Medicina

GUIDELINE

Appropriate use of GI endoscopy
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 wasdrafted. 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 andshould 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 positionstatement. Progress in endoscopic technology has advanced the practice of medicine as it relates to the gastrointestinal (GI) tract. Direct examination of the mucosal surface provides far greater information than that gained by 2-dimensional scans and x-rays. Further, endoscopic diagnosis and treatment of conditions have now supplanted many surgical procedures. Ongoing technical improvements andinnovations continue to extend potential endoscopic therapies. The ASGE has continually promoted safe and responsible endoscopic practice. It is critical that endoscopists receive thorough training in the cognitive aspects of GI diseases as well as in the technical aspects of endoscopy. Extensive nonendoscopic training is necessary to provide the endoscopist with the depth of experience and knowledgenecessary to recognize what has been seen and to formulate an appropriate plan for the patient’s subsequent care. The following information has been prepared for use by national and local procedure review committees to assist them in defining standards of endoscopic practice. This information should also be helpful to primary care physicians when deciding how best to evaluate their patients and mayserve as a resource for quality guidelines.

DEFINITION OF GI ENDOSCOPIC PROCEDURES
Esophagogastroduodenoscopy (EGD) affords an excellent view of mucosal surfaces of the esophagus, stomach, and proximal duodenum. Colonoscopy allows examination of the entire colon and rectum and frequently the terminal ileum. Standard diagnostic functions include inspection, biopsy, photography, and videorecording.Diagnostic observations are made concerning focal benign or malignant lesions, diffuse mucosal changes, luminal obstruction, motility, and extrinsic compression by contiguous structures. Common therapeutic endoscopic procedures include polypectomy, dilation of strictures, stent placement, removal of foreign bodies, gastrostomy, treatment of GI bleeding with injection, banding, coagulation,sclerotherapy, and endoscopic therapy of intestinal metaplasia. Flexible sigmoidoscopy (FS) uses a flexible instrument to examine the rectum, sigmoid, and a variable length of more proximal colon. Diagnostic and therapeutic interventions include biopsy, hemostasis, hemorrhoidal banding, and stent placement. Endoscopic retrograde cholangiopancreatography (ERCP) uses endoscopy to identify the major andminor papillae. The biliary and pancreatic ductal systems are cannulated and opacified with contrast material to provide diagnostic information. Other diagnostic tools may be used in conjunction with ERCP including brush cytology, biopsy, intraductal ultrasound (US), cholangioscopy, and pancreatoscopy. Therapeutic maneuvers performed during ERCP include endoscopic sphincterotomy with or without...