A summary of the upper gastrointestinal endoscopy quality standards and associated strength of recommendation
| Summary of quality standards | Grade of evidence | Strength of recommendation | Agreement |
| Patients should be assessed for fitness to undergo a diagnostic OGD | Weak | Strong | 100% |
| Patients should receive appropriate information about the procedure before undergoing an OGD | Weak | Strong | 100% |
| An appropriate time slot should be allocated dependent on procedure indications and patient characteristics | Weak | Strong | 100% |
| Informed consent should be obtained before performing an OGD | Weak | Strong | 100% |
| A safety checklist should be completed before starting an OGD | Moderate | Strong | 100% |
| A checklist should be undertaken after completing an OGD, before the patient leaves the room | Weak | Strong | 90% |
| Only an endoscopist with appropriate training and the relevant competencies should independently perform OGD | Weak | Strong | 100% |
| We suggest that endoscopists should aim to perform a minimum of 100 OGDs a year, to maintain a high-quality examination standard | Weak | Weak | 100% |
| UGI endoscopy should be performed with high-definition video endoscopy systems, with the ability to capture images and take biopsies | Weak | Strong | 90% |
| Intravenous sedation and local anaesthetic throat spray can be used in conjunction if required. Caution should be exercised in those at risk of aspiration | Moderate | Strong | 100% |
| A complete OGD should assess all relevant anatomical landmarks and high-risk stations | Weak | Strong | 100% |
| Photo-documentation should be made of relevant anatomical landmarks and any detected lesions | Weak | Strong | 100% |
| The quality of mucosal visualisation should be reported. | Weak | Strong | 100% |
| Adequate mucosal visualisation should be achieved by a combination of adequate air insufflation, aspiration and the use of mucosal cleansing techniques | Moderate | Strong | 100% |
| It is suggested that the inspection time during a diagnostic OGD should be recorded for surveillance procedures, such as Barrett’s oesophagus and gastric atrophy/intestinal metaplasia surveillance | Weak | Weak | 90% |
| Where a lesion is identified, this should be described using the Paris classification and targeted biopsies taken | Weak | Strong | 100% |
| Endoscopy units should adhere to safe sedation practice | Weak | Strong | 100% |
| The length of a Barrett’s segment should be classified according to the Prague classification | Weak | Strong | 100% |
| Where a lesion is identified within a Barrett’s segment, this should be described using the Paris classification and targeted biopsies taken | Weak | Strong | 100% |
| When no lesions are detected within a Barrett’s segment, biopsies should be taken in accordance with the Seattle protocol | Moderate | Strong | 90% |
| If squamous neoplasia is suspected, full assessment with enhanced imaging and/or Lugol’s chromo-endoscopy is required | Moderate | Strong | 100% |
| Oesophageal ulcers and oesophagitis that is grade D or atypical in appearance, should be biopsied, with further evaluation in 6 weeks after PPI therapy | Weak | Strong | 100% |
| The presence of an inlet patch should be photo-documented | Weak | Weak | 90% |
| The presence of a hiatus hernia should be documented and measured | Weak | Weak | 100% |
| Biopsies from two different regions in the oesophagus should be taken to rule out eosinophilic oesophagitis in those presenting with dysphagia/food bolus obstruction, where an alternate cause is not found | Moderate | Strong | 100% |
| Varices should be described according to a standardised classification | Weak | Strong | 100% |
| Strictures should be biopsied to exclude malignancy before dilatation | Weak | Weak | 90% |
| Gastric ulcers should be biopsied and re-evaluated after appropriate treatment, including H. pylori eradication where indicated, within 6–8 weeks | Weak | strong | 90% |
| Where there are endoscopic features of gastric atrophy or IM separate biopsies from the gastric antrum and body should be taken | Weak | Weak | 100% |
| Where iron deficiency anaemia is being investigated, separate biopsies from the gastric antrum and body should be taken, as well as duodenal specimens if coeliac serology is positive or has not been previously measured | Weak | Weak | 80% |
| Where gastric or duodenal ulcers are identified, H. pylori should be tested and eradicated if positive | Moderate | Strong | 100% |
| The presence of gastric polyps should be recorded, with the number, size, location and morphology described, and representative biopsies taken | Moderate | Strong | 100% |
| Where coeliac disease is suspected, a minimum of four biopsies should be taken, including representative specimens from the second part of the duodenum and at least one from the duodenal bulb | Strong | Strong | 100% |
| A malignant looking lesion should be described, photo documented and a minimum of six biopsies taken | Weak | Strong | 100% |
| After OGD readmission, mortality and complications should be audited | Weak | Strong | 100% |
| A report summarising the endoscopy findings and recommendations should be produced and the key information provided to the patient before discharge | Weak | Strong | 100% |
| A method for ensuring histological results are processed must be in place | Weak | Strong | 100% |
| Endoscopy units should audit rates of failing to diagnose cancer at endoscopy up to 3 years before an oesophago-gastric cancer is diagnosed | Weak | Strong | 100% |
IM, intestinal metaplasia; OGD, oesophago-gastro-duodenoscopy; PPI, proton pump inhibitor.