Quality indicators for major endoscopic procedures defined
17 May 2006
Oak Brook, Ill., USA. The objective measures that could be
used to define high-quality endoscopic services have been compiled into a
series of papers by the US Task Force on Quality in Endoscopy.
The Task Force, a joint effort of the American Society for
Gastrointestinal Endoscopy (ASGE) and the American College of
Gastroenterology (ACG), has developed quality indicators for the four major
- esophagogastroduodenoscopy (EGD, also known as upper endoscopy);
- endoscopic retrograde cholangiopancreatography (ERCP); and
- endoscopic ultrasonography (EUS).
The task force of nationally recognized endoscopic experts identified
objective measures that could be used to define high-quality endoscopic
services for the diagnosis and treatment of diseases and conditions of
the digestive tract. The task force, led by Douglas O. Faigel, MD,
FASGE, Oregon Health & Science University, Portland, and Irving M. Pike,
MD, FACG, Gastroenterology Consultants, Virginia Beach, Va., recommends
that these guidelines be adopted by facilities where endoscopic
procedures are performed.
"As with all medical specialties, we
anticipate that reimbursement for endoscopy will soon be linked to
performance against quality measures. As the experts in endoscopy, we must
proactively define those quality measures. We cannot leave the
standards-setting to an administrative or regulatory agency with little
experience in the practice of endoscopy. It is our responsibility to ensure
high-quality care for our patients," said Robert Hawes, MD, FASGE, ASGE
president, professor of medicine at the Digestive Disease Center at the
Medical University of South Carolina.
The series of papers released on
quality indicators for Endoscopy were published as a supplement to the April
issue of GIE: Gastrointestinal Endoscopy, the official peer-reviewed
publication of ASGE, and within the April issue of The American Journal of
Gastroenterology, the official peer-reviewed publication of ACG. The five
titles published by the Task Force include:
- Quality Indicators for Gastrointestinal Endoscopic Procedures:
- Quality Indicators for Colonoscopy
- Quality Indicators for Esophagogastroduodenoscopy
- Quality Indicators for Endoscopic Retrograde
- Quality Indicators for Endoscopic Ultrasonography
The Quality Indicators papers serve as a reference for physicians
trained in endoscopy who can use the indicators to assess, measure
and improve their performance. They help to ensure that patients
receive an indicated procedure; that correct and clinically relevant
diagnoses are made (or excluded); that therapy is properly performed
and that all these are accomplished with minimum risk to the
For each endoscopic procedure, quality indicators were
considered for three time periods: preprocedure, intraprocedure and
postprocedure. The quality indicators were identified using published data.
When data was absent, indicators were chosen based on expert consensus.
"We know that it will not be feasible for the endoscopist to reach 100%
compliance with every indicator, in every patient, in all cases. We also
recognize that there are many areas requiring further study. This effort,
however, represents a major commitment within endoscopy to improving the
quality of patient care through evidence-based measures," said Jack A.
DiPalma, MD, FACG, ACG president and director of the Division of
Gastroenterology at the University of South Alabama.
endoscopic procedures allow the gastroenterologist to visually inspect the
upper intestinal tract (esophagus, stomach and duodenum) and the lower bowel
(colon and rectum) through an endoscope, a thin, flexible device with a
lighted end and a powerful lens system.
Endoscopy has been a major advance in the treatment of
gastrointestinal diseases. For example, the use of endoscopes allows
the detection of ulcers, cancers, polyps and sites of internal
bleeding. Through endoscopy, tissue samples (biopsies) may be
obtained, areas of blockage can be opened and active bleeding can be
stopped. Polyps in the colon can be removed, which has been shown to
prevent colon cancer.
developed quality indicators assume that specialty training and
credentialing in gastroenterology has taken place before a practitioner
begins the practice of endoscopy. ASGE has guidelines specifically
addressing standards for training, assessing competence and granting
privileges to perform endoscopy (available online at
"Quality Indicators for Gastrointestinal Endoscopic Procedures" can
be accessed online through ASGE at:
or by calling ASGE at +1 (630) 573-0600 or through ACG's Journal Web
site at www.amjgastro.com/
, or by calling ACG at +1 (301) 263-9000.
For more information
about endoscopic procedures or digestive diseases, visit the ASGE public
www.askasge.org/ or the ACG Web site at