Julie Yang

Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy

Ashley L. Faulx, MD, FASGE, Jenifer R. Lightdale, MD, MPH, FASGE, NASPGHAN representative, Ruben D. Acosta, MD, Deepak Agrawal, MD, MPH, David H. Bruining, MD, Vinay Chandrasekhara, MD, Mohamad A. Eloubeidi, MD, MHS, FASGE, Suryakanth R. Gurudu, MD, FASGE, Loralee Kelsey, BSN, RN, CGRN, SGNA representative, Mouen A. Khashab, MD, Shivangi Kothari, MD, V. Raman Muthusamy, MD, FASGE, Bashar J. Qumseya, MD, MPH, Aasma Shaukat, MD, MPH, FASGE, Amy Wang, MD, FASGE, Sachin B. Wani, MD, Julie Yang, MD, John M. DeWitt, MD, FASGE, Chair

The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections

V. Raman Muthusamy, MD, FASGE, Vinay Chandrasekhara, MD, Ruben D. Acosta, MD, David H. Bruining, MD, Krishnavel V. Chathadi, MD, Mohamad A. Eloubeidi, MD, MHS, FASGE, Ashley L. Faulx, MD, FASGE, Lisa Fonkalsrud, BSN, RN, CGRN, SGNA representative, Suryakanth R. Gurudu, MD, FASGE, Mouen A. Khashab, MD, Shivangi Kothari, MD, Jenifer R. Lightdale, MD, MPH, FASGE, NASPGHAN representative, Shabana F. Pasha, MD, John R. Saltzman, MD, FASGE, Aasma Shaukat, MD, MPH, FASGE, Amy Wang, MD, Julie Yang, MD, Brooks D. Cash, MD, FASGE, Previous Committee Chair, John M. DeWitt, MD, FASGE, Chair

The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms

V. Raman Muthusamy, MD, FASGE, Vinay Chandrasekhara, MD, Ruben D. Acosta, MD, David H. Bruining, MD, Krishnavel V. Chathadi, MD, Mohamad A. Eloubeidi, MD, MHS, FASGE, Ashley L. Faulx, MD, FASGE, Lisa Fonkalsrud, BSN, RN, CGRN, SGNA representative, Suryakanth R. Gurudu, MD, FASGE, Mouen A. Khashab, MD, Shivangi Kothari, MD, Jenifer R. Lightdale, MD, MPH, FASGE, NASPGHAN representative, Shabana F. Pasha, MD, John R. Saltzman, MD, FASGE, Aasma Shaukat, MD, MPH, FASGE, Amy Wang, MD, Julie Yang, MD, Brooks D. Cash, MD, FASGE, Previous Committee Chair, John M. DeWitt, MD, FASGE, Chair

The role of endoscopy in the management of suspected small-bowel bleeding

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical literature was conducted by using PubMed. Additional references were obtained from a search of Web of Science, SCOPUS, and the bibliographies of the identified articles and from recommendations of expert consultants. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines were drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations are based on reviewed studies and are graded on the strength of the supporting evidence (Table 1). The strength of individual recommendations is based on both the aggregate evidence quality and an assessment of the anticipated benefits and harms. Weaker recommendations are indicated by phrases such as “we suggest,” whereas stronger recommendations are typically stated as “we recommend.” This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline 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

Devices and techniques for ERCP in the surgically altered GI tract

The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, performing a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported adverse events of a given technology. Both are supplemented by accessing the related articles feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the Committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through January 2015 for relevant articles by using the key words “ERCP,” “altered anatomy,” “Billroth II,” “Roux-en-Y,” “double balloon enteroscopy ERCP,” “bariatric surgery,” “pancreaticoduodenectomy,” and “hepaticojejunostomy,” and “Roux-en-Y gastric bypass.” Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating,

The role of endoscopy in subepithelial lesions of the GI tract

Ashley L. Faulx, MD, FASGE,* Shivangi Kothari, MD,* Ruben D. Acosta, MD, Deepak Agrawal, MD, MPH, David H. Bruining, MD, Vinay Chandrasekhara, MD, Mohamad A. Eloubeidi, MD, MHS, FASGE, Robert D. Fanelli, MD, FACS, FASGE, (SAGES representative), Suryakanth R. Gurudu, MD, FASGE, Mouen A. Khashab, MD, Jenifer R. Lightdale, MD, MPH, FASGE, (NASPGHAN representative), V. Raman Muthusamy, MD, FASGE, Aasma Shaukat, MD, MPH, FASGE, Bashar J. Qumseya, MD, MPH, Amy Wang, MD, FASGE, Sachin B. Wani, MD, Julie Yang, MD, John M. DeWitt, MD, FASGE, Chair

Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer

Barrett’s esophagus (BE) is defined by the replacement only at academic and tertiary care centers but also of the normal squamous epithelium of the distal esophagus with metaplastic intestinal-type columnar epithelium. BE is an adverse event of chronic GERD and the only identifiable premalignant condition for esophageal adenocarcinoma (EAC), a cancer that continues to increase in incidence. In 2014 there were approximately 18,170 incident cases of esophageal cancer in the United States, nearly 60% of which were EAC. Although uncommon, EAC is a highly lethal cancer associated with a poor 5year survival rate of 15% to 20% and an overall median survival of <1 year in cases with advanced disease. It is estimated that BE is present in 1% to 2% of the general adult population. The stepwise and hypothesized progression of BE to invasive EAC is believed to occur through the histopathologic stages of intestinal metaplasia to low-grade dysplasia (LGD) to high-grade dysplasia (HGD) to intramucosal EAC and finally to invasive EAC. Endoscopic eradication therapy (EET) has significantly changed the management of patients with BE-related neoplasia and allows a minimally invasive treatment approach that avoids the morbidity and mortality associated with esophagectomy. Contemporary EET, supported by published literature, entails endoscopic mucosal resection (EMR) of visible lesions within the Barrett’s segment and ablative techniques that include radiofrequency ablation (RFA) and cryotherapy. Several studies, including randomized controlled trials (RCTs), large observational studies, and population-based studies, have demonstrated the efficacy, effectiveness, and safety of EET to achieve complete eradication of intestinal metaplasia (CE-IM) and neoplasia while maintaining disease remission. In addition, population-based studies report comparable outcomes between esophagectomy and EET in the management of BE-related HGD and mucosal EAC. Available data suggest that EET is being performed not