How to measure quality in upper GI endoscopy.

Esophagogastroduodenoscopy (EGD) is used in the diagnosis of neoplastic and non-neoplastic diseases. The rate of missed cancers remains high and exceeds 8 % for esophageal and gastric cancer. Several quality indicators have been identified to enhance the detection capability and decrease the neoplasia miss rate. Recently, the cleanliness of the mucosa has been identified as one such indicator. To achieve better visibility, premedication with N-acetylcysteine and simethicone should be considered. Advanced imaging modalities, such as virtual chromoendoscopy, may be helpful in the diagnosis of neoplasia and precancerous conditions, such as esophageal squamous cell carcinoma, Barrett's esophagus, and gastric dysplasia. Biopsy protocols, such as the MAPS and Seattle protocols, are another quality indicator, as they aim to identify patients at risk of gastric cancer and Barrett's esophagus-related dysplasia, respectively. Adequate inspection may be reflected in the procedure time or the endoscope withdrawal time. Several indicators have been proposed to monitor operator performance. The endoscopist's biopsy rate, composite detection rate, and Vater's papilla photodocumentation can be useful tools for auditing an endoscopist's performance and any link to neoplasia detection or missed cancers. In addition, monitoring patients' experiences using validated questionnaires is a performance measure of the endoscopy unit along with recording adverse events after therapeutic procedures.