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!

Figure 2 Algorithm. Algorithm summarizing steps to recognize and manage bizarre performance of gastrointestinal endoscopy by an impaired gastroenterologist-endoscopist. The first three steps relate to syndrome recognition. The next two steps describe recommended actions by Chief of Gastroenterology. The last step relates to recommended patient work-up in emergency room. See Discussion section and Supplementary Table 1 for fuller discussion of syndrome recognition and management.