Updated Quality Indicators for Upper GI Endoscopy

Video Transcription

Video Summary

The April 2025 Quick Byte features Dr. Raina Yadlapati (UC San Diego) presenting updated ACG/ASGE quality indicators for upper GI endoscopy (EGD), reflecting major advances since prior versions (2006; revised 2015). With EGD volume rising and 5–49% potentially lacking appropriate indications, the update aims to standardize high-quality practice using graded recommendations and defined performance targets (minimum “floors,” with some “never events” set at >98% adherence).<br /><br />Pre-procedure indicators emphasize performing EGD only for appropriate indications and completing inpatient/observation upper GI bleed endoscopy within 24 hours (not <6 hours, and excluding very low-risk patients).<br /><br />Intra-procedure updates include a new priority indicator for systematic photodocumentation of key landmarks, plus expanded quality measures for eosinophilic esophagitis (biopsies from ≥2 levels; ideally ≥6 total; use EREFS scoring). Priority documentation includes Los Angeles grading for erosive esophagitis and comprehensive Barrett’s standards (Prague classification, landmark documentation, avoid biopsying irregular Z-lines <1 cm, Seattle protocol, separate jars for visible lesions). Ulcer care includes Forrest classification, avoiding epinephrine monotherapy, documenting hemostasis success, and appropriate gastric ulcer follow-up/biopsy. New emphasis covers gastric premalignant conditions using the Sydney biopsy protocol and celiac biopsy protocols (≥4 duodenal biopsies including bulb).<br /><br />Post-procedure indicators address repeat EGD for LA C/D esophagitis, appropriate PPI use (including post-hemostasis high-dose PPI x3 days), avoiding too-frequent Barrett’s surveillance, achieving complete eradication of intestinal metaplasia after eradication therapy, and robust H. pylori test/treat/confirm-eradication workflows plus documented surveillance plans for gastric intestinal metaplasia.<br /><br />Discussion highlights implementation challenges due to current software limitations, recommending practice-specific rollout, manual steps initially, and team-based education. Future QIs may include inspection time, neoplasia detection rates, AI, and emerging procedures.

Keywords

ACG/ASGE EGD quality indicators 2025

upper GI endoscopy appropriateness and performance targets

systematic EGD photodocumentation key landmarks

Barrett’s esophagus documentation Prague classification Seattle protocol

eosinophilic esophagitis biopsy protocol EREFS scoring

upper GI bleed endoscopy within 24 hours Forrest classification hemostasis

gastric premalignant conditions Sydney protocol H. pylori test and confirm eradication