Original article Clinical endoscopy| Volume 94, ISSUE 1, P172-177.e2, July 2021

Download started.


Management of code status in the periendoscopic period: a national survey of current practices and beliefs of U.S. gastroenterologists

Published:January 18, 2021DOI:

      Background and Aims

      This study aims to assess current practices and perspectives of gastroenterologists on approaches to code status before inpatient endoscopy.


      Self-reported data were obtained through a voluntary, anonymous survey of gastroenterologists and gastroenterology trainees in the United States. The survey assessed respondents’ approach to, beliefs, and knowledge regarding inpatient periprocedural code status discussions.


      Four hundred thirty-six gastroenterologists and 83 trainees completed the survey. For patients with an existing do not resuscitate (DNR) order, respondents reversed the code status before endoscopy either all (40.8%, n = 212) or most of the time (18.3%, n = 95). When asked their personal opinion, 32.6% (n =169) supported automatic DNR reversal to full resuscitation attempt during a procedure, 18.5% (n = 96) supported that DNR orders could be sustained, and 48.7% (n = 253) supported offering limited resuscitation. Many gastroenterologists were unaware of institutional (40.7%, n = 211) or national (80.7%, n = 419) policies, and a majority reported that a gastroenterology-specific guideline would be helpful (88.6%, n = 460).


      Although most of the gastroenterologists reverse DNR orders more than 75% of the time before endoscopy, many also believe patients should be allowed to remain DNR during a procedure and supported a third option for limited resuscitation. Most gastroenterologists were unaware of institutional policies or existing national guidelines. These findings suggest considerable variation in knowledge and current approaches regarding periendoscopic code status reversal.

      Graphical abstract


      DNR (do not resuscitate)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rao V.L.
        • Gupta N.
        • Swei E.
        • et al.
        Predictors of mortality and endoscopic intervention in patients with upper gastrointestinal bleeding in the intensive care unit.
        Gastroenterol Rep. 2020; 8: 299-305
        • Kopecky K.
        • Pelletier P.
        • Miller P.
        Strategies for collaborative consideration of patients' resuscitation preferences.
        AMA J Ethics. 2020; 22: E325-E332
        • Rao V.L.
        • Feld L.D.
        • Rubin D.T.
        Discussion of code status in the peri-endoscopic period.
        Am J Gastroenterol. 2019; 114: 372-374
        • ASA House of Delegates
        Ethical guidelines for the anesthesia care of patients with do-not-resuscitate orders or other directives that limit treatment. American Society of Anesthesiologists.
        (Available at:) (Accessed May 1, 2019)
        • Wada K.
        • Szego M.J.
        Revisiting code status in patients undergoing GI endoscopy with a "do not resuscitate" order.
        Gastrointest Endosc. 2019; 89: 380-382
        • Feld L.D.
        • Rao V.L.
        Code status reversal for do-not-resuscitate patients undergoing invasive procedures: current practices and beliefs of medical and surgical residents.
        J Palliat Med. 2019; 22: 1024-1025
        • Roter D.L.
        • Hall J.A.
        • Aoki Y.
        Physician gender effects in medical communication: a meta-analytic review.
        JAMA. 2002; 288: 756-764
        • Rabinowitz L.G.
        • Anandasabapathy S.
        • Sethi A.
        • et al.
        Addressing gender in gastroenterology: opportunities for change.
        Gastrointest Endosc. 2020; 91: 155-161
        • Arlow F.L.
        • Raymond P.L.
        • Karlstadt R.G.
        • et al.
        Gastroenterology training and career choices: a prospective longitudinal study of the impact of gender and of managed care.
        Am J Gastroenterol. 2002; 97: 459-469
        • Silverman T.B.
        • Schrimshaw E.W.
        • Franks J.
        • et al.
        Response rates of medical providers to internet surveys regarding their adoption of preexposure prophylaxis for HIV: methodological implications.
        J Int Assoc Provid AIDS Care. 2018; 172325958218798373
        • Nicholls K.
        • Chapman K.
        • Shaw T.
        • et al.
        Enhancing response rates in physician surveys: the limited utility of electronic options.
        Health Serv Res. 2011; 46: 1675-1682