GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (Virtual) | February 2026-ASGE minimum staffing guidelines

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The American Society for Gastrointestinal Endoscopy (ASGE) issued updated guidelines on minimum staffing requirements and scope of practice in GI endoscopy units to ensure safe, efficient patient care. These recommendations stem from a systematic literature review, a nationwide survey of 193 U.S. endoscopy unit directors, and expert consensus.<br /><br />Key points include:<br /><br />1. Staffing varies with procedure complexity (routine vs. advanced) and sedation type (none, endoscopist-directed moderate or deep sedation, anesthesia provider-assisted). <br /><br />2. For routine procedures without sedation, a minimum of 1 trained endoscopy staff member (registered nurse [RN] or unlicensed assistive personnel [UAP]/endoscopy technician) should be present. Moderate sedation requires at least 1 RN who may assist with endoscopic tasks if interruptions are possible. Deep sedation directed by the endoscopist requires 1 RN plus a second staff member during any interventional tasks. When sedation is administered by an anesthesia provider, minimum staffing includes 1 trained endoscopy staff member.<br /><br />3. For advanced procedures (e.g., EUS, ERCP, EMR), the recommendations parallel those for routine procedures but emphasize the need for an RN plus a second staff member during interventions for both moderate and deep sedation. With anesthesia provider assistance, a minimum of 1 trained endoscopy staff member is suggested.<br /><br />4. The role of unlicensed assistive personnel (UAPs) or endoscopy technicians is endorsed with appropriate training and physician supervision. The guidelines recommend that UAPs can safely assist with technical tasks, such as biopsy specimen collection, snare polypectomy, submucosal injections (lifting agents, medications, tattooing), luminal injections, and contrast injection during ERCP. Training standards vary, commonly consisting of standardized onsite institutional curricula. <br /><br />5. The guidelines highlight variability in staffing based on local regulations and institutional policies, recognizing the evolving roles of nurses, technicians, and trainees.<br /><br />6. The ASGE acknowledges limited direct evidence linking staffing levels to patient outcomes and calls for future research on cost-effectiveness, patient safety, and staff training programs to refine recommendations.<br /><br />In summary, the ASGE establishes minimum consistent staffing thresholds tailored to procedure type and sedation method, encourages use of trained UAPs to optimize efficiency and resource use, and aligns recommendations with existing anesthesia and sedation monitoring guidelines to promote safe GI endoscopy practice.

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ASGE Guideline

Minimum Staffing Requirements

Gastrointestinal Endoscopy

Patient Safety

Scope of Practice