Adverse events of upper GI endoscopy


Guideline Developer(s)

American Society for Gastrointestinal Endoscopy

Date Released

2012 Oct

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of evidence supporting the recommendations is not specifically stated.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Review of adverse events as part of a continuing quality improvement process may serve to educate endoscopists, help to reduce the risk of future adverse events, and improve the overall quality of endoscopy.

Potential Harms

Not stated

Rating Scheme for the Strength of the Recommendations

Not applicable

Qualifying Statements

Qualifying Statements
  • This document is based on a critical review of the available data and expert consensus at the time that the document was drafted. Further controlled clinical studies may be needed to clarify aspects of this document. This document may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice.
  • This document is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This document is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from this document.

Methodology

Methods Used to Collect/Select the Evidence

Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases
Searches of Unpublished Data

Description of Methods Used to Collect/Select the Evidence

In preparing this document, a search of the medical literature was performed by using PubMed (NLM) and meeting proceedings of the annual meetings of the American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), and American Society for Gastrointestinal Endoscopy (ASGE) for the period 1990 to October 2011. The search included published trials, abstracts, and case reports, and excluded duplicative reports and non-English language publications. The search terms included EGD, upper endoscopy, endoscopic ultrasound (diagnosis, treatment) AND adverse events, complications, side effects.

Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When few or no data exist from well-designed prospective trials, emphasis is given to results of large series and reports from recognized experts.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence

Expert Consensus

Rating Scheme for the Strength of the Evidence

Not applicable

Methods Used to Analyze the Evidence

Systematic Review

Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations

Expert Consensus

Description of Methods Used to Formulate the Recommendations

Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time that the guidelines are drafted.

Cost Analysis

The guideline developers reviewed published cost analyses.

Method of Guideline Validation

Internal Peer Review

Description of Method of Guideline Validation

This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.

Identifying Information and Availability

Bibliographic Source(s)

ASGE Standards of Practice Committee, Ben-Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, Fisher DA, Fisher L, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Dominitz JA, Cash BD. Adverse events of upper GI endoscopy. Gastrointest Endosc. 2012 Oct;76(4):707-18. [249 references] PubMed

Adaptation

Not applicable: The guideline was not adapted from another source.

Source(s) of Funding

American Society for Gastrointestinal Endoscopy

Guideline Committee

Standards of Practice Committee

Composition of Group That Authored the Guideline

Committee Members: Tamir Ben-Menachem, MD; G. Anton Decker, MBBCh, MHA, MRCP; Dayna S. Early, MD; Jerry Evans, MD; Robert D. Fanelli, MD; Deborah A. Fisher, MD, MHS; Laurel Fisher, MD; Norio Fukami, MD; Joo Ha Hwang, MD, PhD; Steven O. Ikenberry, MD; Rajeev Jain, MD; Terry L. Jue, MD; Khalid M. Khan, MD; Mary L. Krinsky, DO; Phyllis M. Malpas, MA, RN, CGRN, SGNA Representative; John T. Maple, DO; Ravi N. Sharaf, MD, MS; Jason A. Dominitz, MD, MHS (Previous Committee Chair); Brooks D. Cash, MD (Committee Chair)

Financial Disclosures/Conflicts of Interest

All authors disclosed no financial relationships relevant to this publication.

Guideline Status

This is the current release of the guideline.

Guideline Availability

Electronic copies: Available from the American Society for Gastrointestinal Endoscopy Web site.

Print copies: Available from the American Society for Gastrointestinal Endoscopy, 1520 Kensington Road, Suite 202, Oak Brook, IL 60523

Availability of Companion Documents

None available

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI Institute on January 18, 2013.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

Scope

Disease/Condition(s)

Diseases and conditions requiring upper gastrointestinal endoscopy

Guideline Category

Management
Prevention
Risk Assessment

Clinical Specialty

Gastroenterology

Intended Users

Physicians

Guideline Objective(s)

To provide information that may assist endoscopists in providing care to patients undergoing upper gastrointestinal endoscopy procedures and increase knowledge of potential adverse events of these procedures

Target Population

Patients undergoing upper gastrointestinal endoscopy

Interventions and Practices Considered
  1. Awareness of potential endoscopic adverse events, their expected frequency, and the risk factors associated with their occurrence
  2. Careful patient selection
  3. Familiarity with the planned procedure and available technology
  4. Preparation for and management of any adverse events
  5. Review of complications to reduce future risk and improve overall quality
Major Outcomes Considered
  • Reduction of future adverse events
  • Quality improvement

Recommendations

Major Recommendations

Adverse events are inherent in the performance of upper gastrointestinal (UGI) endoscopic procedures. Because endoscopy assumes a more therapeutic role in the management of GI disorders, the potential for adverse events will likely increase. Knowledge of potential endoscopic adverse events, their expected frequency, and the risk factors for their occurrence may help to minimize the incidence of adverse events. Endoscopists are expected to carefully select patients for the appropriate intervention, be familiar with the planned procedure and available technology, and be prepared to manage any adverse events that may arise. Once an adverse event occurs, early recognition and prompt intervention may minimize the morbidity and mortality associated with that adverse event. Review of adverse events as part of a continuing quality improvement process may serve to educate endoscopists, help to reduce the risk of future adverse events, and improve the overall quality of endoscopy.

Clinical Algorithm(s)

None provided

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need

Getting Better
Living with Illness
Staying Healthy

IOM Domain

Effectiveness
Safety

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