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The AGA's new Clinical Practice Update provides essential guidance for gastroenterologists to improve upper endoscopy quality, reduce errors, and enhance patient outcomes.
Focused on refining endoscopic procedures, a review by Satish Nagula et al. consolidated expert opinions, evidence-based recommendations, and best practices to help improve diagnostic accuracy and patient outcomes. No formal rating of evidence strength or quality was conducted, in line with standard American Gastroenterological Association (AGA) Institute Clinical Practice Updates procedures. Below are some takeaways from the expert review:
1. Indication and Informed Consent:
Endoscopists should ensure that the procedure is being performed for a reasonable indication. The medical record of a patient should comprise informed consent, including clear elucidations of the procedural risks, advantages, alternatives, sedation plans, and potential diagnostic or therapeutic treatment plans.
2. Visualization and Documentation:
Proper mucosal visualization with cleansing and insufflation of the upper gastrointestinal mucosa should be confirmed and noted by the endoscopist.
3. Usage of High-Definition Endoscopy:
The review stresses the importance of using a high-definition white-light endoscopy system whenever possible, as it provides superior image quality than standard-definition systems. The procedure notes should mention the type of endoscope noted.
4. Image Enhancement Technologies for Improved Diagnosis:
The image enhancement technologies should be employed by endoscopists for enhancing diagnosis, especially for noticing preneoplasia and neoplasia. For accuracy, the doubtful regions should be thoroughly described, photographed, and biopsied separately.
5. Thorough Mucosal Inspection:
Endoscopists should devote adequate time to carefully inspecting the foregut mucosa in both views (anterograde and retroflexed) to detect and characterize the abnormalities.
6. Standardized Documentation of Abnormalities:
Standard terminology and classifications should be noted to recognize the abnormalities to confirm consistency and clarity in medical records.
7. Follow Standardized Biopsy Protocols:
Endoscopists should follow standardized biopsy protocols for proper evaluation.
8. Management Recommendations and Documentation:
Patients should be provided with transparent management recommendations as per the specific endoscopic findings after the procedure. Document if the management plan depends on histopathology results (for Helicobacter pylori infection or Barrett's esophagus), with a note on future guidance.
9. Further Investigation and Follow-Up:
The need for surveillance endoscopy and appropriate intervals should be noted by the endoscopists. Clinicians should note that intervals will be advised once the histopathology outcomes are obtained.
Clinical Gastroenterology and Hepatology
AGA Clinical Practice Update on High-Quality Upper Endoscopy: Expert Review
Satish Nagula et al.
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