GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (Virtual) | February 2026-ASGE interventions to improve upper GI endoscopy performance

ASGE interventions to improve upper GI endoscopy performance

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This 2022 document from the American Society for Gastrointestinal Endoscopy’s Quality Assurance in Endoscopy Committee systematically reviews interventions aimed at improving established quality indicators for upper gastrointestinal (GI) endoscopy (esophagogastroduodenoscopy, EGD). Over 6.1 million EGDs are performed annually in the U.S., by gastroenterologists as well as other healthcare providers, necessitating standardized and monitored quality measures to ensure optimal diagnostic and therapeutic outcomes.<br /><br />The review focuses on interventions enhancing compliance with 2015 ASGE EGD quality indicators across three procedural phases: preprocedure, intraprocedure, and postprocedure. Key findings include:<br /><br />Preprocedure:<br />- Educational interventions, audits, feedback, and standardized electronic order sets can improve appropriate indications for EGD requests, especially in patients with cirrhosis and those with upper GI bleeding (UGIB).<br />- Protocolized order sets improve compliance with preprocedural therapies such as prophylactic antibiotics and medications critical in UGIB management.<br />- Web-based educational tools increase adherence to Barrett’s esophagus (BE) screening and surveillance protocols, improving detection of neoplasia.<br /><br />Intraprocedure:<br />- Quality audits, dictation templates, and training programs enhance documentation completeness and lesion description in EGD reports.<br />- Education may improve biopsy sampling compliance for gastric pathology, though strong evidence is limited.<br />- Concentrating bleeding peptic ulcer and variceal bleeding treatment within dedicated teams or educating endoscopists may improve outcomes, though robust supporting data are sparse.<br /><br />Postprocedure:<br />- Standardized documentation and direct patient communication, including written discharge instructions and summaries, enhance therapy initiation, surveillance adherence, and patient comprehension.<br /><br />The document highlights a general scarcity of high-quality data supporting specific interventions to improve EGD quality indicators, attributing this to barriers like lack of motivation, advocacy, and infrastructure. It advocates continuous tracking, monitoring, and feedback integration, along with focused research to develop evidence-based best practices balancing diagnostic yield, patient safety, and cost-effectiveness. The systematic literature search spanned multiple databases from 1990 to 2020, concentrating on adult diagnostic EGDs.<br /><br />Overall, while many quality indicators are expert-derived with varied evidence levels, implementing structured education, audits, standardized protocols, and patient-centered communication are promising strategies to raise upper GI endoscopy quality. Further research is needed to solidify these approaches and optimize EGD performance across diverse clinical settings.

Keywords

Upper gastrointestinal endoscopy

Esophagogastroduodenoscopy (EGD)

Quality indicators

ASGE guidelines

Preprocedure interventions

Intraprocedure interventions

Postprocedure interventions

Educational interventions

Audit and feedback

Patient communication