Table 1.

Prioritization of endoscopic procedures according to the indication

Priority 1—perform always
Upper	Emergent upper GI bleeding (Blatchford score over 1) (16) Foreign body or severe/progressive dysphagia Treatment of perforation/leak/fistula/abscess
Lower	Acute obstruction needing decompression
ERCP	Obstructive jaundice or symptomatic CBD stone Ascending cholangitis
Priority 2—should perform
Upper	Nonemergent upper GI bleeding (Blatchford score over 1) High likelihood of upper GI cancer based on imaging, physical examination or symptoms* Variceal ligation after acute bleeding PEG/PEJ or NG/NJ tube placement Endoscopic resection of histologically proven neoplasm (high-grade dysplasia)
Lower	Acute lower GI bleeding Investigation of active colitis/new diagnosis or flare of IBD High likelihood of colon cancer based on imaging, physical examination or symptoms*
EUS	EUS-guided drainage of symptomatic or infected pancreatic fluid collections/necrosectomy Staging or biopsy for suspected or confirmed cancer* Suspected CBD stone(s), if MRCP not available
Priority 3—could perform
Upper	Endoscopic resection of duodenal polyp/ampullectomy Mild/stable dysphagia Enteroscopy for obscure bleeding
Lower	Endoscopic resection of large or complex polyp Positive FIT Repeat procedures for prior inadequate preparation Iron-deficiency anemia Rectal bleeding
EUS	EUS for submucosal lesion
ERCP	Pancreatico-biliary stent removal/revision/replacement
Priority 4—defer
Upper	Assessment of reflux esophagitis/PUD healing Investigation for nonalarm symptoms Screening and surveillance gastroscopy
Lower	Investigation for nonalarm symptoms Screening and surveillance
EUS	Investigation for nonalarm symptoms
ERCP	Asymptomatic biliary stricture/gallstones (normal liver enzymes)

Every decision to perform endoscopy should take into consideration: (a) risks to the patient and endoscopy staff; (b) the potential to change management and/or to alter the prognosis of the patient and (c) health system capacity. Severity of symptoms/laboratory or imaging findings or time spent on the waiting list may change the priority of a given patient that may need to be reassessed on a case-by-case basis. All procedures that do not fit the definition of priority 1–3 should be considered priority 4. A list of patients and their conditions should be updated regularly to reassess the priority of procedures.

*For oncology cases, priority should be based on access to subsequent treatments and expected time to progression.

CBD; common bile duct; ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasound; FIT, fecal immunochemical test; GI, gastrointestinal; IBD, inflammatory bowel disease; MRCP, magnetic resonance cholangiopancreatography; NG, nasogastric; NJ, nasojejunal; PEG, percutaneous endoscopic gastrostomy; PEJ, percutaneous endoscopic jejunostomy; PUD, peptic ulcer disease.