19 Indicators for Achieving Quality GI Endoscopy

A joint American College of Gastroenterology (ACG) and American Society for Gastrointestinal Endoscopy (ASGE) Task Force has updated quality indicators considered “fundamental” to all gastrointestinal (GI) endoscopic procedures — most of which have a performance target > 98%, implying they should be achieved in nearly every case. 

The task force’s work was published online on August 21 in The American Journal of Gastroenterology.

“The purpose of this paper is to delineate all of the steps that the endoscopist should be thinking about before they perform any endoscopy,” task force member Nicholas Shaheen, MD, MPH, Division of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, told Medscape Medical News. 

“Some of these are straightforward — for instance, did we get informed consent? Others are more nuanced — did we appropriately plan for sedation for the procedure, or did we give the right antibiotics before the procedure to prevent an infectious complication after?

“While the vast majority of endoscopists do these measures with every procedure, especially in unusual circumstances or when the procedure is an emergency, they can be overlooked. Having these quality indicators listed in one place should minimize these omissions,” Shaheen said.

Four Priority Indicators

The update represents the third iteration of the ACG/ASGE quality indicators on GI endoscopic procedures, the most recent of which was published nearly a decade ago.

As in preceding versions, the task force “prioritized indicators that have wide-ranging clinical implications and have been validated in clinical studies.” There are 19 in total, divided into three time periods: Preprocedure (8), intraprocedure (4), and postprocedure (7).

While all 19 indicators are intended to serve as a framework for continual quality improvement efforts among endoscopists and units, the task force recognized a subset of four they identified as being a particular priority:

1. Frequency with which endoscopy is performed for an indication that is included in a published standard list of appropriate indications and the indication is documented (performance target > 95%) 
2. Frequency with which prophylactic antibiotics are administered for appropriate indications (performance target > 98%) 
3. Frequency with which a plan for the management of antithrombotic therapy is formulated and documented before the procedure (performance target = 95%) 
4. Frequency with which adverse events are documented (performance target > 98%) 

Room for Improvement 

There remains a lack of compliance with some of these indicators, the task force said. 

“Procedures are still performed for questionable indications, adverse events are not always captured and documented, and communication between the endoscopist and patient and/or involved clinicians is sometimes lacking.

“For these reasons, strict attention to the quality indicators in this document and an active plan for improvement in areas of measured deficiency should be a central pillar of the successful practice of endoscopy,” they wrote. 

The task force advised that quality improvement efforts initially focus on the four priority indicators and then progress to include other indicators once it is determined that endoscopists are performing above-recommended thresholds, either at baseline or after corrective interventions.

Reached for comment, Ashwin N. Ananthakrishnan, MD, MPH, a gastroenterologist with Massachusetts General Hospital and Harvard Medical School, both in Boston, told Medscape Medical News that these updated recommendations are “important and commonsense standard procedures that should be followed for all procedures.”

“We recognize endoscopic evaluation plays an important role in the assessment of GI illnesses, but there are also both risks and costs to this as a diagnostic and therapeutic intervention. Thus, it is important to make sure these standards are met, to optimize the outcomes of our patients,” said Ananthakrishnan, who was not involved in this work. 

This work had no financial support. Shaheen and Ananthakrishnan disclosed having no relevant competing interests.