Table 1

A summary of the upper gastrointestinal endoscopy quality standards and associated strength of recommendation

Summary of quality standardsGrade of evidenceStrength of recommendationAgreement
Patients should be assessed for fitness to undergo a diagnostic OGDWeakStrong100%
Patients should receive appropriate information about the procedure before undergoing an OGDWeakStrong100%
An appropriate time slot should be allocated dependent on procedure indications and patient characteristicsWeakStrong100%
Informed consent should be obtained before performing an OGDWeakStrong100%
A safety checklist should be completed before starting an OGDModerateStrong100%
A checklist should be undertaken after completing an OGD, before the patient leaves the roomWeakStrong90%
Only an endoscopist with appropriate training and the relevant competencies should independently perform OGDWeakStrong100%
We suggest that endoscopists should aim to perform a minimum of 100 OGDs a year, to maintain a high-quality examination standardWeakWeak100%
UGI endoscopy should be performed with high-definition video endoscopy systems, with the ability to capture images and take biopsiesWeakStrong90%
Intravenous sedation and local anaesthetic throat spray can be used in conjunction if required. Caution should be exercised in those at risk of aspirationModerateStrong100%
A complete OGD should assess all relevant anatomical landmarks and high-risk stationsWeakStrong100%
Photo-documentation should be made of relevant anatomical landmarks and any detected lesionsWeakStrong100%
The quality of mucosal visualisation should be reported.WeakStrong100%
Adequate mucosal visualisation should be achieved by a combination of adequate air insufflation, aspiration and the use of mucosal cleansing techniquesModerateStrong100%
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 surveillanceWeakWeak90%
Where a lesion is identified, this should be described using the Paris classification and targeted biopsies takenWeakStrong100%
Endoscopy units should adhere to safe sedation practiceWeakStrong100%
The length of a Barrett’s segment should be classified according to the Prague classificationWeakStrong100%
Where a lesion is identified within a Barrett’s segment, this should be described using the Paris classification and targeted biopsies takenWeakStrong100%
When no lesions are detected within a Barrett’s segment, biopsies should be taken in accordance with the Seattle protocolModerateStrong90%
If squamous neoplasia is suspected, full assessment with enhanced imaging and/or Lugol’s chromo-endoscopy is requiredModerateStrong100%
Oesophageal ulcers and oesophagitis that is grade D or atypical in appearance, should be biopsied, with further evaluation in 6 weeks after PPI therapyWeakStrong100%
The presence of an inlet patch should be photo-documentedWeakWeak90%
The presence of a hiatus hernia should be documented and measuredWeakWeak100%
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 foundModerateStrong100%
Varices should be described according to a standardised classificationWeakStrong100%
Strictures should be biopsied to exclude malignancy before dilatationWeakWeak90%
Gastric ulcers should be biopsied and re-evaluated after appropriate treatment, including H. pylori eradication where indicated, within 6–8 weeksWeakstrong90%
Where there are endoscopic features of gastric atrophy or IM separate biopsies from the gastric antrum and body should be takenWeakWeak100%
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 measuredWeakWeak80%
Where gastric or duodenal ulcers are identified, H. pylori should be tested and eradicated if positiveModerateStrong100%
The presence of gastric polyps should be recorded, with the number, size, location and morphology described, and representative biopsies takenModerateStrong100%
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 bulbStrongStrong100%
A malignant looking lesion should be described, photo documented and a minimum of six biopsies takenWeakStrong100%
After OGD readmission, mortality and complications should be auditedWeakStrong100%
A report summarising the endoscopy findings and recommendations should be produced and the key information provided to the patient before dischargeWeakStrong100%
A method for ensuring histological results are processed must be in placeWeakStrong100%
Endoscopy units should audit rates of failing to diagnose cancer at endoscopy up to 3 years before an oesophago-gastric cancer is diagnosedWeakStrong100%
  • IM, intestinal metaplasia; OGD, oesophago-gastro-duodenoscopy; PPI, proton pump inhibitor.