Improving Quality and Safety in the Endoscopy Unit (Virtual) | November 2025-Defining and Measuring Quality in Upper GI Endoscopy

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This presentation by Dr. Brian C. Jacobson outlines quality definitions and measurement standards for upper gastrointestinal (GI) endoscopy, specifically esophagogastroduodenoscopy (EGD). With 7.5 million EGDs performed annually in the US, optimizing quality is essential for effective diagnosis, therapy, and patient safety.<br /><br />High-quality EGD involves clear indication, accurate diagnosis inclusion/exclusion, appropriate therapy, and minimized harm. Quality indicators, developed collaboratively by ASGE and ACG through iterative updates, are categorized by recommendation strength: strong (widely applicable), intermediate, weak, and expert opinion-based, guiding clinical practice standards.<br /><br />Pre-procedure metrics emphasize appropriate indications documented in 95% of cases and performing EGDs within 24 hours for hospitalized upper GI bleeding patients (goal 80%), linked to improved outcomes such as reduced length of stay and mortality.<br /><br />Intra-procedure quality focuses on thorough photodocumentation of key anatomical sites (goal 90%), complete biopsy sampling for dysphagia and conditions like eosinophilic esophagitis, and standardized classification documentation such as the Los Angeles (LA) system for esophagitis. For Barrett’s Esophagus (BE), documentation of anatomical landmarks, use of Prague criteria, and biopsy techniques are stressed, employing high-definition imaging and chromoendoscopy to enhance detection.<br /><br />In upper GI bleeding, priority is accurate stigmata documentation and effective endoscopic treatment with dual modalities as needed, aiming for successful hemostasis 90% of the time. Gastric cancer prevention includes systematic biopsies in high-risk patients and advanced imaging methods. Celiac disease evaluation requires targeted duodenal biopsies for accurate diagnosis.<br /><br />Post-procedure recommendations include appropriate acid suppression, surveillance intervals for BE, eradication goals for intestinal metaplasia, H. pylori testing and eradication plans, and documentation of gastric premalignant condition management.<br /><br />The key message encourages sharing protocols to communicate expectations, focus tracking on metrics not yet consistently met, and use benchmarking among endoscopists to identify outliers and guide improvements, ultimately aiming to standardize and elevate EGD quality across practice settings.

Asset Subtitle

Brian Jacobson, MD, MPH, FASGE

Keywords

Upper gastrointestinal endoscopy

Esophagogastroduodenoscopy (EGD)

Quality indicators

ASGE and ACG guidelines

Pre-procedure metrics

Photodocumentation

Los Angeles classification

Barrett’s Esophagus

Upper GI bleeding management

Post-procedure recommendations