EoE ToT Module 5 References-Nagula et al Clin Gastroenterol Hepatol 2024 AGA Clinical practice update on high quality upper endoscopy Expert review

Nagula et al Clin Gastroenterol Hepatol 2024 AGA Clinical practice update on high quality upper endoscopy Expert review

Pdf Summary

The American Gastroenterological Association (AGA) has released an expert review aimed at guiding clinicians toward performing high-quality upper endoscopic exams. This document outlines a series of best practice advice (BPA) statements based on a mix of evidence, guidelines, and expert consensus, although it does not formally rate the evidence strength. <br /><br />Key BPAs highlighted include:<br /><br />1. **Appropriate Indication and Informed Consent:** Ensure endoscopy procedures are warranted and that patients understand the risks, benefits, sedation plan, and alternatives.<br />2. **Mucosal Visualization:** Achieve and document adequate mucosal cleansing and insufflation.<br />3. **Use of High-Definition Endoscopy:** Prefer high-definition (HD) white-light endoscopy systems over standard systems, and document the equipment used.<br />4. **Image Enhancement Technologies:** Utilize technologies like narrow band imaging (NBI) and linked color imaging (LCI) to improve diagnostic accuracy for conditions like preneoplasia and neoplasia.<br />5. **Thorough Mucosal Inspection:** Spend sufficient time inspecting the upper gastrointestinal (GI) mucosa to detect abnormalities.<br />6. **Documentation:** Use standardized classifications and terminology to document any abnormalities.<br />7. **Biopsy Protocols:** Follow standardized biopsy protocols for various GI conditions.<br />8. **Post-Procedure Management Recommendations:** Provide management advice based on specific findings and document these recommendations in the medical record.<br />9. **Surveillance Documentation:** Clearly indicate whether follow-up endoscopy is needed and suggest appropriate intervals based on histopathology results.<br /><br />The review also covers the importance of photodocumentation, ensuring anatomic features are captured to validate thorough inspection, and adherence to biopsy protocols for accurate diagnosis. There is an emphasis on the practical application and clinician compliance to enhance patient care quality without causing an undue burden on endoscopists.<br /><br />Post-procedure, clear communication with patients about their results and subsequent steps is critical, ensuring they understand management steps, especially where further actions hinge on biopsy results.<br /><br />In conclusion, this review aims to standardize and elevate the quality and diagnostic accuracy of upper endoscopic examinations while minimizing undue patient risk and healthcare costs. Future research is encouraged to establish specific benchmarks correlating adherence to these best practices with improved clinical outcomes.

Keywords

AGA

upper endoscopy

best practice advice

mucosal visualization

high-definition endoscopy

image enhancement

biopsy protocols

post-procedure management

surveillance documentation

patient communication