An expert group of gastroenterologists have made 40 recommendations on what constitutes a quality endoscopic evaluation.
Gastroenterologists from both sides of the Tasman have collaborated to develop the first recommendations and position statement for upper gastrointestinal endoscopy in Australia and New Zealand.
Until recently there were no validated standards or quality indicators for upper gastrointestinal (UGI) endoscopy in Australia and New Zealand, which made it difficult to promote equitable access to high-quality endoscopy for patients.
But that has now changed following the recent publication of a joint position statement from Australian and New Zealand gastroenterologists establishing standards for performing quality UGI across the two countries.
“We aimed to review the current guidelines on quality of UGI endoscopy and prioritize key quality standards for the Australasian context. The disease-specific recommendations are particularly relevant to adult patients, whereas the preprocedural, intraprocedural, and postprocedural recommendations are relevant to both adult and paediatric practice,” the authors wrote in the Journal of Gastroenterology and Hepatology.
Two members of the authorship group drafted the initial recommendation statements after conducting a thorough literature search. All authors then reviewed and discussed the recommendations through a Delphi process; ≥80% of the group had to agree with a statement for it to be included in the final position statement.
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The authorship group agreed on 40 recommendations covering a range of domains, including pre-, intra- and post-procedural care and considerations as well as recommendations specific to different parts of the gastrointestinal tract.
For example, the position statement recommends that:
- UGI endoscopy should be performed with high-definition video endoscopy systems that can capture images during the procedure and with access to equipment and devices to perform any additional diagnostic tests and/or therapeutic interventions;
- A routine UGI endoscopic examination should take at least seven minutes to complete (to allow for examination and photographic documentation of all relevant anatomical landscapes); and
- Any neoplastic lesions observed during the UGI endoscopy should be documented with photographs, and at least six targeted biopsy samples should be obtained.
The position statement also features a list of common indications for UGI endoscopy. Key signs and symptoms to consider include abdominal and oesophageal symptoms that persist despite appropriate therapy, dysphagia or odynophagia and investigations of iron deficient anaemia.
The recommendations have been reviewed and approved by the GESA endoscopy faculty, along with the Boards of GESA, the Endoscopy Guidance Group for New Zealand, the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians.
“These recommendations provide a framework, tailored to Australasian endoscopic practice and patients, for endoscopists to improve and measure the quality of UGI endoscopy,” the authorship group concluded.
“Implementation of quality standards in UGI endoscopy will allow identification of key performance indicators linked to patient outcomes that can be measured and audited to ensure high-quality and safe UGI endoscopy services across Australia and Aotearoa New Zealand.”
