Table 1.

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

Summary of quality standards	Grade of evidence	Strength of recommendation	Agreement
Patients should be assessed for fitness to undergo a diagnostic OGD	Weak	Strong	100%
Patients should receive appropriate information about the procedure before undergoing an OGD	Weak	Strong	100%
An appropriate time slot should be allocated dependent on procedure indications and patient characteristics	Weak	Strong	100%
Informed consent should be obtained before performing an OGD	Weak	Strong	100%
A safety checklist should be completed before starting an OGD	Moderate	Strong	100%
A checklist should be undertaken after completing an OGD, before the patient leaves the room	Weak	Strong	90%
Only an endoscopist with appropriate training and the relevant competencies should independently perform OGD	Weak	Strong	100%
We suggest that endoscopists should aim to perform a minimum of 100 OGDs a year, to maintain a high-quality examination standard	Weak	Weak	100%
UGI endoscopy should be performed with high-definition video endoscopy systems, with the ability to capture images and take biopsies	Weak	Strong	90%
Intravenous sedation and local anaesthetic throat spray can be used in conjunction if required. Caution should be exercised in those at risk of aspiration	Moderate	Strong	100%
A complete OGD should assess all relevant anatomical landmarks and high-risk stations	Weak	Strong	100%
Photo-documentation should be made of relevant anatomical landmarks and any detected lesions	Weak	Strong	100%
The quality of mucosal visualisation should be reported.	Weak	Strong	100%
Adequate mucosal visualisation should be achieved by a combination of adequate air insufflation, aspiration and the use of mucosal cleansing techniques	Moderate	Strong	100%
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 surveillance	Weak	Weak	90%
Where a lesion is identified, this should be described using the Paris classification and targeted biopsies taken	Weak	Strong	100%
Endoscopy units should adhere to safe sedation practice	Weak	Strong	100%
The length of a Barrett’s segment should be classified according to the Prague classification	Weak	Strong	100%
Where a lesion is identified within a Barrett’s segment, this should be described using the Paris classification and targeted biopsies taken	Weak	Strong	100%
When no lesions are detected within a Barrett’s segment, biopsies should be taken in accordance with the Seattle protocol	Moderate	Strong	90%
If squamous neoplasia is suspected, full assessment with enhanced imaging and/or Lugol’s chromo-endoscopy is required	Moderate	Strong	100%
Oesophageal ulcers and oesophagitis that is grade D or atypical in appearance, should be biopsied, with further evaluation in 6 weeks after PPI therapy	Weak	Strong	100%
The presence of an inlet patch should be photo-documented	Weak	Weak	90%
The presence of a hiatus hernia should be documented and measured	Weak	Weak	100%
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 found	Moderate	Strong	100%
Varices should be described according to a standardised classification	Weak	Strong	100%
Strictures should be biopsied to exclude malignancy before dilatation	Weak	Weak	90%
Gastric ulcers should be biopsied and re-evaluated after appropriate treatment, including H. pylori eradication where indicated, within 6–8 weeks	Weak	strong	90%
Where there are endoscopic features of gastric atrophy or IM separate biopsies from the gastric antrum and body should be taken	Weak	Weak	100%
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 measured	Weak	Weak	80%
Where gastric or duodenal ulcers are identified, H. pylori should be tested and eradicated if positive	Moderate	Strong	100%
The presence of gastric polyps should be recorded, with the number, size, location and morphology described, and representative biopsies taken	Moderate	Strong	100%
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 bulb	Strong	Strong	100%
A malignant looking lesion should be described, photo documented and a minimum of six biopsies taken	Weak	Strong	100%
After OGD readmission, mortality and complications should be audited	Weak	Strong	100%
A report summarising the endoscopy findings and recommendations should be produced and the key information provided to the patient before discharge	Weak	Strong	100%
A method for ensuring histological results are processed must be in place	Weak	Strong	100%
Endoscopy units should audit rates of failing to diagnose cancer at endoscopy up to 3 years before an oesophago-gastric cancer is diagnosed	Weak	Strong	100%

IM, intestinal metaplasia; OGD, oesophago-gastro-duodenoscopy; PPI, proton pump inhibitor.