GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (Virtual) | February 2026-ASGE ACG quality indicators

ASGE ACG quality indicators_upper GI endoscopy

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This 2025 guideline document from the American Society for Gastrointestinal Endoscopy and American College of Gastroenterology updates quality indicators (QIs) specifically for esophagogastroduodenoscopy (EGD), a key diagnostic and therapeutic tool for disorders of the esophagus, stomach, and duodenum. EGD volumes have increased significantly in the U.S., underscoring the need for standardizing high-quality care to improve diagnostic accuracy, therapeutic effectiveness, and patient safety while minimizing harm.<br /><br />The document categorizes quality indicators into preprocedure, intraprocedure, and postprocedure phases, further classified as process or outcome measures with assigned strength-of-evidence grades and performance targets. Preprocedure QIs emphasize appropriate indication documentation (target 95%), timely EGD within 24 hours for upper GI bleeding (target 80%), and comprehensive history, sedation planning, and consent standards.<br /><br />Intraprocedure indicators include photodocumentation of key mucosal landmarks (target 90%), biopsy protocols for eosinophilic esophagitis and dysphagia (≥6 biopsies from ≥2 esophageal levels, target 90%), accurate classification systems documentation such as Los Angeles classification for erosive esophagitis (target 98%) and Prague criteria for Barrett’s esophagus (BE) extent (target 95%), and surveillance practices for BE incorporating high-definition white-light and chromoendoscopy with systematic four-quadrant biopsies every 2 cm to detect dysplasia effectively (target 90%). Management of bleeding peptic ulcers via Forrest classification documentation (target 98%), appropriate endoscopic hemostasis (90%), and use of adjunctive therapies like high-dose proton pump inhibitors post-hemostasis (target 95%) are highlighted.<br /><br />Additional QIs focus on sampling protocols for gastric premalignant conditions (GPMCs), appropriate biopsy of gastric polyps >10 mm, and adequate duodenal biopsies (≥4 including bulb) for suspected celiac disease.<br /><br />Postprocedure indicators include appropriate surveillance interval recommendations for severe erosive esophagitis (repeat EGD after acid suppression, target 90%), acid suppression following dilation of peptic strictures (target 98%), adherence to surveillance intervals for nondysplastic BE (≥3 years, target 80%), and achievement of complete eradication of intestinal metaplasia within 18 months following BE eradication therapy (target 75%). Documentation and management plans for Helicobacter pylori infection testing, treatment, and eradication verification are also prioritized (target 95%).<br /><br />These QIs aim to serve as a framework for quality improvement rather than mandatory standards. The document recognizes areas for future research and inclusion, such as procedure time documentation, neoplasia detection rates, and integration of artificial intelligence. The emphasis on evidence-based protocols for biopsy sampling, lesion characterization, timely intervention, and follow-up care collectively seeks to optimize patient outcomes and resource utilization in upper GI endoscopy.

Keywords

esophagogastroduodenoscopy

quality indicators

American Society for Gastrointestinal Endoscopy

American College of Gastroenterology

biopsy protocols

Barrett's esophagus

upper gastrointestinal bleeding

endoscopic hemostasis

Helicobacter pylori management

surveillance intervals