British Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland guidance on best practice for upper gastrointestinal endoscopy

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Background National root cause analysis of post-endoscopy upper gastrointestinal (UGI) cancer in England has found wide variations in UGI endoscopy quality. This guidance aims to provide a practical UGI endoscopy guide to improve procedural quality, optimise early malignant and pre-malignant lesion detection and common pathology managment. Methods An initial consensus document was drafted in 2023 by the Scottish National Endoscopy Training Programme. A Guidance Development Group including endoscopy academy and regional endoscopy leads, devolved nation, JAG, AUGIS and BSG representatives was subsequently convened to adapt the document for UK-wide use. Targeted literature reviews were undertaken to provide evidence where available and recommendations were refined through expert consensus. Results High quality UGI examination is facilitated by closed mouth local anaesthetic spray application and combined sedation with opioids and benzodiazepines when sedation is needed. Mucosal cleansing with Simethicone and N-Acetyl Cysteine is recommended. Systematic inspection is recommended during diagnostic UGI endoscopy: first full oesophageal assessment using both white light and digital chromoendoscopy (facilitates squamous neoplasia detection); then complete gastric examination with white light in retroflexion and antegrade, with virtual chromendoscopy for any focal abnormality; and finally duodenal examination. In Barrett’s oesophagus, following mucosal cleansing and white light examination, virtual chromoendoscopy and acetic acid enhance dysplasia detection. When gastric atrophy or intestinal metaplasia are suspected, virtual chromoendoscopy with targeted biopsies, if a focal lesion is present, and Sydney protocol biopsies to establish the extent of atrophy/metaplasia are recommended. Conclusions Optimising mucosal visualisation through sedation when appropriate, mucosal cleansing and chromoendoscopy enhances recognition of pre-malignant and early maligant lesions in the oesophagus and stomach and is recommended.

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