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ASGE ACG quality indicators_EUS

Pdf Summary

This document, approved by the American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG), establishes updated quality indicators for endoscopic ultrasound (EUS) procedures, reflecting advances in diagnostic and interventional EUS over recent decades. EUS, initially developed in the 1980s for upper GI cancer staging, now encompasses a broad range of diagnostic uses (cancer staging, subepithelial lesion evaluation, pancreaticobiliary disease assessment) and therapeutic interventions (e.g., pseudocyst drainage, biliary and gallbladder drainage, gastroenterostomy, EUS-directed transgastric ERCP).<br /><br />Quality indicators are divided into preprocedure, intraprocedure, and postprocedure phases and categorized as process or outcome measures with performance targets set based on evidence and expert consensus. Priority indicators highlight key quality metrics. Highlights include:<br /><br />Preprocedure indicators emphasize performing EUS for appropriate documented indications (target ≥90%), obtaining informed consent with specific risk discussion (98%), administering prophylactic antibiotics per guidelines (98%), and ensuring procedures are performed by credentialed, trained endosonographers (98%).<br /><br />Intraprocedure indicators stress comprehensive visualization and documentation of relevant anatomy and pathology (98%), accurate TNM staging for luminal cancers (98%), characterization and biopsy of subepithelial lesions (98%), adequate EUS-guided liver biopsy yield (≥85%), detection and measurement of pancreatic masses ≤10 mm (≥90%), and diagnostic sampling adequacy of malignant pancreatic masses (≥87%). Technical success benchmarks include pancreatic fluid collection drainage (≥92%), gallbladder drainage (90%), biliary drainage (≥85%), gastroenterostomy (85%), and EUS-directed transgastric ERCP (92%).<br /><br />Postprocedure indicators focus on complete procedure reporting (98%), systematic adverse event (AE) documentation (98%), and AE rates consistent with literature thresholds (perforation ≤0.5%; infection ≤1%; pancreatitis ≤1%; bleeding ≤1%, except liver biopsy bleeding up to 5%). AE rates vary by procedure type, with interventional EUS AE targets ranging from 10% to 25% depending on complexity.<br /><br />The document underscores the importance of thorough patient evaluation, multidisciplinary collaboration, and ongoing quality improvement as EUS applications rapidly evolve. It advocates balancing aspirational performance targets with realism, given data mainly from high-volume expert centers. Continuous reassessment of quality indicators will guide optimal practice standards as evidence expands.

Keywords

Endoscopic Ultrasound

EUS Quality Indicators

American Society for Gastrointestinal Endoscopy

American College of Gastroenterology

Diagnostic EUS

Interventional EUS

Preprocedure Indicators

Intraprocedure Indicators

Postprocedure Indicators

Adverse Event Rates