missed.

As the ward doctor, you are often the first person called.

Your job is to:

Recognise red flags early
Start basic management
Escalate quickly

This guide focuses on what juniors should actually do on the ward.

✅ First principle

After any endoscopy, always ask:

Is this expected discomfort, or a complication?

Mild symptoms are common.
Systemic signs are not.

If the patient looks unwell → assume complication until proven otherwise.

🚨 Red flags after ANY endoscopy

If you see any of these, escalate early:

Tachycardia
Hypotension
Fever
Severe or worsening pain
Guarding/rigidity
Bleeding
Confusion
Oxygen requirement

These are not normal post-procedure findings.

🔵 OGD complications (what to watch for)

🔴 Bleeding

More common after:

Biopsies
Ulcer therapy
Variceal banding

Signs:

Haematemesis
Melaena
Hb drop
Tachycardia

What to do:

A–E assessment
IV access
Bloods + group & save
Fluids
Inform gastro urgently

May need repeat endoscopy.

🔴 Perforation (rare but serious)

Signs:

Severe chest/epigastric pain
Tachycardia
Fever
Surgical abdomen
Subcutaneous emphysema

What to do:

A–E
NBM
IV antibiotics
Urgent CT
Surgical + gastro review

Never ignore severe pain after OGD.

🟡 Sore throat / mild discomfort

Common and benign.
Reassure only if patient otherwise well.

🟢 Colonoscopy complications

🔴 Perforation (most serious)

Risk higher:

Elderly
Difficult procedure
Polypectomy
IBD

Signs:

Severe abdominal pain
Distension
Tachycardia
Peritonism
Fever

What to do:

A–E
NBM
IV fluids
Antibiotics
Urgent CT
Surgical + gastro review

Do not label as “gas pain” if severe.

🔴 Post-polypectomy bleeding

Can occur:

Immediately
Or days later

Signs:

PR bleeding
Hb drop
Dizziness

What to do:

Assess stability
Bloods
Escalate

May need repeat colonoscopy.

🟡 Bloating/cramping

Very common from air insufflation.
If mild and stable → reassurance.

🔴 ERCP complications (very important)

ERCP has the highest complication rate.

Always be cautious.

🔴 Post-ERCP pancreatitis (most common)

Presents:

Epigastric pain
Nausea/vomiting
Pain worse than expected
Raised amylase/lipase

Usually within hours.

What to do:

Bloods (including amylase)
IV fluids
Analgesia
Treat as acute pancreatitis
Inform gastro

Never ignore pain after ERCP.

🔴 Cholangitis

Signs:

Fever
Jaundice
Sepsis

What to do:

Blood cultures
IV antibiotics
Urgent gastro review

May need repeat ERCP.

🔴 Bleeding

Especially post-sphincterotomy.

Manage like any GI bleed.

🔴 Perforation

Severe pain + sepsis → urgent CT + surgical review.

✅ Practical ward approach (simple and safe)

When called about an unwell patient post-endoscopy:

Step 1 – A–E assessment

Always first

Step 2 – Basic actions

IV access
Bloods
Fluids
NBM
Analgesia

Step 3 – Think complication type

Bleeding?
Perforation?
Pancreatitis?
Sepsis?

Step 4 – Escalate early

Gastro ± surgery

Do not sit and observe a deteriorating patient.

✅ Quick “cheat sheet”

After OGD → think

Bleed or perforation

After colonoscopy → think

Perforation or bleed

After ERCP → think

Pancreatitis first

This helps you react fast on call.

❌ Common junior mistakes

Dismissing severe pain
Delaying imaging
Not checking amylase after ERCP pain
Attributing tachycardia to “anxiety”
Waiting too long to escalate
Forgetting NBM

If unsure → escalate. Nobody gets criticised for early escalation.

✅ Take-home concept

Mild discomfort is normal.
Severe pain, bleeding, or systemic signs are not.
Assess early, investigate early, escalate early.

That mindset keeps patients safe.