Useful background information
Patient information/counselling
Anticoagulation guidelines
Sedation guidelines
Procedure
in accordance with BSG/AUGIS quality statement 2017
- Standardised anatomical landmarks in a complete OGD: Procedure should start at the upper oesophageal sphincter and reach the second part of the duodenum, to include the upper oesophagus, gastro-oesophageal junction, fundus, gastric body, incisura, antrum, duodenal bulb and distal duodenum. The fundus should be inspected by a J-manoeuvre in all patients, and where there is a hiatus hernia the diaphragmatic pinch should be inspected while in retroflexion, and size and integrity of the oesophago-gastric junction assessed.
- Photo-documentation of relevant landmarks and any detected lesions (see ESGE guidelines with eight anatomical landmarks)
![](articles/images/photodoc.jpg) Image from Synder et al
- Inspection (during withdrawal) of OGD should take an average of 7 mins. Total inspection time for high-risk and surveillance procedures should be recorded.
- Paris classification should be used to describe lesions detected (including those within Barrett's segment) and targeted biopsies taken.
![](articles/images/paris.png) Image from Hurlstone et al
- Prague classification should be used to describe Barrett's oesophagus.
![](articles/images/prague.png) Image from Shaheen et al
An excellent article detailing each step of the upper GI endoscopy procedure can be found here
Management of lesions detected on endoscopy
- If no lesions detected within Barrett's segment: Take biopsies according to Seattle protocol (quadrantic biopsy specimens taken at 2 cm intervals).
- Suspected squamous neoplasia: Full assessment with enhanced imaging and/or Lugol's chromo-endoscopy.
- Oesophageal ulcers and oesophagitis that is grade D or atypical in appearance: Take biopsy and further evaluate in 6 weeks after proton pump inhibitor therapy.
![](articles/images/laclass.jpg) Source: International Working Group for the Classification of Oesophagitis
- Varices: Classify according to size (Grade 1-3)
![](articles/images/varices.jpg) Image from Tripathi et al
- Gastric or duodenal ulcers: H. pylori should be tested and eradicated if positive. Additionally for gastric ulcers, biopsy and re-evaluate after appropriate treatment (e.g. H. pylori eradication where indicated) within 6-8weeks.
- Endoscopic features of gastric atrophy or intestinal metaplasia: Take separate biopsies from the gastric antrum and body.
- Gastric polyps: Document presence, number, size, location and morphology, and take biopsies.
- Malignant looking lesion: Photo-document and take a minimum of six biopsies
- Suspected coeliac disease: Take a minimum of four biopsies, including representative biopsies from the second part of the duodenum and at least one from the duodenal bulb
- Where iron deficiency anaemia is being investigated: Take separate biopsies from the gastric antrum and body, as well as duodenal biopsies if coeliac serology is positive or has not been previously measured.
- For patients with dysphagia/food bolus obstruction with no cause found: Take biopsies from two different regions in the oesophagus to rule out eosinophilic oesophagitis.
References
Beg S, Ragunath K, Wyman A, et al. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 2017;66:1886-1899.
Lee SH, Park YK, Cho SM, et al.Technical skills and training of upper gastrointestinal endoscopy for new beginners. World J Gastroenterol. 2015 Jan 21; 21(3): 759-785. doi: 10.3748/wjg.v21.i3.759
Snyder CW, Vandromme MJ, Tyra SL, et al. Retention of colonoscopy skills after virtual reality simulator training by independent and proctored methods. Am Surg 2010;76:743-6.
Hurlstone D, Sanders D, Atkinson R, et al. Endoscopic mucosal resection for flat neoplasia in chronic ulcerative colitis: Can we change the endoscopic management paradigm?. Gut 2007;56:838-46. doi:10.1136/gut.2006.106294.
Shaheen N, Falk G, Iyer P, Gerson L. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. American Journal of Gastroenterology 2016;111:30-50. doi: 10.1038/ajg.2015.322.
Tripathi D, Stanley AJ, Hayes PC, et al. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut 2015;64:1680-1704.
Further Reading on Colonoscopy
Patient information
Anticoagulation guidelines
Sedation guidelines
Bowel preparation guidelines
Surveillance guidelines
Author:
Ms Yanyu Tan
| Speciality:
Surgical Procedures
| Date Added:
12/11/2019
|