Phyllis M. Malpas

Complications of ERCP

d ( t s f t c s n d i a s a This is one of a series of position statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. This document is an update of a previous ASGE publication.1 In preparing this document, a search of the medical iterature was performed using PubMed. Additional refernces were obtained from the bibliographies of the identied articles and from recommendations of expert consulants. When limited or no data exist from well-designed rospective trials, emphasis is given to results from large eries and reports from recognized experts. Position stateents are based on a critical review of the available data nd expert consensus at the time that the document was rafted. Further controlled clinical studies may be needed o clarify aspects of this document, which may be revised s necessary to account for changes in technology, new ata, or other aspects of clinical practice. This document is intended to be an educational device o provide information that may assist endoscopists in roviding care to patients. This position statement is not a ule and should not be construed as establishing a legal tandard of care or as encouraging, advocating, requirng, or discouraging any particular treatment. Clinical ecisions in any particular case involve a complex analsis of the patient’s condition and available courses of ction. Therefore, clinical considerations may lead an ndoscopist to take a course of action that varies from this osition statement. Since its introduction in 1968, ERCP has become a comonly performed endoscopic procedure.2 The diagnostic nd therapeutic utility of ERCP has been well demonstrated or a variety of disorders, including the management of choedocholithiasis, the diagnosis and management of biliary nd pancreatic neoplasms, and the postoperative manageent of biliary perioperative complications.3-5 The evolution of the role of ERCP has occurred simultaneously with that of other diagnostic and therapeutic modalities, most notably magnetic resonance imaging/MRCP, laparoscopic cholecystectomy (with or without intraoperative cholangiography), and EUS. For endoscopists to accurately assess the clinical appropriateness of ERCP, it is important to have a thorough

Complications of colonoscopy

Summary Endoscopic complications are rare but inevitable, occurring in fewer than 0.35% of procedures [B]. Knowledge of potential complications and their expected frequency can lead to an improved informed consent process [C]. Complications from the procedure include perforation, hemorrhage, postpolypectomy coagulation syndrome, infection, preparation-associated complications, and death, and are more likely to occur with therapeutic procedures rather than diagnostic procedures [B]. Risk factors for poylpectomy-associated complications include the location and size of the polyp, experience of the operator, polypectomy technique and possibly the type of electrocoagulation current used [B]. Use of saline solution injection under large sessile polyps decreases depth of thermal injury [A] and may decrease complications [B]. Early recognition of complications and prompt intervention may decrease patient morbidity [C]. Treatment of complications range from supportive for postpolypectomy coagulation syndrome, to repeat colonoscopy with injection or electrocoagulation for bleeding, to surgical repair for free perforation [B]. Consideration of the risks and benefits may improve clinical outcome by identifying potential complications and taking appropriate steps to minimize the risks [C].

The role of endoscopy in Barrett's esophagus and other premalignant conditions of the esophagus

i ( n d m e 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 prepared this text. In preparing this guideline, a search of the medical literature was performed using PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When limited or no data exist from well-designed prospective trials, emphasis is given to results of large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines are 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 were based on reviewed studies and were graded on the strength of the supporting evidence (Table 1).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 endoscopist to take a course of action that varies from these guidelines.

The role of endoscopy in the management of acute non-variceal upper GI bleeding

d c p B s i R 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 performed by using PubMed. 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 from large series and reports from recognized experts. 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. 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 evidence1 (Table 1). he strength of individual recommendations is based on oth the aggregate evidence quality and an assessment of the nticipated benefits and harms. Weaker recommendations re indicated by phrases such as “We suggest . . . ,” whereas tronger recommendations are typically stated as “We recmmend . . . .” 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 endoscopist to take a course of action that varies from these guidelines.

Adverse events of upper GI endoscopy

c f s a a e l 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 document, a search of the medical literature was performed by using PubMed. 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. 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.

Appropriate use of GI endoscopy

o s t This is one of a series of position 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. Position statements are based on a critical review of the available data and expert consensus at the time the document was drafted. Further controlled clinical studies may be needed to clarify aspects of this document, which may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This position statement 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 position statement.

The role of endoscopy in the management of choledocholithiasis

a t 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 performed using PubMed. 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. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines are 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 were based on reviewed studies and were graded on the strength of the supporting evidence (Table 1).1 The strength of individual recommendations is based n both the aggregate evidence quality and an assessment f the anticipated benefits and harms. Weaker recommenations are indicated by phrases such as “we suggest,” hereas stronger recommendations are typically stated as we recommend.” This guideline is intended to be an educational device o provide information that may assist endoscopists in roviding care to patients. This guideline is not a rule and hould not be construed as establishing a legal standard of are or as encouraging, advocating, requiring, or discourging any particular treatment. Clinical decisions in any articular case involve a complex analysis of the patient’s ondition and available courses of action. Therefore, clincal considerations may lead an endoscopist to take a ourse of action that varies from these guidelines.

Endoscopic mucosal tissue sampling

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 performed by using PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When few or no data exist from welldesigned prospective trials, emphasis is given to results from large series and reports from recognized experts. 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. 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..” These statements are included in Table 2, rather than as specific statements, as in other Standards of Practice documents. 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 endoscopist to take a course of action that varies from these guidelines.

The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia.

d t m n d m e D m 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. This guideline is an update of a previous ASGE guideline published in 2005.1 In preparing this guideline, a search of the medical literature was performed by using PubMed. 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 from large series and reports from recognized experts. 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. 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).2 The trength of individual recommendations is based on both he aggregate evidence quality and an assessment of the nticipated benefits and harms. Weaker recommendaions are indicated by phrases such as “We suggest,” hereas stronger recommendations are typically stated as We recommend.” This guideline is intended to be an educational device o provide information that may assist endoscopists in roviding care to patients. This guideline is not a rule and hould not be construed as establishing a legal standard of are or as encouraging, advocating, requiring, or discourging any particular treatment. Clinical decisions in any articular case involve a complex analysis of the patient’s ondition and available courses of action. Therefore, clincal considerations may lead an endoscopist to take a ourse of action that varies from these guidelines.

Minimum staffing requirements for the performance of GI endoscopy

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 performed by using PubMed. Additional references were obtained from 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 are 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. 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 patients condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from these guidelines.