Ensuring High-Quality Upper Endoscopy: What You Need to Know

Upper endoscopy, a procedure commonly performed to diagnose and treat various digestive tract conditions, has recently been updated with new guidelines from the American Gastroenterological Association (AGA). These guidelines are designed to help clinicians deliver the highest quality care during endoscopic procedures by following specific quality indicators.
 
The AGA guidelines are based on a comprehensive review conducted by experts from esteemed institutions, including the Icahn School of Medicine at Mount Sinai in New York City, Yale School of Medicine in New Haven, Connecticut, and the University of California, San Diego.
 
This blog will guide you in understanding whether your previous upper endoscopy met these high standards and will help you ensure that any upcoming procedure is performed according to the latest guidelines. By being informed, you can have greater confidence in the quality of care provided by your gastroenterologist.


Introduction
 
Upper endoscopy, also known as esophagogastroduodenoscopy (EGD), is a widely used procedure for diagnosing and managing conditions affecting the esophagus, stomach, and upper part of the small intestine. This blog summarizes recent guidelines from the American Gastroenterological Association (AGA) to help you understand what constitutes a high-quality upper endoscopy.

 
What is an Upper Endoscopy?
 
Upper endoscopy involves using a flexible tube with a camera (endoscope) to visualize the upper digestive tract. This procedure can help diagnose issues like ulcers, inflammation, tumors, and more. It’s generally safe and can also allow for biopsies and certain treatments.


Quality Indicators for Upper Endoscopy
 
The AGA’s guidelines outline several best practices for ensuring a high-quality endoscopy:
 
1. Appropriate Indication and Informed Consent
 

• Ensure Necessity and Benefit: The procedure should be recommended only when truly beneficial.
• Informed Consent: Obtain clear consent detailing risks, benefits, alternatives, and sedation plans.

 
2. Adequate Visualization of the GI Mucosa
 

• Clear Views: Use mucosal cleansing and proper insufflation to achieve clear views.
• Documentation: Record the quality of visualization.

 
3. Use of High-Definition White-Light Endoscopy
 

• High-Definition Systems: Prefer high-definition (HD) systems over standard-definition ones to improve detection rates.
• Up-to-Date Equipment: Ensure the endoscope and other equipment are suitable for HD imaging.

 
4. Image Enhancement Technologies
 

• Advanced Imaging: Utilize technologies like Narrow Band Imaging (NBI) to enhance mucosal visualization and better detect abnormalities.
• Clear Description and Biopsy: Describe, photograph, and biopsy suspicious areas thoroughly.

 
5. Thorough Inspection of the Foregut
 

• Comprehensive Examination: Spend adequate time examining the foregut in both forward and retroflexed views to identify abnormalities.

 
6. Documentation of Abnormalities
 

• Standard Terminology: Use standard terms and classifications to accurately document findings.

 
7. Standardized Biopsy Protocols
 

• Consistent Biopsies: Follow established protocols for biopsies to ensure consistent and accurate results.

 
8. Post-Procedure Management Recommendations
 

• Clear Recommendations: Provide clear management recommendations based on findings.
• Follow-Up Plan: Document the follow-up plan, including any additional tests or treatments needed after biopsy results.

 
9. Surveillance Endoscopy
 

• Indications for Follow-Up: Indicate whether follow-up endoscopies are necessary and suggest appropriate intervals.

 
Pre-Procedure Best Practices
 

• Informed Consent: Clearly explain the procedure, risks, and benefits. Ensure the patient understands and consents.
• Medication Management: Follow guidelines for managing medications like antithrombotic agents before the procedure.

 
Intra-Procedure Best Practices
 

• Mucosal Visualization: Use tools and techniques to clear the view of the GI mucosa thoroughly.
• Use of High-Definition and Image Enhancement: Leverage advanced imaging technologies to enhance the detection of abnormalities.
• Inspection Time: Spend sufficient time inspecting the GI tract to avoid missing significant findings.

 
Post-Procedure Best Practices
 

• Documentation and Communication: Accurately document the procedure and findings. Communicate results and follow-up plans to the patient and referring physician.
• Follow-Up Care: Provide clear instructions on post-procedure care and any necessary follow-up tests or treatments.

 

Why Quality Matters

High-quality upper endoscopy is crucial for accurate diagnosis and effective treatment. Adhering to these guidelines helps ensure that patients receive the best possible care, reducing the risk of missed diagnoses and improving overall outcomes.
 

Conclusion
 
Upper endoscopy is a vital tool in diagnosing and managing upper GI conditions. By following the AGA’s best practice guidelines, clinicians can provide high-quality care, ensuring accurate diagnoses and effective treatments for their patients. Understanding these standards can also help you evaluate whether your past or upcoming endoscopy meets the high standards set by the AGA.
 
 
by Tossapol Kerdsirichairat, MD, FASGE
Clinical Associate Professor of Medicine
Advanced/Bariatric Endoscopy, Digestive Disease Center
Bumrungrad International Hospital