Performance measure	We recommend that it is made clear which diagnostic and therapeutic procedures endoscopists are competent in and allowed to perform in the service
Domain	Quality
Category	Structure
Rationale	An endoscopist performing a procedure he/she is not trained and competent to perform will put patients at risk and is therefore a major governance issue, so we suggest a register is kept of who is allowed to do what in the endoscopy unit, which will empower nursing staff and other endoscopists, ideally through the leadership team, to challenge endoscopists who perform procedures for which they do not have permission This raises issues of who is responsible for governance, such as local services, professional bodies, national health services, or health insurance companies, and also how competence is defined, which will be the subject of future ESGE guidance There is also the issue of how many procedures an individual should be expected to do during a given time period and what cover there should be for emergency endoscopy (e.g. for upper gastrointestinal [GI] bleeding and endoscopic retrograde cholangiopancreatography [ERCP]), two points that are beyond the remit of this guideline
Standards	Minimum standard: an up-to-date register is kept of who is allowed to perform which endoscopic procedures Target standard: review of the register of who is allowed to perform procedures in the department (based on performance; see Performance measures 3.1 and 3.2) at least annually
Consensus agreement	88.89% (3 disagree votes)
PICO	Not applicable
Concordance with other guidelines	ASGE Yes	Canada Yes	EU Yes	GRS/JAG accreditation Yes
Evidence grading	Low/very low